Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
20 Cards in this Set
- Front
- Back
|
168. Tx of Systolic dysfunction-CHF?
|
a. Sodium restriction: 4 g/day (initially)
b. Diuretics: c. ACE inhibitors d. Angiotensin II receptor blockers (ARBs) e. β-blockers f. Digitalis g. Hydralazine and isosorbide dinitrates. |
|
|
169. Diuretics for CHF?
|
a. Most effective means of providing symptomatic relief to pts w/moderate to severe CHF.
b. Have not been shown to reduce mortality or improve prognosis!!!!! c. Loop diuretics: Furosemide (Lasix) - most potent. d. Thiazide diuretics: HCTZ- modest potency e. Spironolactone (Aldactone) - Low potency. |
|
|
170. B-type natriuretic peptide (BNP)?
|
a. Is released from the ventricles in response to ventricular volume expansion and pressure overload.
|
|
|
171. What BNP levels correlate strongly w/the presence of decompensated CHF?
|
a. >100 pg/ml correlates strongly w/the presence of decompensated CHF.
|
|
|
172. What is BNP useful in differentiating?
|
a. Dyspnea caused by CHF vs. COPD.
|
|
|
173. ACE Inhibitors for CHF?
|
a. Cause venous and arterial dilation, decreasing preload and afterload.
b. The combination of a diuretic and an ACE inhibitor should be the initial tx in most symptomatic pts. c. ACE inhibitors reduce mortality!!! They prolong survival, and alleviate sx in mild, moderate, and severe CHF |
|
|
174. Why should you always start at a low dose w/an ACE inhibitor in CHF?
|
a. To prevent hypotension.
|
|
|
175. All pts w/systolic dysfunction should be on what, even if they are asymptomatic?
|
a. ACE inhibitor.
|
|
|
176. What 3 values should be monitored for a person on an ACE inhibitor?
|
a. BP
b. Potassium c. BUN d. Creatinine |
|
|
177. When are angiotensin II receptor blockers (ARBs) used for CHF?
|
a. In pts unable to take ACE inhibitors due to side effect of cough, but should NOT replace ACE inhibitors if pt tolerates ACE inhibitors.
|
|
|
178. β-blockers for CHF?
|
a. Proven to decrease mortality in pts w/post-MI heart failure.
b. Reported to improve sx of CHF; may slow progression of heart failure by slowing down issue remodelling. c. Should be given to stable pts w/mild to moderate CHF (Class I, II, and III) unless there is a non-cardiac contraindication. |
|
|
179. Digitalis for CHF?
|
a. Positive inotropic agent.
b. Useful in pts w/EF <30%, severe CHF, or severe atrial fib. c. Provides short-term symptomatic relief but has NOT been shown to improve mortality. d. Can be added to diuretics and ACE inhibitors in CHF. e. Serum digoxin level should be checked periodically. |
|
|
180. When are Hydralazine and isosorbide dinitrates used in CHF?
|
a. Can be used in pts who cannot tolerate ACE inhibitors
b. The combination of hydralazine and isosorbide dinitrate has been shown to improve mortality in CHF: But not as effective as ACE inhibitors and requires inconvenient dosing schedules. |
|
|
181. Tx options for diastolic dysfunction?
|
a. Few therapeutic options available; pts are treated symptomatically.
|
|
|
182. What should be monitored in pts w/CHF?
|
a. Wt- unexplained wt. gain can be an early sign of worsening CHF.
b. Clinical manifestations (exercise tolerance is key); peripheral edema. c. Lab values (electrolytes, K, BUN, creatinine levels; serum digoxin, if applicable). |
|
|
183. What did the COMET trial show regarding β-blockers?
|
a. It compared 2 β-blockers in the tx of CHF and showed that carvedilol led to significant improvement in survival compared w/metoprolol.
|
|
|
184. 3 Signs of Digoxin toxicity?
|
a. GI: N/V, anorexia.
b. Cardiac: Ectopic (ventricular) beats, AV block, Afib. c. CNS: Visual disturbances, disorientation. |
|
|
185. What are Premature atrial complexes (PACs)?
|
a. This early beat arises w/in the atria, firing on its own.
b. On ECG, look for early P waves that differ in morphology from the normal sinus P wave (because these P waves originate w/in the atria and not the sinus node). |
|
|
186. QRS complex w/PACs?
|
a. QRS complex is normal bc conduction below the atria is normal. There is normally a pause before the next sinus P wave.
|
|
|
187. Causes of Premature atrial complexes (PACs)?
|
a. Causes include adrenergic excess, drugs, ETOH, tobacco, electrolyte imbalances, ischaemia, and infections.
|
