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C&R TPX > C&R E2 > Flashcards

C&R E2 Flashcards

SIHD ACS PAD HF

1
Q

Antithrombotic therapy is ____ + ____

A

Anticoagulant
Antiplatelet

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2
Q

Antiplatelets therapies are

A

Aspirin
P2Y12 inhibitors (ticagrelol, prasugrel, ,clopidogrel)
G2a/3b inhibitors

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3
Q

P2Y12 inhibitors are

A

ticagrelor, prasugrel, clopidogrel

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4
Q

Anticoagulant therapies are

A

Heparin
Enoxaparin
Bivalirudin
Argatroban
Fondaparinux

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5
Q

SIHD therapy goal

A

prevent future rupture, so Antiplatelet agents 1 -2

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6
Q

ACS therapy goal

A

Stop the current process, so antiplatelet agents 2 -3 and anticoagulant

Prevent exacerbation in the future, so antiplatelet agents 1 - 2

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7
Q

Order of PO P2Y12i therapies? what is it antiplatelet or anticoagulant? what used for?

A

antiplatelets, used for both SIHD and ACS

pretty tiger cubs
prasugrel + ticagrelor > clopidogrel

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8
Q

when is an anticoagulant used?

A

only ACS

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9
Q

Prasugrel Dosing and what use?

A

PCI only

Load: 60mg
Maint: 10mg QD, 5mg only if less than 60kg or over 75 yo

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10
Q

GP 2b/3a’s biggest side effect?

A

acute profound thrombocytopenia

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11
Q

Clopidogrel what used for?

A

Medical Management, PCI, and STEMI with thrombolytics

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12
Q

Ticagrelor what used for?

A

PCI and medical management only

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13
Q

pt has stemi with thrombolytics, what kind of p2y12 can you use?

A

clopidogrel only

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14
Q

pt needs PCI, what kind of p2y12 can you use?

A

Prasugrel, Ticagrelor, and clopidogrel

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15
Q

pt needs medical management, what kind of p2y12 can you use?

A

Ticagrelor and clopidogrel

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16
Q

Clopidogrel PCI Dosing

A

Load 600 mg ASAP
MD 75mg QD

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17
Q

Clopidogrel Medical Management Dosing

A

Load 300 - 600mg
MD 75 mg QD

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18
Q

Clopidogrel STEMI with thrombolytics

A

Load 300mg, 75 if greater than 75 yo
MD 75mg QD

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19
Q

Ticagrelor PCI dosing?

A

load 180mg
MD, 90mg BID then 60mg BID after 12 months

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20
Q

Ticagrelor Medical management dosing?

A

same as PCI dosing

load 180mg
MD, 90mg BID then 60mg BID after 12 months

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21
Q

Prasugrel

How long D/C prior to surgery
ADE
Contraindications

A

D/C 7 days prior
ADE bleeding
Contra is hx of stroke/tia with less than 60kg and older than 75 yo being relative contra

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22
Q

Ticagrelor

How long D/C prior to surgery
ADE
Contraindications
DDI

A

D/C 5 days prior
ADE dyspnea, bradycardia, bleeding
contra is hx of cerebral bleed, and severe liver disease
DDI is to avoid concomitant strong CUP3A4 inhibitors and inducers, max ASA dose is 100mg QD

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23
Q

Clopidogrel

How long D/C prior to surgery
ADE
Contraindications

A

D/C 5 days prior
ADE bleeding
NO CONTRA

thats why pkpd is terrible but still keep because it has no contra and its the only one that can be used with fibrinolytic on board

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24
Q

Anticoagulation recommendations?

A

ACS event? immediately place an anticoag rx (heparin or enoxaparin)

Medical management: Heparin for 48hrs and enoxaparin for 7 days
early invasive: until the procedure is done

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25
Q

Ranolazine DDI with which enzyme and which P2y12 inhibitor?

A

DDI with CYP3A4, 2D6, and pGp

therefore, can not be used with ticagrelor because tig is meta by 3A4

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26
Q

which CCB can be used with BB?

A

DHP can (amlodipine, nifedipine ER)

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27
Q

which CCB can NOT be used with BB?

A

non DHP can NOT be used (Diltiazem ER)

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28
Q

G2a3b MOA and pearl?

A

potent antiplatelet agents that block the binding site for fibrinogen

Increases bleed risk, especially in combination with aspirin, a P2Y12 inhibitor and an anticoagulant

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29
Q

MRA initiation is contraindicated in what?

