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31 Cards in this Set

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

atropine; epi
tank

tx
not enough fluid (bleeding), too large(squeeze)

BA, phosphodiesterase
pump

tx
fluids

dompamine, NE, phenylephrine