Cardiac Cases

Question 1

INR foal for an atrial fib patient?

Answer 1

2-3

Question 2

INR goal for a patient with valve replacement?

Answer 2

2.5-3.5

Question 3

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

Answer 3

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

Question 4

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

Answer 4

Cephalexin and clindamycin

Question 5

What is the reversal agent for coumadin?

Answer 5

Vitamin K

Question 6

What foods are high in vitamin K?

Answer 6

Basically green vegetables.

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

Question 7

What advantages does warfarin have over DOAC’s?

Answer 7

Cheap
Best for ESRD
Must use in valvular AF

Question 8

What are the drawbacks to warfarin?

Answer 8

Many food and drug interactions

Narrow therapeutic window

Question 9

What are the advantages of DOAC’s?

Answer 9

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

Question 10

What are the drawbacks to DOAC’s?

Answer 10

Costly
Costly/unavailable reversal agents
Higher rate of GI bleeding

Question 11

Which anticoagulants require renal dosing?

Answer 11

All of them

Question 12

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

Answer 12

Yes, Vitamin K

Question 13

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

Answer 13

Yes, Praxbind

Question 14

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

Answer 14

Yes - AndexXa

Question 15

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

Answer 15

Yes - AndexXa

Question 16

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

Answer 16

No

Question 17

What are the CrCl limitations to Savaysa?

Answer 17

Do not use in patients with a CrCl >95q

Question 18

What is the CHA2DS2-VASc score?

Answer 18

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

Question 19

What is the strict HR goal for atrial fib patients?

Lenient goal?

Answer 19

Strict - < 80

Lenient - <110

Question 20

What is the exertional HR goal for atrial fib patients?

Answer 20

<115

Question 21

What options are available for rate control for atrial fib?

Answer 21

Beta blockers, CCBs.

Question 22

What are some electrolyte side effects of hydrochlorothiazide?

Answer 22

Hyponatremia
Hypokalemia
Hypomagnesemia
Hyperurecemia

Question 23

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

Answer 23

130/80

Need to keep BP high enough to perfuse kidneys

Question 24

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

Answer 24

Diuretics, ACEi’s/ARBs, CCBs.

Question 25

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

Answer 25

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.

Question 26

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

Answer 26

Peripheral edema

Question 27

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

Answer 27

5mg

Question 28

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

Answer 28

Blacks

Question 29

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

Answer 29

Angina, MI, hypotension, pulmonary edema.

Question 30

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

Answer 30

Whites

Question 31

Metabolism of CCB's occurs where?

Answer 31

Liver

Question 32

Where does metabolism of ACEi's occur?

Answer 32

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

Question 33

What are some common side effects to lisinopril?

Answer 33

Hyperkalemia, increased creatinine, dizziness, cough

Question 34

What are some life threatening side effects of lisinopril?

Answer 34

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

Question 35

What is the usual starting dose for lisinopril?

Answer 35

10mg

Question 36

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

Answer 36

Succinate (long acting)