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Exam 3
Lecture 5
32
Archaeology
6th Grade
05/04/2013

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Term
symptoms of being "wet"-6
Definition
periperal edeam
pulmonary edema
JVD
ascites
fullness
heaptomegaly
Term
symptoms of being "cold"-4
Definition
renal insuff.
cold extremities
mental status
hypotension
Term
when do you use a diuretic?
what are most?
Definition
any fluid overload (wet)
warm and wet
Term
you want to titrate diuretics to lose _ per day
Definition
1.5 kg
Term
which loop diuretic is most potent?
Definition
all the same potency
Term
initial dose of furosemide w/ no prior diuretic use-
Definition
40 mg IV bolus
Term
initial dose of torsemide w/ no prior diuretic use-
Definition
20 mg IV bolus
Term
initial dose of bumetadine w/ no prior diuretic use-
Definition
1 mg IV bolus
Term
if the patient has had previous diuretic use what is the initial dose-
Definition
double the home PO dose and give IV
Term
2 ADEs of loop diuretics I never remember -
Definition
ototoxicity at high dose
contraction alkalosis
Term
if patient responds to the initial diuretic bolus dose what is the next step?
why?
Definition
give this dose twice a day
to prevent kidneys from filling again
Term
if urine output doesnt increase with the initial diuretic bolus- what are the options in order of what to do next-5
Definition
double the initial bolus IV
start continuous infusion
change to thiazide
-then add ionotrope/vasodilator
-ultrafiltration/hemodialysis
Term
if patient experience hypotension after initiation of diuretic- 3 options
Definition
decrease diuresis rate, IV fluid bolus, hold HTN meds
Term
if the patient experiences worsening renal failure after diuretic initiation what are the options: 3
Definition
decrease diuresis, ionotrope, vasodilator
Term
vasodilators are used in what patients
Definition
warm wet
cold wet when BP > 110/65
Term
what are the vasodilators:
Definition
nitroglycerin
Na nitroprusside
nesiritide
Term
in which vasodilator do you avoid the Swan-Ganz
Definition
nesiritide
Term
whcih vasodilators do you not stop abruptly?
Definition
nitroglycerin
na nitroprusside
Term
which vasodilator is not usually titrated?
what are the others titrated to-
Definition
nesiritide
relief of congestion with BP>110/65
Term
which vasodilator needs monitoring of thiocyanate levels-
when are they taken?
Definition
na nitroprusside
48 hrs after dose
Term
if patient developds hypotension while on vasodilators- what do you do?
Definition
if on NTG or nitroprusside- lower dose, cant abruptly stop
if on nesiritide- can just stop
Term
when do you use ionotropes-
Definition
cold and wet if BP< 110.65
cold and dry
Term
what are the ionotropes-2
Definition
dobutamine
milirone
Term
which inotrope is more chronotropic, and whcih is more vasodilating
Definition
dobutamine- chrono
milirone- vasodilator
Term
which ionotrope is used if patient is on a beta blocker?
Definition
milirone
Term
what ionotrope is used if the patient is in frank hypotension
Definition
dobutamine
Term
what is the dose adjustment for milirone
Definition
Cr Cl<50
Term
which ionotrope do you titrate?
what is the target?
what can be used to help titrate?
Definition
dobutamine
CI >2.2
Swan Ganz
Term
what continuous monitoring do you do for ionotropes?
why?
Definition
EKG
for arrythmias
Term
what are the main ADEs of the ionotropes-3
Definition
arrythmia
hypotension
tachycardia
Term
why dont you use ionotropes long term?
what the term when you want to relieve the symptoms more that that?
Definition
increased mortality
pallitative care (more about symtpom relief than mortality)
Term
if the patient goes into cardaic shock (severe hypotension)- what med is used?
Definition
Ne- levophed
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