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35 Cards in this Set
- Front
- Back
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Largest predictors of mortality from acute decompensated heart failure |
- High BUN (>43) - High creatinine (>2.75) - Low systolic BP (<110) |
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Clinically high BNP |
≥500 |
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How can we obectively monitor ADHF? |
Swan-Ganz catheter (pulmonary capillary wedge pressure) |
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Pressure (PCWP) correlates to the total amount of fluid between the __________ and ___________ |
pulmonary artery left atrium |
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First line drug for all patients with ADHF |
IV Loop diuretics If pt already on loop diuretics, will typically double their dose for acute IV administration |
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Monitoring needed during diuresis |
- Electrolytes - Renal fx - BP - Daily weight - Strict input/output |
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Goal net loss of fluids during diuresis |
1-2 L per day (commonly get 5 L the first day, but in the following days you only want 1-2) |
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Monitoring for overdiuresis |
BUN: SCr Ratio (Overdiuresis >20:1)
Serum bicarbonate (Overdiuresis >28)
Hypotension |
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Strategies for inadequate diuresis |
- Give more loop diuretic - Continuous infusion - Try a different diuretic - Add Thiazide diuretic |
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Bioavailability of PO furosemide |
50% bioavailability |
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Bioavailability of PO bumetanide or tordemide |
100% bioavailability |
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In what situation would you start with continuous IV infusion of loop diuretics for ADHF? |
Shouldn't ever - commonly used for refractory cases |
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Thiazides used for diuretic resistance |
Metolazone (PO) Hydrochlorothiazide (PO) Chlorothiazide (IV) |
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MOA of vasopressin antagonists |
Causes renal water loss without NA+ loss
(can change sodium levels quickly- requires close monitoring, not used often) |
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Why do we use vasodilators? (MOA?) |
Venous dilation= decreased preload - Improves pulm congestion - Improves contractility
Arterial dilation reduces SVR - Improves CO |
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Most common vasodilator used |
Nitroglycerin IV - Great venous dilation - Arterial dilation only at high doses - Tolerance (tachyphylaxis) can occur after 12-72 hours |
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Most common SE of nitroglycerin |
Headaches- very common, most patients don't tolerate very well |
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Main risk for nitroprusside |
Risk of cyanide toxicity (especially with hepatic or renal failure at high doses for long duration) |
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MOA of Nesiritide |
Recombinant form of BNP - venous/arterial dilation - increased CO - diuretic effect
(NOT used that often due to $$$$) |
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T/F: Vasodilators are preferred over inotropes |
True |
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Contraindication for inotropes |
hypotension |
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Inotropes are use for ______ HF only |
Systolic (LVEF <40%) |
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Inotrope drugs |
Dobutamine Milrinone (Primacor) |
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What can we find out from a PA catheter? |
Pulmonary capillary wedge pressure Cardiac index Systemic Vascular Resistance |
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MOA of Nitroprusside |
Mixed venous/arterial vasodilation |
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MOA of Dobutamine |
B1 and B2 agonist
B1 increases CO B2 decreases SVR (can increase/decrease BP) |
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Dobutamine vs Milrinone |
Dobutamine half-life minutes Milrinone half-life 1-3 hours |
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MOA of Milrinone |
PDE-3 inhibitor -Prevent cAMP breakdown -Mixed vasodilation -Potentially less tachycardia |
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For patients on chronic Beta blockers, the preferred inotropic therapy is __________ |
Milrinone
(Dobutamine may be used on patients with B1 selective agents such as metoprolol) |
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What do you give for cardiogenic shock? |
Dobutamine
D/C beta blockers! (hypotension) |
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Milrinone is __________ eliminated |
**Renally** |
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Does ultrafiltration (Aquapheresis) improve clinical outcomes? |
NO! -worsened renal fx -no diff in 96-hr net fluid loss vs diuretics |
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Intra-aortic balloon pump is synchronized with ______ and _________ during diastole. |
EKG Inflates |
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Which of the non-pharm therapies for ADHF improves mortality? |
VAD (Ventricular Assist Device) |
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When is heart transplant indicated? |
NYHA Class IV, chronic, irreversible HF |
