Term
| symptoms of being "wet"-6 |
|
Definition
periperal edeam
pulmonary edema
JVD
ascites
fullness
heaptomegaly |
|
|
Term
| symptoms of being "cold"-4 |
|
Definition
renal insuff.
cold extremities
mental status
hypotension |
|
|
Term
when do you use a diuretic?
what are most? |
|
Definition
any fluid overload (wet)
warm and wet |
|
|
Term
| you want to titrate diuretics to lose _ per day |
|
Definition
|
|
Term
| which loop diuretic is most potent? |
|
Definition
|
|
Term
| initial dose of furosemide w/ no prior diuretic use- |
|
Definition
|
|
Term
| initial dose of torsemide w/ no prior diuretic use- |
|
Definition
|
|
Term
| initial dose of bumetadine w/ no prior diuretic use- |
|
Definition
|
|
Term
| if the patient has had previous diuretic use what is the initial dose- |
|
Definition
| double the home PO dose and give IV |
|
|
Term
| 2 ADEs of loop diuretics I never remember - |
|
Definition
ototoxicity at high dose
contraction alkalosis |
|
|
Term
if patient responds to the initial diuretic bolus dose what is the next step?
why? |
|
Definition
give this dose twice a day
to prevent kidneys from filling again |
|
|
Term
| if urine output doesnt increase with the initial diuretic bolus- what are the options in order of what to do next-5 |
|
Definition
double the initial bolus IV
start continuous infusion
change to thiazide
-then add ionotrope/vasodilator
-ultrafiltration/hemodialysis |
|
|
Term
| if patient experience hypotension after initiation of diuretic- 3 options |
|
Definition
| decrease diuresis rate, IV fluid bolus, hold HTN meds |
|
|
Term
| if the patient experiences worsening renal failure after diuretic initiation what are the options: 3 |
|
Definition
| decrease diuresis, ionotrope, vasodilator |
|
|
Term
| vasodilators are used in what patients |
|
Definition
warm wet
cold wet when BP > 110/65 |
|
|
Term
| what are the vasodilators: |
|
Definition
nitroglycerin
Na nitroprusside
nesiritide |
|
|
Term
| in which vasodilator do you avoid the Swan-Ganz |
|
Definition
|
|
Term
| whcih vasodilators do you not stop abruptly? |
|
Definition
nitroglycerin
na nitroprusside |
|
|
Term
which vasodilator is not usually titrated?
what are the others titrated to- |
|
Definition
nesiritide
relief of congestion with BP>110/65 |
|
|
Term
which vasodilator needs monitoring of thiocyanate levels-
when are they taken? |
|
Definition
na nitroprusside
48 hrs after dose |
|
|
Term
| if patient developds hypotension while on vasodilators- what do you do? |
|
Definition
if on NTG or nitroprusside- lower dose, cant abruptly stop
if on nesiritide- can just stop |
|
|
Term
| when do you use ionotropes- |
|
Definition
cold and wet if BP< 110.65
cold and dry |
|
|
Term
| what are the ionotropes-2 |
|
Definition
|
|
Term
| which inotrope is more chronotropic, and whcih is more vasodilating |
|
Definition
dobutamine- chrono
milirone- vasodilator |
|
|
Term
| which ionotrope is used if patient is on a beta blocker? |
|
Definition
|
|
Term
| what ionotrope is used if the patient is in frank hypotension |
|
Definition
|
|
Term
| what is the dose adjustment for milirone |
|
Definition
|
|
Term
which ionotrope do you titrate?
what is the target?
what can be used to help titrate? |
|
Definition
dobutamine
CI >2.2
Swan Ganz |
|
|
Term
what continuous monitoring do you do for ionotropes?
why? |
|
Definition
|
|
Term
| what are the main ADEs of the ionotropes-3 |
|
Definition
arrythmia
hypotension
tachycardia |
|
|
Term
why dont you use ionotropes long term?
what the term when you want to relieve the symptoms more that that? |
|
Definition
increased mortality
pallitative care (more about symtpom relief than mortality) |
|
|
Term
| if the patient goes into cardaic shock (severe hypotension)- what med is used? |
|
Definition
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