GFR
SCR
K

A

GFR < 30ml/min
SCR > 2.5 (M), > 2 (F)
K > 5 (hyperkalemia)

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30
Q

MRA initiation is okay when?

GFR
SCR
K

A

GFR > 30ml/min
SCR < 2.5 (M) or < 2 (F)
K < 5

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31
Q

Fibrinolytic therapy should be used when….

A

door to balloon is greater than 90mins

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32
Q

Fibrinolytic therapy should be used in caution when….because of increased bleed risk

A

when you have an ASA, P2Y12, and an anticoag on board

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33
Q

Clopidogrel is useful because….

A

only P2Y12 inhibitor that can be used with a fibrinolytic (which will be used if door to balloon is greater than 90 mins)

AND NO CONTRA

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34
Q

Fibrinolytics/thrombolytic therapy examples and their corresponding specificity:

A

Alteplase (tpa) – least specific, so high bleed risk
Reteplase
Tenecteplase – most specific, so low bleed risk

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35
Q

What is cilostazol used for?

A

for symptomatic relief of PAF and to increase walking distance in patients with claudication

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36
Q

Cilostazol MOA

A

inhibits phosphodiesterase III and inhibits vascular smooth muscle cell proliferation

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37
Q

Cilostazol takes how long to work?

A

effect on walking is within 2 - 4 wks but may take up to 12 weeks

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38
Q

Cilostazol BBW

A

Contra in patients with HF

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39
Q

Cilostazol ADE and DDI?

A

HA and GI upset/diarrhea

many DDI

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40
Q

What is HF?

A

It is a decrease in cardiac output such that the cardiac output isn’t able to meet the demands of the body

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41
Q

What is HFrEF

A

Your heart pump doesn’t work so <40% of the blood in the ventricle leaves when it contracts
EF <40%

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42
Q

What is HFpEF

A

Your LV isn’t filling properly but does contract. So the same % of the blood is leaving the ventricle but from a smaller starting volume.
EF >50%

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43
Q

what type of HF has EF >50%

A

HFpEF

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44
Q

what type of HF has EF <40%

A

HFrEF

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45
Q

Morbidity and Mortality reducing drugs for HF

A

BB
RAAS Inhibition
MRA
SGLT2
Vaso/Veno dilators

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46
Q

Morbidity-reducing drugs for HF

A

Ivabradine
Soluble guanylate cyclase stimulators
Digoxin
Diuretics

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47
Q

Sacubitril/valsartan brand name?

A

Entresto

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48
Q

Sacubitril/valsartan contraindications

A

Prego and hx of angioedema

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49
Q

Sacubitril/valsartan MOA

A

Sacubitril: blocks breakdown of BNP resulting in natriuresis and vasodilation
Valsartan: blocks angiotensin receptor

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50
Q

Sacubitril/valsartan drug interactions

A

ACE inhibitors (36 hr washout)

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51
Q

Sacubitril/valsartan monitoring

A

Blood pressure (because the ARNI will drop bp more than ACE/ARB)
Electrolytes and renal function 2 - 4 weeks after initiating therapy or changing disease

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52
Q

Sacubitril/valsartan ADE

A

hyperkalemia

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53
Q

Sacubitril/valsartan pearls

A

Do not initiate if K >5.5 and D/C rx if > 5.6
Protects the myocardium from remodelling/hypertrophy in patients with HF
Do not use RAAS drugs in combination

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54
Q

ACEi Contra

A

Prego
hx of angioedema
No use within 36 hrs of an ARNI

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55
Q

ACEi monitoring

A

electrolytes and renal function 2 - 4 weeks post initiation

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56
Q

ACEi Pearls

A

Target organ protection, drug of choice in pts with DM/HF/Post MI, stroke and or CKD
Do not initiate if K > 5 and D/C rx if > 5.6
Protects the myocardium from remodelling/hypertrophy in patients with HF
Do not use RAAS drugs in combination

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57
Q

Enalapril brand name

A

Vasotec

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58
Q

Lisinopril brand name

A

Prinivil/Zestril

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59
Q

Entresto target doses?

A

97/103 mg BID

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60
Q

Entresto starting doses?

A

24/26 mg - 49/51mg BID

61
Q

Lisinopril doses starting?

A

2.5 - 5mg QD

62
Q

Lisinopril doses target?

