Pharm

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Author:
lrnino
ID:
50143
Filename:
Pharm
Updated:
2010-11-17 17:05:20
Tags:
Heart Failure
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Description:
Heat Failure
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  1. What is heart failure?
    Heart can't pump good enough to meet needs of body.
  2. Causes of heart failure?
    • Coronary artery disease
    • Previous MI
    • abnomalities
    • HTN
  3. What happens during HF?
    • Increased HR and contractility
    • Increase pre-load and stroke volume
    • Vasoconstriction
    • Ventricular hypertrophy
  4. What are the 4 stages of HF symptoms?
    • I: No limitations on physical activity. Normal activity doesn't lead to fatigue n shit.
    • II: Slight limits. Activity leads to fatigue n shit.
    • III: Marked limits. Comfortable at rest. Little activity leads to fatigue n shit.
    • IV: Symptoms at rest. Can't do shit even at rest. Activity increases discomfort.
  5. What are you trying to shoot for when treating chronic heart failure?
    • Treat and reduce symptoms
    • Prevent from comin back
    • Minimize hospital visits during exacerbations
  6. How are diuretics used in HF therapy? Do we have to watch the low-dose/high-dose levels?
    Reduces preload = reduce congestion and edema.

    • Improves tolerance.
    • Does NOT improve progression or mortality of HF.

    No. No info on dose levels.
  7. How are ACE-I used in HF therapy? Do we have to watch the low-dose/high-dose levels?
    • If you prevent RAAS you prevent deleterious effects of:
    • cardiac remodeling
    • vasoconstriction
    • fluid retention

    No info on dose levels.
  8. How are beta-blockers used in HF therapy? Do we have to watch the low-dose/high-dose levels?
    Used on the front lines cuz they redice progression.

    Careful though, BB reduce contractility so that my worsen symptoms. Use on stable patients with the lowest dose possible.

    No info on dose levels.
  9. How are ARB used in HF therapy? Do we have to watch the low-dose/high-dose levels?

    (angiotensin receptor blockers)
    • If they can't handle ACE-I then use ARBs.
    • When used with ACE-Is then help with hospitalization.

    No info on dose levels.
  10. How are aldosterone antagonists used in HF therapy? Do we have to watch the low-dose/high-dose levels?
    Add-on to BB, ACE-I n all that. Use with stable renal and K+ levels. Yes. Low is good, high can worsen.
  11. How is digoxin used in HF therapy? Do we have to watch the low-dose/high-dose levels?
    Add-on to BB, ACE-I, diuretics...works with ATRIAL FIBRILATION

    improves symptoms and reduce hospitalizations.

    Yes. Low is good, high can worsen.
  12. What is the site of action for digoxin?
    Inhibits the sodium/potassium exchange channels which keeps Ca++ in the cell.
  13. We know digoxin keeps Ca++ in the cell. What does digoxin do to the heart?
    Since it keeps Ca++ in heart, increase contractility and refractory period.

    decreases HR and AV node conduction.
  14. What are things to look out for when using Digoxin?
    • Potassium levels. Too much counteracts effects. Too little increases toxicity.
    • Renal dysfunction. They'll get poisoned if they can't get rid of it, right?
    • Bradycardia and heart block.
  15. When should you use digoxin?
    Afib.
  16. Patient has ADHF. What is the difference between wet and dry volume conditions?
    • Wet: some kinda edema
    • Dry: dehydration, hypovolemia
  17. Patient has ADHF, what's the difference between warm and cold perfusion?
    • Warm: warm extremities, no signs of hypoperfusion
    • Cold: cool extremities, decreased urine output.
  18. Patient has ADHF, presents warm/dry conditions. Problem is hypovolemic. What do you do?
    Give IV fluid.
  19. Patient has ADHF. Presenting warm/wet conditions. Problem is fluid overload. What do you give?
    IV diuretic or vasodilators.
  20. Patient has ADHF. Presenting cold/dry conditions. Problem IS hypovolemic. What do you give?
    IV fluid.
  21. Patient has ADHF. Presenting cold/dry conditions. Problem IS NOT hypovolemic. It goes to Perfusion. What do you give?
    Inotrope.
  22. Patient has ADHF. presenting cold/wet conditions. Patient IS hypotensive. What do you do?
    Vasopressor.
  23. Patient has ADHF. Presenting cold/wet conditions. Problem is hypotensive and you give a vasopressor, but there is low output. What do you do?
    Inotrope.
  24. Patient is ADHF. Presenting cold/wet. Problem is NOT hypotensive. What do you do?
    IV diuretics or vasodilators.
  25. How do vasopressors help with ADHF therapy?
    Constricts vessels = increase SVR and blood return.
  26. How do inotrops help with ADHF therapy? When do you use it? What do you have to look out for?
    Stronger heart contraction.

    correct fluid status and peripheral resistance.

    Poor outcomes with use. Reserve for poor organ perfusion and low cardiac output.
  27. What is dobutamine?

    A) Inotrop
    B) BB
    C) Vasopressor
    D) ACE-I
    A) Inotrop
    (this multiple choice question has been scrambled)
  28. What is Milrinone?

    A) Inotrop
    B) ACE-I
    C) BB
    D) Vasopressor
    A) Inotrop
    (this multiple choice question has been scrambled)

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