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Insight Spring 2018 Issue

Page 34

CONTINUING EDUCATION DRUG/ STRENGTH(S)/ MANUFACTURER(S)

BOLUS

DOSE DRUG KINETICS (MCG/KG) (T 1/2-ELIMINATION INFUSION HALF-LIFE) RATE (/MIN)

EFFECTS

POSSIBLE ADVERSE REACTIONS

COMMENTS

PHOSPHODIESTERASE INHIBITOR Mechanism of Action: a bipyridine with positive inotrope and vasodilator, and little chronotropic activity Milrinone

Various manufacturers (Primacor®)

no

0.125 to 0.75

2.5 hours

- Increased Cardiac Decreased Output blood pressure - Increased Heart rate Tachyarrhythmia - Decreased Systemic vascular resistance - Decreased Pulmonary vascular resistance

Metabolism-hepatic Renal impairmentsignificantly increases the terminal elimination half-life-Reductions in infusion rate may be necessary

REFERENCES 1. Centers for Disease Control and Prevention, Heart Failure Fact Sheet, Division for Heart Disease and Stroke Prevention, https:// www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm (accessed January 25, 2018). 2. National Heart, Lung, and Blood Institute, Health Topics: Heart Failure, https://www.nhlbi.nih.gov/health-topics/heart-failure (accessed January 25, 2018). 3. D. Mozaffarian, E. Benjamin, A.S. Go, et al (American Heart Association Statistics Committee; Stroke Statistics Subcommittee), “Heart disease and stroke statistics–2016 update: A report from the American Heart Association,” Circulation 133, no. 4 (2016): 38-360.

15. National Heart, Lung, and Blood Institute, Health Topics: Cardiomyopathy, https://www.nhlbi.nih.gov/health-topics/ cardiomyopathy (accessed January 25, 2018). 16. WebMD, Heart Disease: Guide: Heart Disease and Dilated Cardiomyopathy, https://www.webmd.com/heart-disease/guide/ dilated-cardiomyopathy (aaccessed January 25, 2018).

4. A.S. Desai, L.W. Stevenson, “Rehospitalization for heart failure: predict or prevent?” Circulation 126, no. 4 (2012): 501-516.

17. American Heart Association. 2018. Conditions: Heart Failure. http://www.heart.org/HEARTORG/Conditions/HeartFailure/ Heart-Failure_UCM_002019_SubHomePage.jsp (accessed January 25, 2018).

5. American Heart Association. 2018. “Interactive Cardiovascular Library: Heart Failure,” https://watchlearnlive.heart.org/CVML_ Player.php?moduleSelect=hrtflr (accessed January 25, 2018).

18. National Heart, Lung, and Blood Institute, Health Topics: Atrial Fibrillation, https://www.nhlbi.nih.gov/health-topics/atrialfibrillation (accessed January 25, 2018).

6. C.W. Yancy, M. Jessup, B. Bozkurt, et al, “2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines,” J Am Coll Cardiol. 62 (2013): 147–239.

19. National Heart, Lung, and Blood Institute, Health Topics: Anemia, https://www.nhlbi.nih.gov/health-topics/anemia (accessed January 25, 2018).

7. Criteria Committee of the New York Heart Association, Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels, 9th ed. (Boston: Little, Brown & Co., 1994): 253-256. Referenced in American Heart Association, “Professional Heart Daily,” http://professional.heart.org/professional/General/ UCM_423811_Classification-of-Functional-Capacity-and-ObjectiveAssessment.jsp (accessed January 3, 2018).

20. National Heart, Lung, and Blood Institute, Health Topics: High Blood Pressure, https://www.nhlbi.nih.gov/health-topics/high-bloodpressure (accessed January 25, 2018). 21. P. Karlström, U. Alehagen, K. Boman, et al, “Brain natriuretic peptide-guided treatment does not improve morbidity and mortality in extensively treated patients with chronic heart failure: Responders to treatment have a significantly better outcome,” Eur J Heart Fail. 13 (2011): 96–103.

8. C.W. Yancy, M. Jessup, B. Bozkurt, et al, “2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure,” Circulation 134 (2016): 282-293.

22. National Institutes of Health, U.S. National Library of Medicine, DailyMed, https://dailymed.nlm.nih.gov/dailymed/drugInfo. cfm?setid=9188ab17-8539-48a5-905f-ad35ab5a0b93 (accessed December 19, 2017).

9. C.W. Yancy, M. Jessup, B. Bozkurt, et al, “2017 ACC/AHA/ HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure,” Journal of the American College of Cardiology 70 (6): 776-803.

23. National Institutes of Health, U.S. National Library of Medicine, DailyMed, https://dailymed.nlm.nih.gov/dailymed/drugInfo. cfm?setid=eadfe464-720b-4dcd-a0d8-45dba706bd33 (accessed December 19, 2017).

10. American Heart Association. 2017. “Warning Signs of Heart Failure,” http://www.heart.org/HEARTORG/Conditions/HeartFailure/ WarningSignsforHeartFailure/Warning-Signs-of-Heart-Failure_ UCM_002045_Article.jsp#.Wh79dCyou70 (accessed November 29, 2017).

24. National Institutes of Health, U.S. National Library of Medicine, DailyMed, https://dailymed.nlm.nih.gov/dailymed/drugInfo. cfm?setid=cf288ad5-d4e7-4b0b-bfd0-41c5327e6984 (accessed December 19, 2017).

11. P. Ponikowski, A.A. Voors, S.D. Anker, et al, “2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure,” Eur Heart J. 37 (2016): 2129-2200.

25. National Institutes of Health, U.S. National Library of Medicine, DailyMed, https://dailymed.nlm.nih.gov/dailymed/drugInfo. cfm?setid=bd936e35-1af8-42da-bcc0-f22489d68574 (accessed December 19, 2017).

12. Corrine Y. Jurgens, Sarah Goodlin, Mary Dolansky, et al, “American Heart Association/Heart Failure Society of America Scientific Statement: Heart Failure Management in Skilled Nursing Facilities,” Circ Heart Fail. 8 (2015): 655-687. DOI: https://doi.org/10.1161/ HHF.0000000000000005. 13. Page, et al, “Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement from the American Heart Association,” published ahead of print on July 11, 2016; appears in Circulation 134 (2016): 32– 69. DOI: 10.1161/CIR.0000000000000426.

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14. Steve Stiles, “Prescribing Pitfalls in Heart Failure with Multiple Comorbidities,” Medscape, October 9, 2017. https://www.medscape. com/viewarticle/886762 (accessed December 27, 2017).

Insight

26. National Institutes of Health, U.S. National Library of Medicine, DailyMed, https://dailymed.nlm.nih.gov/dailymed/drugInfo. cfm?setid=534700dd-ed21-4381-abbe-300893e0ced7 (accessed December 19, 2017). 27. National Institutes of Health, U.S. National Library of Medicine, DailyMed, https://dailymed.nlm.nih.gov/dailymed/drugInfo. cfm?setid=afbefaff-97c4-4f84-b989-1595f882a885 (accessed December 19, 2017).


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