A

20 - 40mg QD

63
Q

ARB contraindications

A

prego ONLY

64
Q

ARB Monitoring

A

electrolytes and renal function 2 - 4 weeks post initiation

65
Q

ARB Monitoring

A

electrolytes and renal function 2 - 4 weeks post initiation

66
Q

ARB ADE

A

hyperkalemia

67
Q

ARB Pearls

A

target organ protection…
Do not initiate if K > 5 and D/C if K > 5.6
Do not use RAAS drugs in combination
No wash out period needed with ARNI
Less dry cough/angioedema vs ACE

68
Q

Losartan Brand?

A

Cozaar

69
Q

Valsartan Brand?

A

Diovan

70
Q

Losartan Dose starting

A

25 - 50 QD

71
Q

Valsartan Dose starting?

A

40mg BID

72
Q

BB MOA

A

decreases HR and myocardial contractility, which is why only used in chronic HF pts

If in acute decompensated hf, will need to increase CO to compensate

73
Q

BB Contra

A

Severe Bradycardia

74
Q

BB ADE

A

Bradycardia, bronchospasm

75
Q

BB Pearls

A

Must be tapered on D/C
Only carvedilol, bisoprolol, and metoprolol succinate have mortality benefit in HF

DO NOT INITIATE WHEN IN EXACERBATION (ADHF), JUST TRY TO REDUCE THE DOSE IN EXACERBATION – TRY NOT TO D/C COMPLETELY (possible rebound htn)

76
Q

Which bb in hf?

A

Carvedilol
Bisoprolol
Metoprolol Succinate

77
Q

Bisoprolol Brand?

A

Zebeta

78
Q

Metoprolol succinate brand?

A

Toprol XL

79
Q

Carvedilol brand?

A

Coreg

80
Q

Cardioselective BB

A

Bisoprolol and Metoprolol Succinate

81
Q

Non-cardioselective BB (alpha and B blockade)

A

Carvedilol, therefore can help push bp down lower

82
Q

Bisoprolol dose starting and target dose?

A

start 2.5 QD, target is 10mg QD

83
Q

Metoprolol succinate starting and target dose?

A

12.5 - 25mg QD
200mg QD

84
Q

Carvedilol dose starting and target dose?

A

3.125 - 6.25mg BID

25mg BID but if > 85kg then 50mg BID m

85
Q

MRA Contra

A

Hyperkalemia (K > 5), anuria, and CrCl < 30ml/min

86
Q

MRA DDI

A

Eplerenone is a CYP3A4 substrate

87
Q

MRA Monitoring

A

monitor electrolytes and renal function at 2 -3 days following initiation, then 7 days after initiation/titration, then check monthly for 3 months then every 3 months afterwards

88
Q

MRA ADE

A

dehydration, hyponatremia, dizziness
Spironolactone: gynecomastia, breast tenderness, impotence

89
Q

Eplerenone starting and target dose?

A

25mg QD - 50mg QD

90
Q

Spironolactone starting and target dose?

A

12.5 - 50mg QD

91
Q

MRA for HF is —- than MRA for HTN

A

LOWER

92
Q

SGLT2i Contra

A

Dapagliflozin GFR < 30
Empagliflozin GFR < 20

93
Q

SGLT2i Monitoring

A

500ml UO

94
Q

SGLT2i ADE

A

Genetical mycotic infections/UTI
Dehydration

95
Q

SGLT2i pearls

A

may require adjustment to loop diuretic doses

96
Q

Dapagliflozin and Empagliflozin dose?

A

10mg QD, only titrate up if for DM control

97
Q

Direct Vasodilators Monitoring

A

BP/HR and drug induced lupus

98
Q

Direct vasodilators ADE

A

reflex tachycardia, peripheral edema, palpitations, DILE

99
Q

Direct venodilators CONTRA

A

Concomitant use with PDE5 inhibitors

100
Q

Direct Venodilators Monitoring

A

BP and HR

101
Q

Direct Venodilators Pearls

A

Isosorbide dinitrate + Hydralazine (BiDil) is approved for HFrEF
Need to prevent nitrate tolerance by providing a 10 - 14 hour nitrate free exposure (usually in sleep because chronic therapy decreases efficacy)

102
Q

Hydralazine Brand?

A

Apresoline

103
Q

Hydralazine starting dose?

A

25mg TID

104
Q

Hydralazine target dose?

A

75mg TID

105
Q

Isosorbide dinitrate starting?

A

20mg TID

106
Q

Isosorbide dinitrate target?

