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43 Cards in this Set
- Front
- Back
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When is Digoxin used?
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As an add-on agent with patients who are on ACEI, BB, and diuretic therapy
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what are the effects of Dobutamine?
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B1 and B2 agonist
B1 - Positive inotrope B2 - Vasodilation |
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What is the dosing of Dobutamine?
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2.5 to 5 mcg/kg/min, progressively increased to 20 mcg/kg/min
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which drug causes cyanide toxicity if used longer than 24 hrs?
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Nitroprusside
It is a mixed arterial/venous vasodilator |
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You have a pt with CHF and you want to prescribe a BB. Which drug and dose would you use?
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Carvedilol 3.125 mg BID; target 25 mg BID (<85kg)
You can also choose from the others |
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which drug should be used on all patients with LVD and also reduces the breakdown of bradykinin?
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ACE I
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What are the adverse effects of ACE I?
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Cough
Angioedema Hyperkalemia |
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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
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Enalapril 2.5mg BID
Lisinopril 2.5 mg BID |
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what is the effect of BBs on the heart and vascular system?
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they block the effect of norepi
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you have a pt who has developed a cough due to ACE I therapy, what drug and dose would you use instead?
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ARBs
Losartan 25 mg qd, max of 100 mg qd |
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Name a drug that decreases renal absorption and increases cardiac contractility
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Digoxin
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This test is done to check for heart failure; the levels will be elevated during a CHF attack
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BNP Test
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which drugs competively inhibit loop diuretics?
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NSAIDs and Probenecid (a gout medication)
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What are the doses for the loop diuretics in CHF treatment?
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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 |
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Name 3 causes of CHF
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HTN, MI, CAD
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which drug directly stimulates adrenergic receptors by causing norepi release and works on B1, B2, A1, and D1 receptors?
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Dopamine
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what is the dose of spironalactone when used as an add-on drug?
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25 mg/day
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What is the optimal dosing of Digoxin?
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0.125 mg PO
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how do you treat CHF?
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positive inotropes
Vasodilators Diuretics ACE I ARBs Digoxin Aldosterone antagonist BBs |
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what is the goal of pharm. Tx for CHF?
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block comp. neurohormonal activity
Minimize sodium/water retention Minimize symptoms of HF Preserve cardiac fx |
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What is your first line diuretic for CHF?
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Loops
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which diuretic can be used in combo with loops?
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Metalazone
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what is the NTW of Digoxin?
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0.6 - 1 ng/dl
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when would you used dopamine?
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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 |
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Name an exogenous BNP that interrups neurohormonal, renal, and hemodynamic comp. systems due to CHF
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Nersiritide
promotes vasodilation, natriuresis, and diuresis. |
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what should you monitor when prescribing ACE Is.
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Sr Cr
B/P K+ |
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what do Dobutamine, Nitroprusside, and Nitroglycerin all have in common?
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They all have vasodilating properties which reduces after load
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what are the goals of Tx in CHF?
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> CO
< cardiac workload Relieve symptoms |
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what are the comp. mechanisms in CHF?
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> symp. activity (>HR, SV, preload, and afterload)
Fluid retention Cardiomegaly |
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name a drug that decreases HR and at the same time increases contractility
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Digoxin, used for acute decompensated CHF
also <renal absorption; works on the Na/K ATPase pump |
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A pt comes in with an acute CHF, what do you give him?
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Dobutamine
Lasix IV push |
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what do you monitor in pts with CHF?
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Weight
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why would you be concerned if a pt with CHF is taking NSAIDs or Probenecid?
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Because they are competitive at the renal level so you will prolong the actions of other renal cleared drugs like loops.
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85 y/o Pt comes into ER, h/o CHF, SOB, HR 47, BP 90/60, RR 7. What do you do?
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Give Dobutamine for its positive inotropic effects and low dose dopamine(renal effects)
2.5 mcg/kg/min |
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what does a high dose (>10)of dopamine affect?
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Alpha receptors; positive inotropic effect
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what does a low dose (1-5 mcg/kg)of dopamine affect?
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affects dopamine receptors; improves vasodilation at the nephron to increase diuresis
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when do you use Nitroprusside?
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In CHF with pts that have B/P ~ 200
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a pt on nitroprusside starts to turn blue, what's happening?
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the pt is having cyanide toxicity
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Name some benefits of Nesiritide
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< PCWP
improves pulm congestion > lung oxygenation |
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which drugs induce prostaglandin-mediated increase in renal blood flow?
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Loop diuretics
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A pt has severe CHF, how do you treat?
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ACEI plus a loop diuretic with spirinalactone as an add-on.
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What would be an alternative to use with pts having CHF that cannot tolerate ACE I, or ARBs?
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Imdur 30 mg daily
Hydralazine |
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what drug would you use if your CHF pt has marked hypertension?
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Nitroprusside
0.1 mcg/kg/min Don't use longer than 24 hrs (cyanide toxicity) |
