Shared Flashcard Set

Details

Acute Decompensated Heart Failure
Pharmacotherapy Exam 2
74
Pharmacology
Professional
03/24/2014

Additional Pharmacology Flashcards

 


 

Cards

Term
ADHF
Definition
new or worsened symptoms of heart failure (dyspnea, fatigue or edema) leading to unscheduled medical care or hospital admission
Term
ADHF triggered by volume overlaod
Definition
excess dietary sodium, hepatic dysfunction and kidney diseas
Term
ADHF triggered by increased metabolic demands
Definition
infection, major surgery
Term
ADHF triggered by medications
Definition
non-adherence, cardiotoxic drugs
Term
ADHR related to substance abuse
Definition
stimulant drugs like cocaine and methamphetamine
Term
ADHR stress induced
Definition
takotsubo
Term
Signs and symptoms
Definition
dyspnea, *orthopnea, fatigue, edema, *paroxysmal nocturnal dyspnea (PND), GI
Term
most common S/Sx
Definition
orthopnea nd paroxysmal nocturnal dyspnea are signs of impending ADHF
Term
left sided (systolic)
Definition
pulmonary edema, decreased perfusion to organs (kidney, GI, Brain)
Term
right sided (diastolic)
Definition
peripheral edema and hepatic congestion
Term
physical exam
Definition
CNS, pulmonary, Cardiovascular (jugular venous pressure), Renal and extremeties
Term
non-invasive
Definition
ECG, chest radiography, and ECHO
Term
electrocardiogram (ECG)
Definition
left ventricular hypertrophy (MI), arrhythmias
Term
chest radiography
Definition
alveolar edema, cardiomegaly
Term
echocardiography (ECHO)
Definition
extent of ventricular dysfuction: ejection fraction, evaluate valves
Term
invasive studies with no mortality improvement and high risks
Definition
Pulmonary artery catheter (Swan-Ganz), cental venous catheter, coronary angiography
Term
Pulmonary artery catheter
Definition
determines hemodynamic parameters (PCWP, CVP, SvO2, CI)
Term
Pulmonary artery catheter indications
Definition
ADHF with persistent symptoms despite standard therapies (diuretics etc), uncertain hemodynamics
Term
Central venous pressure (CVP)
Definition
measures RA pressure (RV preload)
Term
pulmonary capillary wedge pressure (PCWP)
Definition
reflects left sided filling pressure (LV preload)
Term
cardiac index (CI)
Definition
CO/BSA
Term
systemic vascular resistance (SVR)
Definition
resistance of peripheral circulation (afterload)
Term
Mean arterial pressure (MAP)
Definition
perfusion pressure
Term
ScvO2
Definition
central venous oxygen saturation
Term
SvO2
Definition
mixed oxygen saturation, oxy sat in the pulmonary artery
Term
BNP > 100 pg/mL
Definition
86% pos predictive value for ADHF
Term
BNP < 50 pg/mL
Definition
96% neg predictive value for ADHF
Term
"flash" pulmonary edema
Definition
sudden onset, very serious, intubation is often required
Term
acute kidney injury (AKI)
Definition
common after prolonged episodes of hypoperfusion
Term
hypotension leading to cardiogenic shock
Definition
worst case scenario
Term
category I
Definition
warm and dry (normal); minimal perfusion issues and congestion
Term
category II
Definition
warm and wet; more congestion but minimal perfusion issues
Term
category III
Definition
cold and dry; more perfusion but minimal congestion issues
Term
category IV
Definition
cold and wet; serious issues with perfusion AND congestion
Term
initial monitory and management
Definition
stabilization: O2 supplement, vitals, continuous cardiac rhythm and urine output
Term
initial correction of volume overload and hemodynamic abnormalities
Definition
in this order: diuretics, vasodilators, inotropes and vasopressors
Term
oxygenation is VERY important because
Definition
both cardiac output AND oxygen saturation is depleted in ADHF
Term
beta blocker
Definition
should be continued during hospitalization
Term
sometimes home meds need to be stopped (low BP leading to shock)
