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Cam's Cards > Cardiac Cases > Flashcards

Cardiac Cases Flashcards

1
Q

INR foal for an atrial fib patient?

A

2-3

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2
Q

INR goal for a patient with valve replacement?

A

2.5-3.5

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3
Q

T/F. Coumadin failure is defined as a VTE while a patient is taking coumadin.

A

False - the patient MUST be on coumadin at a THERAPUTIC LEVEL

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4
Q

A shit load of antibiotics have interactions with coumadin. Name 2 antibiotics that have MINIMAL interactions with coumadin.

A

Cephalexin and clindamycin

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5
Q

What is the reversal agent for coumadin?

A

Vitamin K

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6
Q

What foods are high in vitamin K?

A

Basically green vegetables.

Banana, chickpeas, fuit, oil, peppers, and tomatoes also have some vitamin K

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7
Q

What advantages does warfarin have over DOAC’s?

A

Cheap
Best for ESRD
Must use in valvular AF

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8
Q

What are the drawbacks to warfarin?

A

Many food and drug interactions

Narrow therapeutic window

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9
Q

What are the advantages of DOAC’s?

A

Few interactions
Less ICH and fatal bleeding events
No monitoring needed
Bridging not needed due to rapid onsent/offset

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10
Q

What are the drawbacks to DOAC’s?

A

Costly
Costly/unavailable reversal agents
Higher rate of GI bleeding

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11
Q

Which anticoagulants require renal dosing?

A

All of them

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12
Q

Does Coumadin have a reversal agent? If so, what is it?

A

Yes, Vitamin K

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13
Q

Does Dabigatran (Pradaxa) have a reversal agent? If so, what is it?

A

Yes, Praxbind

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14
Q

Does Rivaroxaban have a reversal agent? If so, what is it?

A

Yes - AndexXa

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15
Q

Does Apixiban (Eliquis) have a reversal agent? If so, what is it?

A

Yes - AndexXa

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16
Q

Does Savaysa have a reversal agent? If so, what is it?

A

No

17
Q

What are the CrCl limitations to Savaysa?

A

Do not use in patients with a CrCl >95q

18
Q

What is the CHA2DS2-VASc score?

A 
CHF - 1 point
HTN - 1 point
Age >74 - 2 points
DM - 1 point
Stroke - 2 points
Vascular disease - 1 point
Age 65-74 - 1 point
Sex category - female = 1 point

Score of 2 or greater indicates need for anticoagulation

19
Q

What is the strict HR goal for atrial fib patients?

Lenient goal?

A

Strict - < 80

Lenient - <110

20
Q

What is the exertional HR goal for atrial fib patients?

A

<115

21
Q

What options are available for rate control for atrial fib?

A

Beta blockers, CCBs.

22
Q

What are some electrolyte side effects of hydrochlorothiazide?

A

Hyponatremia
Hypokalemia
Hypomagnesemia
Hyperurecemia

23
Q

What is the blood pressure goal in a patient with HTN and DM?

A

130/80

Need to keep BP high enough to perfuse kidneys

24
Q

What are the ideal medications used to treat HTN in a diabetic?

A

Diuretics, ACEi’s/ARBs, CCBs.

25
Q

A 32 year old has a blood pressure of 136/70. Should you add or change their HTN medications?

A

No - In the 30-59 year old age group, there is only strong evidence to reduce diastolic BP to reduce CVA, HF, and mortality risk.

26
Q

What is the most common side effect of amlodipine (Norvasc)?

A

Peripheral edema

27
Q

What is the usual starting dose for amlodipine (Norvasc)?

A

5mg

28
Q

In what patient population are CCBs more effective in lowering BP?

A

Blacks

29
Q

What are the life threatening side effects of amlodipine (Norvasc)?

A

Angina, MI, hypotension, pulmonary edema.

30
Q

In what patient population are ACEi’s more effective in lowering blood pressue?

A

Whites

31
Q

Metabolism of CCB’s occurs where?

A

Liver

32
Q

Where does metabolism of ACEi’s occur?

A

Trick question - it does not get metabolized, excreted as an unchanged drug.

33
Q

What are some common side effects to lisinopril?

A

Hyperkalemia, increased creatinine, dizziness, cough

34
Q

What are some life threatening side effects of lisinopril?

A

Angioedema, cholestatic jaundice (can progress into fulminant hepatic necrosis), hyperkalemia, ARF, hypotension, hypersensitivity reactions.

35
Q

What is the usual starting dose for lisinopril?

A

10mg

36
Q

Is metoprolol tartrate or metoprolol succinate indicated for treatment of HF?

A

Succinate (long acting)

Cam's Cards (103 decks)

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