Cardio Flashcards
(112 cards)
1
Q
Chronic stable angina sees ____ changes in ECG and ___ changes in troponin
A
no changes in ECG or troponin
2
Q
unstable angina ECG and troponin
A
ST depression, no changes in troponin
3
Q
what is the differentiating factor between ACS and nagina pectoris
A
ACE lasts >5 min + not relieved by NTG
4
Q
what is the acute sx tx for stable angina
A
NTG up to 3x
5
Q
what is the chronic symptom tx for stable angina
A
BB (often 1st line, esp in HF), DHP-CCBs (FANN - 1st line for uncomplicated ptx)
6
Q
BB + ____ CCBs = avoid due to risk bradycardia, AV node block, fatigue
A
NDHP
7
Q
to decrease mortality for stable angina, what should be started? what should be stopped?
A
ACEi/ARB, ASA (clopi if ASA intol), HD statin to target LDL <1.8
Stop HRT and NSAIDs
8
Q
what should be started for treatment of NTEMI or unstable angina?
A
BMONAH
9
Q
if a NSTEMI or UA patient is high risk, what should be considered?
A
angioplasty
10
Q
what should be started within 24hrs post NSTEMI, UA, STEMI
A
ACEi
11
Q
what should be started for treatment of STEMI?
A
MONAH (BB once hemodynamically stable)
12
Q
How long should anticoagulation be done in STEMI
A
start heparin in ER, continue for 48hrs or d/c at end of PCI procedure
13
Q
what are some indications for PCI in STEMI
A
PCI facility available, cardiogenic shock, >75yrs, CI to thromboysis
14
Q
if a thrombolysis is done for STEMI, what should be given after?
A
ACE, DAPT (ASA + clopi) F 1 yr, heparin for 48hrs, DVT prophylaxis until ambulatory
15
Q
what are some post STEMI/NSTEMI management drugs?
A
ACEi, BB, HD statin
DAPT F1yr (clopi for thrombolysis, ticagralor for PCI)
16
Q
which heparin is prefered in severe renal impairment
A
UFH
17
Q
which LMWH is the DOC for STEMI w/ fibrinolysis
A
enoxaparin
18
Q
which anticoagulant is the DOC for STEMI + PCI
A
UFH
19
Q
which anticoagulant is the DOC for NSTEMI/UA as part of BMONAH
A
enoxaparin
20
Q
which antiplatelets are reversible
A
clopi and prasugrel
21
Q
clopi, ticagralor are metabolized by which CYP enzymes
A
clopi = 2C19
ticagralor = 3A4
22
Q
what is an AE of clopidogrel
A
rash
23
Q
what is an AE of ticagralor
A
dyspnea
24
Q
what are the 2 high potency statins
A
rosuvastatin, attorvastatin
25
if a patient develops HIT and severe renal impairment, what is the best choice for anticoagulation in DVT?
argatroban- no renal adjustment required
26
PE sx
dyspnea, pleuritic pain, cough, syncope, tachypnea
27
what is elevated in PE and DVT
ESR/CBW and D dimer
28
what is heparin induced thrombocytopenia
low platelet blood counts due to heparin tx which predisposes pts to thrombosis (thrombin generation)
29
what is type 1 HIT + how to tx + onset
nonimmune mediated, onset 1-4d, observation only
30
what is type 2 HIT, onset, how to correct
immune mediated + platelets fall 30%
onset 5-10d after start of heparin
stop heparin + start alternative nonheparin anticoagulant agent (DOAC, fondaparinux, bivalirudin)
tx fro at least 4 wks if no thrombosis, 3mths if thrombosis
31
what is initial tx for VTE
any of the following; fondaparinux, apixaban, rivaroxaban, UFH, LMWH
32
what is ongoing tx for VTE if there is no malignancy
DOACs, warfarin
33
what is ongoing tx for VTE if there is malignancy
LMWH or DOACs
34
what are the LMWHs
dalteparin and enoxaparin
35
when to use UFH
severe renal impairment, high risk bleed who may require rapid reversal, recently received thrombolytic tx
36
what is the antidote for LMWH and UFH
protamine sulphate (not complete reversal in LMWH)
37
why is LMWH preferred to UFH
is more predictable anticoagulation dose response, loss HIT, less routine monitoring and major bleed risk
38
warfarin is metabolized by CYP ___(3)
2C9, 1A2, 3A4
39
what are some reversal agents for warfarin
vit K, octaplex, fresh frozen plasma
40
how to bridge warfarin
LMWH/UFH for at least 5 days + until INR at least 2 for 2 days in a row
41
what is dabigatran dosing
<80yrs: 150mg BID
=>80yrs or >75yr + =>1RF for bleed: 110mg BID po
42
what is the reversal agent for dabigatran
idarucizumab
43