Definition
BUT reinitiation ASAP improves outcomes
Term
discontinue home meds in the setting of
Definition
hypoTN, cardiogenic shock, AKI, or hyperkalemia
Term
if patient doesn't present with fluid overload
Definition
still consider diuretic because most likely they have some pulmonary congestion
Term
loop diuretic pharmacology
Definition
reduce right and left filling pressures (preload) to improve forward flow
Term
caution with loop diuretics
Definition
in hemodynaic instability and aortic stenosis
Term
loop diuretic dose
Definition
start patient on IV dose same as home dose to achieve double the diuretic dose with increased bioavailability
Term
max furosemide dose
Definition
200 mg
Term
doses higher than 100 mg of furosemide
Definition
should be administered over 1 hour to prevent ototoxicity
Term
know daily weights, particularly the weight of the patient before ADHF episode
Definition
shoot for this weight goal with loop diuretic therapy
Term
strategies for diuretic resistance
Definition
increase dose or switch drug, use IV formulation continuous infusion, additional thiazide, addition of aldosterone antagonist
Term
vasopressin antagonist agents
Definition
tolvaptan and conivaptin
Term
arginine vasopressin
Definition
elevated in patients with HF
Term
vasopressin antagonists
Definition
antagonizes V1a (smooth muscle vasoconstriction) and V2 (fluid retention)
Term
advantage of vasopressin antagonists
Definition
does not activate neurohormonal system
Term
conivaptan
Definition
IV, failed to show improvement and not considered routine treatment
Term
tolvaptan
Definition
oral, no improvement and leads to rapid increase in Na levels
Term
vasodilator agents
Definition
nitroglycerine and nitroprusside
Term
vasodilator indications
Definition
rapid symptom relief in patients with acute pulmonary edema or severe hyPERtension that do not respond to diuretics alone
Term
vasodilator IV continuous use
Definition
monitor in ICU for BP
Term
venodilation with nitroglycerine
Definition
reduces left ventricular filling pressure (PRELOAD)
Term
dilation of coronary arteries with nitroglycerine
Definition
improves collateral flow to ischemic regions
Term
nitroprusside
Definition
preload and afterload reduction
Term
nitroprusside converted to
Definition
cyanide (hepatic failure-metabolic acidosis) by the liver and excreted as thiocyanate (renal failure-AMS, seizures) in urine
Term
nesiritide
Definition
increases cyclic GMP causing smooth muscle relaxation, results in naturesis, very expensive!
Term
inotropes
Definition
milrinone, dobutamine
Term
increased contractility, some vasodilation
Definition
inotropes
Term
indication for inotropes
Definition
severe LV systolic dysfuction with inadequate response to diuretic therapy, improve end organ function in patients with advanced HF until definitive therapy determines
Term
milrinone
Definition
phosphodiesterase inhibitor resulting in decreased cAMP, can use in combo with nitro and BB
Term
dobutamine
Definition
B1 adrenergic receptor agonist, minor B2 receptor agonist improved CO, minor reduction in SVR and PCWP; must STOP BB
Term
vasopressors
Definition
norepinephrine, dopamine, epinephrine, isoproterenol
Term
pharmacology of vasopressors
Definition
increased strength (inotropy) and frequency (chronotropy) of contraction resulting in increased CO
Term
admin of vasopressor
Definition
avoid peripheral extravasation, use central venous cath
Term
warm and dry (category I)
Definition
continue maintenance therapy, prevent progression
Term
warm and wet (II)
Definition
diuretics (+/- vasodilators)
Term
cold and dry (III)
Definition
diuretics, inotropes
Term
cold and wet (IV)
Definition
diuretics, inotropes, vasopressors
Supporting users have an ad free experience!