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61 Cards in this Set

  • Front
  • Back
LV dysfunction that causes reduction in the cardiac output is what type of disease?
what is a normal Ejection Fraction?
what is the best way to get an accurate EF?
during an invasive coronary procedure, when you can inject LV with contrast.
#2 2D ECHO
a cause of CHF that impairs the ability of cardiac muscle to contract?
systolic dysfunction
a cause of CHF that impairs the ability of cardiac muscle to relax?
dystolic function
a cause of CHF that increases preload and afterload?
incrased workload
patient presents to the ER suspecting that he has pneumonia. H/O chemotherapy and is now in remission. You admit him for open heart surgery. what happened?
the meds he was taking for CA caused the muscles around his heart to become hardened. there was no damage to the LV, so he was having systolic dysfunction that led him into CHF. the open heart surgeon loosened up the heart muscles again so his heart could function effectively.
what are some causes of CHF?
congenital heart disease
malfuntion of valves
which patients are at higher risk for CHF due to increased workload demands on their heart?
renal patients or patients on dialysis.
congenital heart disease.
what they need is more than their body can do
what are the top two presentations for a p with CHF?
additionally, rales, tachy, decreased exercise tolerance.
increase in venous return is an increase in what?
an increase in mean arterial load is an increase in?
patient presents to the ER ; HR 40, BP 90/50. what do you want to do ?
increase their HR.
GIVE positive inotrope.
Vasodilator: decrease afterload, improve CO
DIURETICS: get extra fluid out
ACE I: part of neuralhormonal cycle
what are some of the compensatory mechanisms done by the body in CHF?
increase sympathetic symptoms, increased preload/afterload, fluid retention: ALD which leads to salt & water retention, Myocardial hypertrophy, neurohormonal effects...leads to decompensated state!
what are some examples of the elements involved in the neurohormonal cycle?
epi/norepi, AngiotensinII, vasopressin, enothelin (tissue necrosis factor), ALD
what type of chf does Aldosterone antagonists play a role in?
chronic CHF.
ex) spiralactone
what is the goal of the pharmocologic treatment?
to block the compensatory mechanisms of the neurohormonal activity: improve s/s, breathe better! get rid of fluids, preserve cardiac fxn!
patient comes into the ER, Edema, Sweating, SOB. BUN, Serum Creatinine are both low. what do you give to treat this patient?
Primary goal:decrease edema and decrease congestion.
need to eliminate fluids: Diuretics given IV acutely.
40mg IV bolus dose (lasix) give another dose until p is urinating and stable. monitor weight!
give two examples of positive inotropes?
Digoxin, Milarone
what effect do vasodilators have?
decrease AFTERLOAD
what do diuretics do?
decrease preload
what do ACE inhibitors do to affect Heart?
reduce afterload
what effects does DIGOXIN have?
decrease HR
improve contraction
what is the main instructions you need to give a patient once D/C, that came in due to CHF and is being sent home on a diuretic?
monitor your weight!
if you see > 5 lb change, call MD stat.
what is BNP?
beta naturetic peptide. the LV releases this in response to stress on the heart
P presents with signs of CHF; smoker, h/o COPD, H/O MI. You ordered ABG. However you are not sure if he is retaining Co2 or is in CHF. what is a way to differentiate between the two?
BNP >200: beta naturetic peptide. the LV will release this if it is under stress/undergoing CHF
what is the strongest diuretic and best for CHF?
loops: furosemide, bumetidine, toresmide
what is the MOA of the Loop Diuretics?
work on the ascending loop of henle
induce prostaglandin-mediated increase in renal blood flood which leads to a natuiretic effect.
what is the dose of lasix/furosemide for CHF?
20-40mg BID
max 400qd
what is the CHF dose for Bumetidine/bumex?
.5-2mg QD
max 10mg
what is the chf dose for toresemide?
