0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45
Acute Heart Failure 27➣Relative Contraindications: Neurogenic pulmonary edema,
seizure disorder, increased intracerebral pressure,
■Intravenous loop diuretics (furosemide, torsemide, bumetanide,
ethacrynic acid): bolus and/ or infusion. May be combined with thi-
azide diuretics (oral or IV) for potentiation of effect
➣Indication: Volume overload, reduce preload
➣Side Effects and Complications: renal failure, thrombocytope-
nia, orthostatic hypotension, dizziness, dry mouth, headache,
nausea/ vomiting, dyspepsia, impotence, rash, hypokalemia,
arrhythmias, muscle cramps, ototoxicity.
➣Absolute Contraindications: hepatic coma
➣Relative Contraindications: anuria, severe electrolyte depletion
■Nitroglycerin: sublingual, intravenous, topical (decreased absorp-
tion in shock states); requires careful blood pressure monitoring
➣Indication: Reduce preload, treat ischemia, mild afterload reduc-
tion
➣Side Effects and Complications: hemolytic anemia, methe-
moglobinemia, headache, dizziness, hypotension, syncope,
angina, reflex tachycardia, nausea/ vomiting, edema rash
➣Absolute Contraindications: Increased intracerebral pressure,
cerebral hemorrhage, symptomatic hypotension, angle-closure
glaucoma
➣Relative Contraindications: stroke, hypotension, severe anemia
■Nitroprusside: IV; careful blood pressure monitoring advised (often
invasive), follow thiocyanate levels
➣Indication: Reduces preload and afterload
➣Side Effects and Complications: cyanide/thiocyanate toxicity,
methemoglobinemia, headache, dizziness, hypotension, syn-
cope, angina, reflex tachycardia, nausea/vomiting, edema rash
➣Absolute Contraindications: increased intracerebral pressure,
cerebral hemorrhage, symptomatic hypotension
➣Relative Contraindications: stroke, hypotension, severe anemia
■Nesiritide: IV, recombinant human B-type natriuretic peptide;
requires careful blood pressure monitoring
➣Indication: Reduce preload, afterload reduction; improve symp-
toms of dyspnea
➣Side Effects and Complications: headache, dizziness, hypoten-
sion, syncope, nausea/vomiting, occasional worsening of renal
function
➣Absolute Contraindications: cardiogenic shock, symptomatic
hypotension, SBP < 90