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100 Cards in this Set
- Front
- Back
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What are causes of CHF?
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Systolic dysfunction
Diastolic dysfunction Incresed work load Uncontrolled HTN CAD MI Endocarditis Congenital heart dz Chronic A-fib Valve malformation |
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How would you trat a patient with systolic dysfunction?
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B1 Ionotrope:
Dopamine 5-10 IV or Dobutamine IV |
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A patient presenting with edema, SOB, Rales, increased HR is showing signs of...
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CHF
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A decreased exercise tolerance is worse in what stages of CHF?
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Stages 3 & 4
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A patient with an ejection fraction <40 must be put on what drug?
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An ACE-I
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If the patient has HTN & CHF, what dose of ACE-I should they be put on?
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An increased dose.
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What is th #1 goal of treatment for CHF?
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Relieve symptoms
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What are the compensatory mechanisms in CHF?
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Increase sympathetic activity
Fluid retention Myocardial hypertrophy |
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Name some vasodilators.
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Hydralazine
Nitroprusside Minoxadil |
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What drug / dose would you give to a patient who has HTN, CHF and is NPO?
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Enapril 1.25mg IV Q6
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If a patient is going for dialysis, what drug (for CHF) should you hold?
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ACE-I
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What is the primary goal of diauretics?
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To decrease edema and pulmonary congestion (REDUCE PRELOAD)
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A CHF patient may be in fluid retention if they gain what amount of weight.
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>3 lb gain in 2 days
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What drug / dose would you give to a patient that presents with acute pulmonary edema?
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60 mg IV Lasix (After 24 hours, decrease dose and start converting to PO)
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What should be measured in a CHF patient?
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Measure I/O's
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What drugs are contraindicated in a patient on diauretics?
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Probenecid & NSAIDs
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What is the max dose of Lasix in a CHF patient?
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400 mg QD
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Where do Lasix work?
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In the ascending LOH
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Iburprofin, naproxin, indomethacin and diflofinate are all examples of what?
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NSAIDs
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When reviewing a patients chart, you see a patient is the drug Metazalone, this is a sign of what?
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The patient has a history of CHF
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How do NSAIDs work and why are they contraindicated in patients on diaruretics?
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They are highly eliminated at the kidney, they compete for elimination at the nephron, they prevent normal kidney function, decrease fluid elimination, increase serum creatinine, decrease creatinine clearance, CAUSE CHF- they block the effects of the loops.
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What drug would you give a CHF patient in place of NSAIDs?
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Tylenol
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How does probenecide work?
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It excretes uric acid
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Why is probenecide contraindicated in CHF?
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It keeps drugs around longer and decreases fluid excretion
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Why would you give probenecide?
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To keep drugs around longer
(Abx fo endocarditis) |
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Aldactazide is what?
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Sprinolactione + HCTZ
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What place in line is Digoxin for CHF?
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As a 3rd or 4th line agent
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How does Digoxin work?
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Increases oxygen to the heart and kidneys, Works on the Na+/ K- pump, increases contractility, decreases renal absorption
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When is Digoxin used in CHF patients?
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On symptomatic patients , who are already on ACE-I, BB & diauretics.
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What is the dose of Digoxin in a patient with normal renal funcion?
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0.125 mg QD
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A patient with imparied renal funcion is on what dose of Digoxin?
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CrCl <20 = 0.125 EOD
(Every Other Day) |
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How does Digoxin work?
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On the Na+/K- pump, helps heart pump work better, decreases renal absorptin of Na+
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What is the range of Digoxin?
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The LOW end of 0.6 - 2 ng/ dl
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What exectrolyte can cause Digoxin toxicity?
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Potassium
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If a patient is on the high end of the digoxin range, what can happen?
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Decreased Na+ / Increased K-
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What should be monitored in a patient on Digoxin?
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Sodium, Potassium, BUN, SCr
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What is the benefit of Digoxin?
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Improves symptoms, NO effect on mortality, decreases hospitalizations
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What receptor does Dobutamine primairly act on?
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B1 (Has some effect on A1 - B2)
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What is the dosing for Dobutamine?
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2.5 - 5 mcg/kg/min
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Why is Dobutamine good for CHF?
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Decreases myocardial oxygen demand
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After Dobutamine is started, how should it be titrated?
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Gradually increased to 20mcg/kg/min
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A patient presents with marked hypotension or cardiogenic shock, what drug and dose should they be given?
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Dopamine 5mcg/kg
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A patient with acute renal insufficiency presents, what drug and dose should they be given?
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Dopamine low dose
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What is the mechanism of action of Dopamine?
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Directly stimulated adrenergic receptors by causing Norepinephrine release
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What receptors does Dopamine work on?
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B1, B2, A1 & D1
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What does Nitroprusside work on?
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Acts on smooth muscle to increase synthesiss of nitric oxide, increases cardiac index and decreases venous pressure
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Does Nitroprusside have a direct ionotropic effect?
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NO
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What is the dose of Nitroprusside?
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Initate 0.1 to 0.25 mch/kg/minute, up to 3 mch/kg/minute (Taper Dose)
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What is Nesiritide?
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Exogenous BNP
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How does Nesiritide work?
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Interrupts CHF cascade
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What is the onset and duration of acton of Nitroprusside?
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Rapid onset, short DOA
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What is the dose of nitroprusside?
