thera 3 test 2 HF

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coal
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268280
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thera 3 test 2 HF
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2014-03-28 12:33:52
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thera test HF
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thera 3 test 2 HF
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  1. HFrEF vs HFpEF
    • reduced
    •   EF < 40%
    •   systolic HF
    •   dilated ventricle
    •   decreased ability to eject
    •   post-MI
    • preserved
    •   EF >40%
    •   diastolic
    •   hypertrophied ventricle
    •   decreased ability to fill
    •   elderly w/long standing HTN
  2. interpretation of BNP's
    • < 100 = unlikely CHF
    • > 500 = likely CHF
    • 100-500 = doesn't rule in or out CHF
  3. NYHA HF classifications
    • I - no limitation
    • II - slight fatigue on exertion
    • III - Marked limitation on exertion
    • IV - limitation even just talking
  4. ACC/AHA stages of HF
    • A - high risk
    • B - asymptomatic
    • C - symptomatic
    • D - end stage HF
  5. Forrester classification of HF
    • cold = poor perfusion, decreased mental cognition, increased LFT, increased SCr
    • warm = normal BP, organs are perfused
    • wet = edema, increased BNP
    • dry = dehydration, decreased urine output, skin tenting
  6. what are the drugs of choice in warm and wet pts
    diuretics
  7. what is a "normal" forrester classification
    dry and warm
  8. when would we use ethacrynic acid in HF
    • sever sulfa allergy
    • ototoxic
  9. which diuretics are 100% bioavailable PO or IV
    • torsemide - demadex
    • bumetanide
    • furosemide - Lasix (50% PO bioavailability)
  10. what kind of response (I&O) are you looking for in furosemide
    • 500 mL out 4-6 hrs later
    • net difference of I/O should be around 1L/day
  11. what is the drug of choice if someone is fluid overloaded and has cirrhosis
    spironolactone - aldactone
  12. if you were giving a loop diuretic and were getting refractory diuresis what would you do
    • add on a thiazide or spironolactone
    • chlorothiazide IV
    • HCTZ - PO
  13. if you were giving a loop diuretic and were getting refractory diuresis, and the pt had a CrCl < 30 what would you do
    • metolazone - zaroxolyn
    • caution very potent diuresis (5mg for 5 days)
  14. 1 kg of weight is equal to how much water
    1L = 1Kg
  15. what classes of medications have evidence for improvement in SYMPTOMS of HF
    • ACEI
    • ARBs
    • beta blockers
    • diuretics
    • digoxin
  16. what classes of medication have evidence for improvement in mortality in HF
    • ACEI
    • ARBs
    • beta blockers
    • vasodilators
    • aldosterone antagonists
  17. 2 groups to avoid statins in
    • dialysis
    • HF - not beneficial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications
  18. when would statins be recommended in HF
    stage B HF + hx of MI or ACS
  19. what pt factors need to be considered when switching and titration of beta blockers
    • how sick are they
    • past dose

    • don't give until they are stabilized on oral diuretic dose
    • no longer in acute decompensation or receiving IV inotropes
  20. goal dose of metorolol succinate, carvedilol & lisinopril and titration
    • m - 200 mg daily
    • c - 25 mg BID (50mg BID > 85 kg)
    • L - 30-40 mg QD

    double dose q 2-4 wks

    • starting dose
    • m- 12.5-25 QD
    • c - 3.125 BID
    • l - 2.5-5 QD
  21. important counseling point of beta blocker titration
    they are going to feel worse for awhile after initiation, but we want to keep them on it even if the dose needs to be decreased
  22. what are some nonpharm recommendations for HF pts
    • <2g Na restriction
    • fluid restrictions
    • smoking cessation
    • alcohol restriction
    • exercise PRN
    • cardiac rehab clinics
    • daily weight monitoring
  23. digoxin range for HF
    • 0.5-0.9
    • starting dose of 0.125 mg QD
  24. HF pt has an elevated A1c what could you give
    • metformin
    • glipizide - Glucotrol (watch for increased fluid retention)
  25. when would you consider adding on a vasodilator to IV loop diuretics
    • "wet" classification
    •   severe pulmonary edema
    •   hypertensive emergency
    •   persistent symptoms despite aggressive diuretics
  26. when would you consider using an inotrope in HF
    • evidence of cardiogenic shock
    •   cold and wet
    •   impaired perfusion of end organ damage
    • HoTN - SBP < 90, MAP < 50 or symptomatic
    • bridge in end stage disease until transplantation or mechanical circulatory support can be provided
  27. what is the preferred agent in HF if the pt is HoTN
    dopamine IV
  28. what is the preferred inotrope in HF and the pt has been taking a beta blocker
    milrinone

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