acute HF
-refers to patients with sudden onset of HF symptoms that previously had normal function
acute decompensated HF
-occurs in patients with existing HF
DOE, orthopnea, edema, GI issues
What are the volume overload symptoms? (4)
fatigue, cool extremities, pallor, confusion, oliguria
What are low cardiac output symptoms? (5)
continue them unless renal issues or hyperkalemia
What do we do with ACEi/ARB/ARNI & AA when a patient has ADHF?
continue unless recent titration seems to be cause; if not currently on, don't start until stable
What do we do with Beta Blockers when a patient has ADHF?
a
Which patients are well perfused & don't have a fluid overload? ( warm & dry)
a) subset 1
b) subset 2
c) subset 3
d) subset 4
c
Which patients have poor perfusion, but no fluid overload? (cold & dry)
a) subset 1
b) subset 2
c) subset 3
d) subset 4
b
Which patients have good perfusion, but have fluid overload? (warm & wet)
a) subset 1
b) subset 2
c) subset 3
d) subset 4
d
Which patients have poor perfusion and fluid overload. (wet & cold)
a) subset 1
b) subset 2
c) subset 3
d) subset 4
a
Which can be treated at home?
a) subset 1
b) subset 2
c) subset 3
d) subset 4
b
Which require ED visit + diuretics?
a) subset 1
b) subset 2
c) subset 3
d) subset 4
c
Which are treated with vasodilators & inotropes?
a) subset 1
b) subset 2
c) subset 3
d) subset 4
d
Which are treated with vasodilators, diuretics, and inotropes?
a) subset 1
b) subset 2
c) subset 3
d) subset 4
>=2.2
Good perfusion =
> 18
Pulmonary edema =
tachyphylaxis (tolerance), increased intracranial pressure
What do we have to watch out for when administering vasodilators? (2)
a
Which is good for pulmonary edema & IHD?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
c
Which has the best effect on HR & CO?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
a
Which has a half-life of minutes therefore must be taken IV?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
a
Which do we have to use glass containers?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
a,c
Which has to be protected from light?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
c
Which uses a volumetric infusion pump?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
c
Which can cause cyanide/thiocyanate toxicity?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
hepatic; renal
Cyanide toxicity can occur in patients with _________ impairment while
Thiocyanate toxicity can occur in patients with _______ impairment.
sodium nitroprusside; intense vasodilation
Which medication in combination with PDE inhibitors should be avoided?
What can this cause?
c
Which has a light-brown tint?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
when red, blue, green, or dark brown
When do we discard sodium nitroprusside?
b
Which can increase CO, natriuresis, & diuresis?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
b
Which is extremely expensive?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
b
Which has the longest half-life?
a) nitroglycerine
b) nesiritide
c) sodium nitroprusside
cardiogenic shock, bridge therapy to maintain perfusion
When do we use inotropes? (2)
a
Which really only affects Alpha-1?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
a
Which is mainly used for severe shock?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
b,d
Which are limited due to intense vasoconstriction & increased PR/afterload?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
b,d
Which can increase O2 demand, meaning we have to watch in patients with IHD?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
c
Which one can turn yellow, and should be discarded when that happens?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
c
Which has dose dependent actions?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
c
Which has a BBW for sloughing & necrosis (extravasation) ?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
g) milrinone
phentolamine mesylate
-adrenergic blocking agent used when extravasation ( sloughing &
necrosis) occurs
f
Which has no IV bolus; rapid onset, and short half-life?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
g) milrinone
f
Which CANNOT be stopped abruptly?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
g) milrinone
f
Which has pink IV solutions?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
g) milrinone
f
Which is CI in patients with sulfite/ corn allergy?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
g) milrinone
g
Which is a PDE inhibitor?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
g) milrinone
g
Which has the longest duration of action?
a) phenylephrine
b) norepinephrine
c) dopamine
d) epinephrine
f) dobutamine
g) milrinone
hemodynamics, BMP, EKG, CBC, vitals, GFR
What do we monitor in Milrinone? (6)