Hosam Mohamed-
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?
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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
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>=2.2
Good perfusion =
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> 18
Pulmonary edema =
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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)