A

40mg TID

107
Q

Loop diuretics CONTRA

A

hypersensitivity to sulfa drugs

108
Q

Loop diuretics DDI

A

NSAID use/drugs that retain water

109
Q

Loop diuretics monitoring

A

electrolytes and renal function REGULARLY

110
Q

loop diuretics ADE

A

hypokalemia, hypocalcemia, hyperuricemia

KAU

111
Q

loop diuretics pearls

A

consider ethacrynic acid if pt has a true sulfa allergy

May need K supplementation if hypokalemia too much

112
Q

Ivabradine brand?

A

Corlandor

113
Q

Vericiguat brand?

A

verquvo

114
Q

Ivabradine MOA

A

impacts the funny channel in the SA node and only decreases HR (not bp)
Hence why the requirement is HR > 70 only

115
Q

Ivabradine CONTRA

A

sever hepatic impairment, acute decompensate HF, HYPOtension, abnormal heart rhythm

116
Q

Ivabradine monitoring

A

heart rate and rhythm

117
Q

Ivabradine ADE

A

bradycardia, afib

118
Q

Ivabradine pearl

A

Morbidity drug only
decreases HF hospitalizations NOT Mortality

119
Q

Morbidity and mortality rx HF

A

BB
RAASi
MRAs
vaso/venodilators
SGLT2s

120
Q

Morbidity rx HF only

A

Ivabradine
Vericigut (soluble guanylate cyclase stimulator)
Digoxin
Diuretics

121
Q

Vericiguat contra?

A

PREGO

122
Q

vericiguat DDI?

A

Do not use with PDE5 inhibitors

123
Q

vericiguat Monitoring

A

negative prego test (that’s how much prego is contra) and bp

124
Q

vericiguat pearl

A

decreases HF hospitalizations, not HF mortality

125
Q

Digoxin DDI

A

PgP and CY3A4

126
Q

Digoxin Monitoring

A

HR and rhythm
Serum concentrations ideally a trough of 0.5 - 0.9

127
Q

Digoxin Pearls

A

Beers Criteria
decrease HF hospitalization, not HF mortality

128
Q

Losartan target dose?

A

150mg QD

129
Q

Valsartan target dose?

A

160mg BID

130
Q

IV NTG Drug Class

A

Vasodilator

131
Q

IV NTG CONTRA

A

Concurrent use with PDE5 inhibitors (-fil ending)
concurrent use with soluble guanylate cyclase stimulators

132
Q

IV Nitroprusside drug class

A

vasodilator

133
Q

IV Nitroprusside vs IV NTG

A

Nitroprusside has more bp impact than NTG
Therefore only use if bp is high enough to be dropped

134
Q

IV Nitroprusside Monitoring

A

BP, cyanide and thiocyanate toxicity (especially if on for more than 3 days for > 3mcg/kg/min)

135
Q

IV Dobutamine drug class?

A

Inotrope

136
Q

IV Dobutamine drug interactions

A

increases arrhythmogenic potential in combination with other proarrhythmic agents

137
Q

IV Dobutamine ADE

A

Increase or decrease in BP, increased HR, arrhythmia

138
Q

IV Dobutamine Pearls

A

HIGH RISK OF ARRHYTHMIA
low risk of hypotension

139
Q

IV Milrinone Drug Class

A

Inotrope therefore might have an impact on arrhythmia potential

140
Q

IV Milrinone DDI

A

Anagrelide is category X

141
Q

IV Milrinone Pearls

A

Moderate risk of arrhythmia
HIGH RISK OF HYPOTENSION
Renally eliminated (more renal dysfunction, the more drug exposure and concerns for hypotension)

142
Q

Norepinephrine drug class?

A

Vasopressors

143
Q

Epinephrine drug class?

A

vasopressors

144
Q

Dopamine drug class?

A

vasopressors

145
Q

Vasopressors DDI

A

Increases arrhythmogenic potential in combination with other pro-arrhythmic agents

146
Q

Vasopressors ADE

A

Increases BP, increased HR, arrhythmia, extravasation (may cause necrosis of tissue if outside IV site)

147
Q

Vasopressors ADE

A

Increases BP, increased HR, arrhythmia, extravasation (may cause necrosis of tissue if outside IV site)

148
Q

Vasopressors ADE

A

Increases BP, increased HR, arrhythmia, extravasation (may cause necrosis of tissue if outside IV site)

C&R TPX (4 decks)

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