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16 Cards in this Set
- Front
- Back
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What diuretics are used in decompensated HF?
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IV loops: furosemide, bumetanid, and torsemide
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How long for bolus diuretics to decrease preload?
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5-15minutes by functional venodilation and greater than 20 minutes via Na and water excretion
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Do diuretics cause an upward shift in the Frank Starling curve or increase in CI?
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no, arterial dilators and positive inotropic agents do
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What AE from excessive preload reduction from diuretics?
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decline in CO
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What is the most common clinical setting in which diuretic resistance is observed?
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HF
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The use of diuretics is associated with a dose dependent increase in what?
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mortality
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High diuretic doses are associated with a decline in what in decompensated HF?
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renal function
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Is the mechanism responsible for diuretic resistance in HF pharmacokinetic or pharmacodynamic?
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both
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How is the rate of absorption affected in HF?
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prolonged 2 fold
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How is peak concentration of diuretic affected in HF?
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half of normal
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What explains the decreased responsiveness of diuretics in HF pts?
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high concentrations of Na reaching the distal tubule as a result of the blockade of Na reabsorption in the loop of Henle
as a result the distal tubule hypertrophies increasing its ability to reabsorb Na |
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What is tx if diuretic resistance?
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other agents: positive inotropes or afterload reducers may improve diuresis by increasing CO and renal perfusion
low dose DA can enhance diuresis larger IV bolus doses of diuretics, continuous IV infusion addition of 2nd diuretic with different MOA: loop with distal tubule blocker (metolazone or HCTZ) further restriction of Na and fluid (less than 1g and less than 1L/day) ultrafiltration |
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What causes synergism for loop thiazide combo?
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increased Na delivery to distal tubule blocked by thiazide
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Is loop thiazide combo used inpatient or outpatient?
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inpatient: close monitoring for profound diuresis with severe electrolyte and volume depletion
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How often can furosemide be given in decompensated HF?
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6x/day
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What effect does furosemide have on HR, MAP, PAOP, CO, SVR?
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decrease PAOP, no change or decrease MAP, no change for others
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