how to switch from warfarin to apixaban or dabigatran
stop warfarin, start A or D when INR <2
44
how to switch from warfarin to edoxaban or rivaroxaban
stop warfarin, start E or R when INR <2.5
45
how to switch from UFH to DOAC
stop UFH infusion, start DOAC immediately (edoxaban = wait 4hrs)
46
how to switch from LMWH to DOAC and vice versa
start other at time of next scheduled dose
47
how long should anticoagulation tx be for after VTE or PE
3 months
48
which anticoagulants are preferred in pregancy
LMWH (preferred), UFH also safe
49
which anticoagulants are safe in post partum
warfarin, LMWH, UFH (not DOACs)
50
which anticoagulants are not safe in pregnancy
warfarin and DOACs
51
concurrent use of ____ and warfarin results in falsely elevated INR
argatroban
52
after orthopedic surgeries, what anticoagulants may be given as VTE prophylaxis + how long
LMWH, DOACs, fondaparinux, ASA 81 for 14-35d postop
53
after nonorthopedic surgeries, what anticoagulants may be given as VTE prophylaxis + how long
LMWH, UFH at least until discharge
54
which is not safe in postpartum: warfarin or DOACs
DOACs
55
which DOACs should be avoided if CrCL <15
DARE
56
what DOACs should be avoided if CrCL <30
dabigatran (ARE = renal adjustment)
57
which DOAC must be taken w/ food
rivaroxaban
58
reduce dabigatran dose to 110mg BID if
>80yrs old or >75yrs + 1 RF for bleed
59
when to reduce edoxaban dose to 30mg?
if wt <60kg
60
which anticoagulant is not appropriate in both STEMI + PCI or severe renal impairment
fondaparinux
61
what is the HAS-BLED score stand for
HPTN, abnormal kidney or liver, hx stroke, hx bleed, hx labile INR, elderly >65yrs), drugs (NSAIDs, ASA)
62
in what kind of AF is warfarin 1st line
valvular AF or mod-severe mitral stenosis or presence of mechanical heart valve
63
when should you use OAC in AF pts
if =>65yrs, stroke, TIA, DM, HPTN, HF
64
when should you use only antiplatelet tx in AF pts
if only CAD or PAD
65
in elective PCI without high risk features for thrombosis, what is the tx?
clopidogrel + OAC for 1-12mths post PCI, then just OAC
66
in ACS w/ PCI or elective PCI w/ high risk features of thrombosis, what is the tx?
triple tx w/ ASA + clopi + OAC for 1d-1mth, then just clopidogrel + OAC for up to 12mths post PCI, then just OAC
67
in ACS (unstable angina) without PCI, what is the tx?
OAC + clopidogrel for 1-12mths post ACS, then just PAC
68
in persistent AF, what is the preferred start?
rate control (BB, ND-CCB)
69
when in AF is the preferred start rhythm control?
if recently dx AF <1yr, highly symptomatic or significant QoL impairment, multiple recurrences, difficulty achieving rate control, arrhythmia induced cardiomyopathy
70
what is used for rhythm control if LVEF =<40%? what if it is >40%
<40%: amiodarone only
>40% = amiodarone or sotalol
71
what may be used for rhythm control if pt does not have HF, but has CAD
sotalol, amiodarone, dronedarone
72
how to use the pill in pocket antiarrhythmic drug tx?
start w/ IR AV nodal blocker (diltiazem, verapamil, or metoprolol) 30 min before a class 1c antiarrhythmic (flecainide or propafenone)
remain seated for 4hrs or until episode resolves
73
what needs to be monitored for amiodarone tx
TSH at baseline and q3-6mths
CXR yearly due to pulmonary fibrosis
LFTs q6mths
74
HFrEF is mainly due to
not pumping enough, CAD problem
75
HFpEF is mainly due to
not filling enough, HPTN problem
76
which of the following HF meds are CI for T1DM; SGLT2i, BB, ARNIs
SGLT2i (empa/dapaglifloxin
77
T or F: ARNIs do not have a dry cough AE
T
78
what is the washout period from ACE to ARNI
36hrs
79
which 2 meds may reduce hospitalizations in HFpEF
candesartan and ARNI
80
which diuretic should be used if pt w/ HFrEF has sulfonamide allergies
ethanoynric acid
81
what to do in acute decompensation of HF
high dose loop diuretics (furosemide), start BB once stable or continue if already on
82
when to use ivabradine in HF
for HFrEF if HR >70 bpm despite quad tx and are in sinus rhythm
83
BB are CI in
>1st degree heart block without a pacemaker
84
how to treat HFpEF patients?
