Lab 2 - Heart Failure, Pulmonary Edema Flashcards Preview

Clinical Pharmacology > Lab 2 - Heart Failure, Pulmonary Edema > Flashcards

Flashcards in Lab 2 - Heart Failure, Pulmonary Edema Deck (26)
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1
Q

Furosemide - MoA

A

Loop diuretic. Inhibit sodium, potassium, chloride symporter.

2
Q

Furosemide - Dose and route

A

20 mg IV

3
Q

Furosemide - Adverse effects

A
Hypokalemia and metabolic alkalosis
Hypocalcemia
Hyponatremia
Hypomagnesemia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
4
Q

Furosemide - Contraindications

A

Diabetes
Gout
Allergy to sulfonamides

5
Q

Furosemide - Interactions

A
  • The diuretic effect will be decreased with NSAIDs.
  • If administered with ACE inhibitors, it may cause excessive hypotension, but have opposite effects on potassium.
  • Increases levels of lithium
6
Q

Captopril - MoA

A

ACE inhibitor. Blocks production of angiotensin II and reduces after load and mortality.

7
Q

Captopril - Dose and route

A

6.25mg orally every 8 hours (3x daily)

8
Q

Captopril - Adverse effects

A

Hypotension
Hyperkalemia
Azotemia
Dry cough

9
Q

Captopril - Contraindications

A
Pregnancy
Renal artery stenosis
Impaired renal function
Hypovolemia
K>5,5
10
Q

Captopril - Interactions

A
  • Potentiate the hyperkalemia effects with potassium-sparing diuretics
  • Opposite effect on potassium with diuretics
  • NSAIDs and ACE inhibitors can cause renal failure because of effect on GFR
  • Increase levels of lithium
11
Q

Digoxin - MoA

A

Positive inotropic agent. Inhibit Na+/K+ ATP-ase.

12
Q

Digoxin - Dose and route

A

0.125 mg orally

13
Q

Digoxin - Adverse effects

A
Nause
Vomiting
Diarrhea
Tachyarrhytmias and Bradyarryhtmias
AV block
Blurred vision
Yellow-green or blue chromatopsia
14
Q

Digoxin - Contraindications

A

Ventricular fibrillation
Rapid IV administration of potassium
AV block
Cardiomyopathies

15
Q

Digoxin - Interactions

A
  • Antacids and cholestyramine reduce the absorption of digoxin
  • Dilitiazem and quinidine increases the levels of digoxin which can lead to toxicity
  • Diuretics cause hypokalemia which can precipitate digoxin toxicity
16
Q

Metoprolol - MoA

A

Selective B1 antagonist

17
Q

Metoprolol - Dose and route

A

12.5 mg orally every 12h (2xdaily)

18
Q

Metoprolol - Adverse effects

A

Dizziness
Drowsiness
Fatique

High doses:
Hypoglycemia (tachycardia sweating)
Bronchoconstriction

19
Q

Metoprolol - Contraindications

A

AV block
Bradycardia
Cardiogenic shock
Hypotension

High doses:
Asthma
Diabetes

20
Q

Metoprolol - Interactions

A
  • Metabolized by cytochrome P450 enzymes so serum concentration can be increased with the use of antiarrhytmics, H2 blockers, COX2 inhibitors and decreased with use of rifampin
  • Potentiate the hypoglycemic effects of insulin
  • Negative ionotropic effect potentiated with dilitiazem and verapamil
21
Q

HF - Diagnosis

A

Laboratory testing to exclude other diseases (anemia, DM, thyroid disease, liver and renal disease): CBC, electrolytes, BUN, urinalysis, fasting glucose, OGTT, TSH, total cholesterol
Biomarkers: BNP and N-terminal pro-BNP
ECG: rhythm, LV hypertrophy, prior MI
CXR: cardiac size, shape, pulmonary vasculature –> ABCDE
Doppler Echo: LV size and function (EF), valvular/regional wall motion abnormalities
MRI: ventricular structure, mass, volume
Other: coronary angiography, stress testing, myocardial biopsy, Swan-Ganz catheterization

22
Q

HF - Treatment

A

Treat the underlying cause, Valve replacement CABG
Life style changes
HF confirmed –> Fluid retention –>: Furosemide (20 mg PO) —> Captopril (6,25 mg x3 PO). (If not fluid retention start directly with Captopril) –> Metoprolol (12,5 mg x4 PO) –> Persistent symptoms: Spironolactone (12,5 mg PO), Hydralazine (10mg) + Isosorbide (10 mg), Digoxin (0,125 mg PO, used if systolic HF + atrial fibrillation)

Class II-III: Implantable cardioverter defibrillator (ICD)
Class III-IV + qrs>120ms: Cardiac resynchronization therapy (CRT); pacemaker

23
Q

HF - Differential diagnosis

A

Pulmonary disease: chronic bronchitis, emphysema, asthma

Other causes of peripheral edema: obesity, varicose veins, venous insufficiency, renal dysfunction

24
Q

PE- Diagnosis

A

ABG: reduction of PaO2 and PaCO2; Hypercapnia and acidosis with progression of disease
CXR: ABCDE
Kerley A and B lines
Biomarkers: low/normal levels of BNP
Swan-Ganz catheter: measures pulmonary capillary wedge pressure; differentiate cardiogenic from noncardiogenic causes of PE
Troponins: to exclude MI
ECG: visualize ischemia, arrhythmia
Echo: check EF, wall motion abnormalities

25
Q

PE - Treatment

A

CPAP (continous positive airway pressure) - 100% O2
Reduce preload:
- sit upright, remove tight clothes
- Nitroglycerin (0,5 mg subl)
- Furosemide (20 mg IV)
- Morphine (10 mg IV) + Metoclopromide (10 mg IV)
- Anxiety - Diazepam (10 mg IV)
- ACE- inh if pt in hypertensive, acute MI with HF
- Ventricular tachycardia - Amiodarone (300 mg IV)

26
Q

PE - Differential diagnosis

A

Asthma, COPD, pneumonia (especially hard to distinguish in elderly –> may coexist)