10-20mg QD
max 200mg
what are some drug interactions with loop diuretics?
probenecid (for gout. works at kidneys)
give an example of a thiazide-like diuretic that can be used in combo c loope diuretics for CHF.
why are NSAID's considered to have a drug interaction with Loop diuretics?
ibuprophen, naproxen, ASA: because they work at the level of the kidney too! they compete at the renal tubule preventing the elimination of these drugs. increase Na, prostaglandins
MOA of Digoxin?
increase cardiac contractility
decrease renal absorb. of Na
what is the optimal dose for digoxin?
SERUM monitoring: .6-1 ng/dl
Patient comes into your office. CHF, they have been complaining of increasing s/s throughout the months. new symptom last week etc. BUN/ Sr creat levels are ok. Na and K+ are low. what can you add-on?
a thiazide would be too strong.
use a thiazide-like diuretic: Metazolone
what are the dangers of using DIG + cimetide?
it is an inhibitor. it does not eliminate DIG. will cause a dig toxicity
you measure your patient's DIGOXIN level. it is 6.0ng/dl. what do you do?
give something to reverse the effects of DIG. DIGIBIND
a B1 and B2 receptor agonist, some effect on A1: good for CHF; minimizes increase in myocardial o2 demand, litle change in mean arterial pressure, little change in BP, not a routine med?
patient in the ED, 85 y/o male c H/O CHF. Severe SOB, He has not been taking his meds for weeks. HR 47, BP 90/60, RR 6-7. what is a great drug to give in this situation?
DOBUTAMINE. positive inotrope that will not affect BP, workload etc.
cant give
Diuretic: it will decrease bp
fluids: heart is not effective to get rid of excess
vasodilator: will decrease HR/BP even more
what are the 3 dose/ranges for Dopamine?
LOW: 1-5 for renal insuff.
MED: 5-10
HIGH: >10
IMPROVES vasodilation ath the nephron
what is the MOA of DOPAMINE?
directly stimulates adrenergic receptors by causing NE release.
has positive inotropic activity
works on B1, B2, A1 and D1
if your patient is stable (HR, BP etc) and you have given a diuretic and they are still not urinating what drug can you try?
your patient has been started on a dopamine drip (low/renal dose), suddenly the nurse calls a code. you must intubate. what do you need to administer?
you can use dompamine as an inotrope. max out on dopamine dose to treat this situation. it is already running IV.
this drug is interchangable with Nitro, does not have inotropic effects, great to use if BP skyrockets, rapid onset, short DOA?
Nitroprusside- a vasodilator. mixed arterial/venous
actus on smooth muscle to increase synthesis of nitric oxide.
what is the dose for nitroprusside?
.1 mcg/kg/min
up to 3
taper dose
which drug is good for CHF + HTN?
a vasodilator
.1mcg/kg/min up to 3
this drug is an exogenous BNP and interrupts the CHF cascade by decreasing cardiac workload and improving PCWP
this drug is great for p with pulmonary edema. stops feedback of BNP from heart and helps lungs get more o2.
what is the MOA of ACE inhibitors?
blocks production of angiotensin II and reduces the breakdown of bradykinin.
what must you monitor for patients on ACE inhibitors?
Sr.Creatinine, BP, K. ACE causes hyperkalemia.
what are some reasons to stop ACE inhibitors?
what is MOA and dose of Captopril?
ace inhib.
blocks production of AGII. reduces breakdown of bradykinin.
DOSE: 6.25mg TID. target 50mg
dose and MOA of INDUR?
Nitrate. (nitro)
30mg QD
increases cGMP in smooth musc and actis as a vasodilator, preduces reduction in afterload.
used in combo with ACE inhib therapy, should be used on all patients with LVD?
what is the MOA of bb?
blocks effects of norepi on heart and vascular system.
dose of metoprolol XL for chronic tx of chf?
12.5mg QD.
target 200mg.
what is used as an alternative tx to ace inhib for patients that cant tolerate them?
Antiotensin receptor blockers.
dose and MOA for Losartan?
25mg QD. mAX 100mg qd.
patient is in class III or class IV CHF, what is a good add-on therapy, as it blocks ALD in the kidneys by decreasing Na retention?
Rales Study: showed that p c CHF did better with add-on of spironalactone.