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43 Cards in this Set

  • Front
  • Back
When is Digoxin used?
As an add-on agent with patients who are on ACEI, BB, and diuretic therapy
what are the effects of Dobutamine?
B1 and B2 agonist

B1 - Positive inotrope
B2 - Vasodilation
What is the dosing of Dobutamine?
2.5 to 5 mcg/kg/min, progressively increased to 20 mcg/kg/min
which drug causes cyanide toxicity if used longer than 24 hrs?

It is a mixed arterial/venous vasodilator
You have a pt with CHF and you want to prescribe a BB. Which drug and dose would you use?
Carvedilol 3.125 mg BID; target 25 mg BID (<85kg)

You can also choose from the others
which drug should be used on all patients with LVD and also reduces the breakdown of bradykinin?
What are the adverse effects of ACE I?
you have a pt with LVD and you want to start him on an ACE I, name two drugs you can use including the dosing
Enalapril 2.5mg BID
Lisinopril 2.5 mg BID
what is the effect of BBs on the heart and vascular system?
they block the effect of norepi
you have a pt who has developed a cough due to ACE I therapy, what drug and dose would you use instead?

Losartan 25 mg qd, max of 100 mg qd
Name a drug that decreases renal absorption and increases cardiac contractility
This test is done to check for heart failure; the levels will be elevated during a CHF attack
BNP Test
which drugs competively inhibit loop diuretics?
NSAIDs and Probenecid (a gout medication)
What are the doses for the loop diuretics in CHF treatment?
Furosemide: 20-40 mg BID, max of 400 mg QD

Bumetadine: 0.5-2 mg daily, max of 10 mg QD

Torsemide: 10-20 mg daily, max of 200 mg
Name 3 causes of CHF
which drug directly stimulates adrenergic receptors by causing norepi release and works on B1, B2, A1, and D1 receptors?
what is the dose of spironalactone when used as an add-on drug?
25 mg/day
What is the optimal dosing of Digoxin?
0.125 mg PO
how do you treat CHF?
positive inotropes
Aldosterone antagonist
what is the goal of pharm. Tx for CHF?
block comp. neurohormonal activity
Minimize sodium/water retention
Minimize symptoms of HF
Preserve cardiac fx
What is your first line diuretic for CHF?
which diuretic can be used in combo with loops?
what is the NTW of Digoxin?
0.6 - 1 ng/dl
when would you used dopamine?
In a pt with marked hypotension or cardiogenic shock. Dopamine is a Alpha 1 agonist, therefore it >NE release and > B/P.

Dose: 5 mcg/kg
Name an exogenous BNP that interrups neurohormonal, renal, and hemodynamic comp. systems due to CHF

promotes vasodilation, natriuresis, and diuresis.
what should you monitor when prescribing ACE Is.
Sr Cr
what do Dobutamine, Nitroprusside, and Nitroglycerin all have in common?
They all have vasodilating properties which reduces after load
what are the goals of Tx in CHF?
> CO
< cardiac workload
Relieve symptoms
what are the comp. mechanisms in CHF?
> symp. activity (>HR, SV, preload, and afterload)
Fluid retention
name a drug that decreases HR and at the same time increases contractility
Digoxin, used for acute decompensated CHF

also <renal absorption; works on the Na/K ATPase pump
A pt comes in with an acute CHF, what do you give him?
Lasix IV push
what do you monitor in pts with CHF?
why would you be concerned if a pt with CHF is taking NSAIDs or Probenecid?
Because they are competitive at the renal level so you will prolong the actions of other renal cleared drugs like loops.
85 y/o Pt comes into ER, h/o CHF, SOB, HR 47, BP 90/60, RR 7. What do you do?
Give Dobutamine for its positive inotropic effects and low dose dopamine(renal effects)

2.5 mcg/kg/min
what does a high dose (>10)of dopamine affect?
Alpha receptors; positive inotropic effect
what does a low dose (1-5 mcg/kg)of dopamine affect?
affects dopamine receptors; improves vasodilation at the nephron to increase diuresis
when do you use Nitroprusside?
In CHF with pts that have B/P ~ 200
a pt on nitroprusside starts to turn blue, what's happening?
the pt is having cyanide toxicity
Name some benefits of Nesiritide
improves pulm congestion
> lung oxygenation
which drugs induce prostaglandin-mediated increase in renal blood flow?
Loop diuretics
A pt has severe CHF, how do you treat?
ACEI plus a loop diuretic with spirinalactone as an add-on.
What would be an alternative to use with pts having CHF that cannot tolerate ACE I, or ARBs?
Imdur 30 mg daily
what drug would you use if your CHF pt has marked hypertension?

0.1 mcg/kg/min

Don't use longer than 24 hrs (cyanide toxicity)