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31 Cards in this Set
- Front
- Back
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tx goals in CHF are to
______ contractility of heart reduce _______ reduce _______ |
increase
preload afterload |
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in R sided failure blood backs into _______ circulation
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systemic
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in L sided failure, blood backs into ____ circulation
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pulmonary
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drugs used to increase contractiligy
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digoxin
B-agonists phosphodiesterace inhibitors |
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digoxin inhibits ________
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Na/K ATPase
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dig has an _____ inotrophic effect
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positive
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it's route of admin is
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IV, PO (bioavailability is 75%)
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digoxin binds to ______ and is _______ eliminated
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albumin, dual
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BA used in CHF
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Dobutamine
Isoproteronol |
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Dobutamine is ________ specific, increases _____ and has _______ effect on heart rate
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B1, contractility, less
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Isoproterenol is a _______ beta agonist
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non-specific (not used much except post transplant)
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SE of digoxin
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concentration dependent
n/v visual disturbance (yellow hallow) arrhythmia (1st heart block) effects of hypomagn, hypoK, Hypercalcemia (predisposes to toxicity) QT segment prolongation |
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drug interactions
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protein displacment interference of dig metabolism
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dig dosing
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loading dose first 1/2 now, 1/4 6 hr, 1/4 6 hr
maintenance 0.125mg to 0.25 q d |
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phosphodiesterase inhibitors
increase __________ |
contractility
Inamrinone (Inocor) Milrinone (Primacor) |
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dosing
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IV infusion preceded by bolus
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SE
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tcp, hypotension
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meds used to reduce preload
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nitrates, vasodilators (Hydralazine)[not used much secondary SE]
diuretics (loops/thiazides) |
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most common diuretics used for CHF
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spironolactone (aldactone) [antagonises aldosterone which is bad for heart condition] and lasix
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another diuretic used
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Eplerenone (Inspra)
similar to aldosterone, but more specific to heart, and no antiandrogenic effects |
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meds used to reduce afterload
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ACE inhibitors, ARBS, CCB, vasodilators, A1B
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beta blockers used in CHF
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carvedilol (Coreg)[A and B], metroprolol (sustained release)[pure B1], labatelolol (mostly A with increased dose)
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severe CHF
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IV tx
dobutamine phosphodiesterase inhibitor nitrates, nesiritide (natrecor) |
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Nesiritide (Natrecor) is indiciated for acute ________ CHF, decreases _________ and is dosed as a ________ infusion
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decompensated; dyspnea; continuous
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Adverse effects
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hypotension; bradycadia; HA; nausea
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Nesiritide (Natrecor) is a recombinant ________ _______ peptide, which binds to natriuretic pepetide receptors which are linked to _____ ________
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B-type natriuetic; guanylyl cyclase
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clinical effects
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vasodilation (a and p load decreased)
diuresis |
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three thing to think of when treating hypotension and shock
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rate; tank; pump
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rate
tx |
is it at least 60 bpm
atropine; epi |
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tank
tx |
not enough fluid (bleeding), too large(squeeze)
BA, phosphodiesterase |
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pump
tx |
fluids
dompamine, NE, phenylephrine |