may use ARNI/ARB/ACI for HPTN
candesartan and ARNI may reduce hospitalizations
loop diuretic may be used if reducing fluid retention
85
what is the tx algo for ischemic stroke?
within 4.5hrs? - yes = see if meets t-PA criteria + start alteplase (tenectaplase alt)
doesn't meet criteria = EVT
>4.5hrs or not eligible for EVT = admit to stroke unit
86
T or F: EVTs can be performed in pts who have had alteplase tx
T
87
in tPA tx, ASA 160mg should be admin at least ___ hrs after alteplase, once _____________
24hrs
CT excludes intracranial hemorrhage
88
what is the target door to alteplase time
<60min
89
what is the tx BP fo pre-t-PA tx
SBP <185, DBP <110
90
which 3 agents are preferred to lower BP pre-t-PA
labetalol, hydralazine, NTG patch
91
during t-PA tx, if SBP > ____ or DBP > _____ for 2 or more readings, continue IV labetalol/ hydralazine/ nitro patch and add enalapril IV if needed
SBP >180
DBP >105
92
if the patient is not already on antiplatelet tx prestroke + not going to receive alteplase _____ should be done once CT excludes hemorrhage, then ________
AS 160mg loading dose, then LD ASA for secondary prevention
93
in acute, high risk TIA or minor ischemic stroke pts who are not at high risk of bleed, ________ may be considered for ________ followed by ___________ as post TIA management
DAPT w/ ASA and clopidogrel for 3-4wks, then ASA monotx
94
in pts receiving alteplase, how long must you wait before starting antiplatelet tx
24hrs post thrombolysis CT scan excludes intracranial hemorrhage
95
what medications should be started after stroke for secondary prevention
statins LDL <1.8
ACEi + thiazide diuretic once stable
antiplatelet tx
96
what antihypertensive class should be avoided in blacks
ACEi/ARBs
97
which combo is preferred: ACE + DHP CCB or ACE + thiazide/ thiazide like diuretic
ACE + DHP CCB
98
what is classified as a high risk patient for HPTN
=>50yrs and SBP >130 and => CV RF such as:
1. clinical or subclinical CVD
2. CKD (nondiabetic nephropathy, proteinuria, eGFR <60)
3. est 10yr global CV risk =>15%
4. =>75yrs
99
what is the target time for fibrinolysis
<30 min (ideally 90 min, ok 120min)
100
what is the time frame for t-PA
<4.5hrs
101
how to do perioperative warfarin management if high thromboembolic risk
bridging w/ LMWH for 3 days pre-op + stop 24hrs before, warfarin stopped 5 days pre-op, get INR value 24hrs before surgery
102
how to do emergent warfarin reversal
IV vit K + octaplex (reversal starts in 2hrs, full in 24hrs)
103
what to do if INR is <0.5 out of range for warfarin
see if you can identify cause, may increase or hold by 0.5-1 dose, then repeat INR in 1-2 wks
104
what is the target LDL for LDL =>5 on statin + what to add if not at target after max dose statin
LDL 50% reduction or =<2.5
if not = + ezetimibe
105
what is target LDL for DM and CKD + what to add if not at target after max statin dose
LDL =<2.0
if not = + ezitimibe
106
what is the target LDL for ACSVD + what to add if not at target after max statin dose
LDL <1.8
if LDL 1.8-2.2 = + ezetimibe
if LDL >2.2 = + PCSK9i
107
what is the most potent LDL lowering agent
LCSK9i (evolocumab, alirocumab)
108
what is the most potent TG lowering agent
fibrates
109
which dyslipidemia agents are not associated w/ myalgias
cholestyramine and bile acid sequestrants
110
which statins are metabolized by 3A4
SAL
111
which statins are metabolized by 2C9
RF
112