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Initally 0.1 to 0.25 mcg/kg/min, taper dose to 3mcg/kg/min
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How is Nitroprusside beneficial?
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Increases cardiac index and decreases venous pressure, no direct ionotropic effect.
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What are the benefits of ACE-I, in regards to CHF?
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Dereases mortality, decreases hospitalizations, symptom improvement
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A patient with Left Ventricular Dysfunction should be on what type of drug?
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An ACE-I
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What needs to be monitored in patients on ACE-I's?
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Serum Cr, Blood pressure and K+
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What are the adverse effects of ACE-I's?
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Cough, Angioedema
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What ACE-I has the highest incidence of cough?
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Captopril
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What ACE-I drug comes in IV form?
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Enalapril (2.5 mg BID - Target 10 mg BID)
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A patient with DM has just been diagnosed with CHF, what ACE-I would you put them on (drug/dose)?
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Ramipril (2.5 mg QD - Target 10 mg QD)
Ramipril has the best studies in DM patients. No generic. |
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How does nitroglycerin work?
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Increases cGMP in smooth muscles, acts as a vasodilator, produces reduction in AFTER LOAD
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What are the benefits of nitroglycerin?
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Preserves Left Ventricle
Prevents remodeling Decreases myocardial O2 demands |
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What are the disadvantages of Nitroglycerin?
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Headache, hypotension, drug interactions
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What drugs should be avoided in patients on nitroglycerin?
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Viagria, Cialis, Revatio
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A 64 y/o female is taking Revatio and is now presenting to the ER, what is she taking the drug Revatio for and what drug would you avoid giving her?
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Revatio- Pulmonary HTN
Avoid Nitroglycerin |
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Nitroglycerin should be prescribed with what in mind?
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The body can not be on a continous dose of nitroglycerin. (It developes a tolerance)
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What is the dosing regimine of Imdur and what is the half life- why?
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Imdur- Q12 hours
Half life- 8 hours The body can not be on a continuous dose of nitroglycerin. (It developes a tolerance) |
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When placing a patient on a nitroglycerin patch, what must be kept in mind?
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The patch should be placed on the body in the AM and removed at night, because the patch will continue to release the drug for 24 hours.
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How do beta blockers help in CHF?
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Preserves the left ventricle, prevents cardiac remodeling, decreases mortality and hospitalizations, improves symptoms
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When placing a patient on a Beta Blocker, what other class of drugs should they be placed on?
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An ACE-I
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What should be monitored in patients on Digoxin?
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Potassium, Sodium, Serum Creatine, BUN
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What receptor does Dobutamine primairly affect?
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B1
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A very high dose of Dobutamine affects what receptors?
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B1, B2 & A1
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What should be monitored in patients on Dobutamine?
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Blood Pressure & Arterial Pressure
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Why is Dobutamine helpful in CHF?
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Because of its ionotropic and vasodilatory effects
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A patient presents with a BP of 50/30 in acute decompensated heart failure and pulmonary edema, what drug / dose would you give and what receptor would that drug act on?
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Dopamine 20 mcg/ kg/ min
A1 Receptor |
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Nitroglycerin is mostly what type of dilator?
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Venous
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Nitroprusside is what type of dilator?
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Arterial and Venous
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Can nitroprusside work alone, why?
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No, it does not have direct ionotropic effects
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When does nitroprusside begin working?
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Right away
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Nitroprusside only comes in what form?
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IV
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What is the duration of action of nitroprusside?
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Short
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How should doses of nitroprusside be given?
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Never start at a high dose, titrate by doubling dose until max dose is obtained. If the patient does not respond to max dose- FIND ANOTHER DRUG
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A patient on chronic nitroprusside (>24-48 hours) MUST be monitored for what?
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Cyanide intoxication
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What is nesiritide (Natrecor)?
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Exogenous BNP
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When is BNP released?
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When the patient is in cardiac stress, rhabdo or renal failure.
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What lab is used to defferentiate between CHF and Pneumonia?
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BNP (If BNP is >100 is may be CHF)
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How does nesiritide (Natercor) work?
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Stabalizes neurohormonal activatiors
Increases renal diarusis (Vasodilates kidneys) Decreases BP Decreases heart work load Improves PCWP in lungs |
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Why is nesiritide (Natercor) no longer a first line agent?
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Because it put patients into renal failure.
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When is nesiritide (Natercor) used?
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Only used in a patient with CHF and a HTN crisis
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What is the #1 side effect of nitroglycerine?
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Headache
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How do ACE-I work?
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Decrease sympathetic stimulation
Decrease production of aldosterone (leads to increased sodium and water retention) Decreases afterload |
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What does the JNC-7 say in regards to medications and CHF patients?
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CHF patients MUST be on an ACE-I unless they have compelling contraindications.
ACE-I decrease mortality |
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If a patient has an ejection fraction <40, what class of drugs must they be on?
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ACE-I
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What drugs are life saving in CHF patients?
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ACE-I
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What is a side effect of beta blockers?
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Depression
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What is the only beta blocker with a weight requirement?
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Carvedilol
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What is the half life of heaprin?
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90 minutes
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Why is heaprin used in STEMI patients?
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Because of its short half life, the patient can go to surgery sooner.
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When is heaprin given SC?
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For prophylaxis
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