Cardiology Cases Wrap Up Flashcards
1
Q
INR goal for pt w.o artificial valve (non-mechanical)
A
2.0-3.0
2
Q
INR goal for pt w. artificial valve (mechanical)
A
2.5-3.5
3
Q
when can you use the term “coumadin failure”
A
only if pt was on therapeutic dose when fail occurred
otherwise, it’s subtherapeutic fail
4
Q
t/f: a single coumadin dose can affect INR
A
t!
need to know what dose pt was on when INR was obtained
5
Q
best AC for severe renal dz or ESRD
A
warfarin
6
Q
AC for pt w. mechanical valve
A
warfarin
7
Q
2 cons of warfarin
A
narrow therapeutic index -> must check INR
many food/ddi
8
Q
3 benefits of DOACs over warfarin
A
fewer interactions
less ICH/fatal bleeding
bridging not needed (rapid onset/offset)
9
Q
4 cons of DOACs
A
expensive
some lack or have expensive reversal agents
higher rate of GIB
not approved in ESRD
10
Q
warfarin has a higher rate of __ bleeds
DOACs have a higher rate of __ bleeds
A
warfarin: ICH/fatal
DOACs: GIB/non fatal
11
Q
what are the 4 doac’s
A
dabigatran (pradaxa)
rivaroxaban (xarelto)
apixaban (eliquis)
edoxaban (savaysa)
12
Q
dabigatran is a __ inhibitor, whereas the other 3 doac’s are __ inhibitors
A
dabigatran: direct thrombin
others: Xa
13
Q
jaynstein’s go to doac
A
apixaban (eliquis)
14
Q
CHADSVASC
A
15
Q
afib rate control: strict vs lenient vs exertional
A
strict: < 80
lenient: < 110
exertional: < 115
16
Q
options for chronic rate control in afib (2)
A
bb
ccb (non dihydropiridines -> diltiazem, verapamil)
17
Q
2 conditions that digoxin is used for
A
HFrEF
afib
only for pt w. inadequate rate control w. bb and/or ccb
18
Q
which ac’s have reversal agents
A
warfarin
dabigatran (pradaxa)
rivaroxaban (xarelto)
apixaban (eliquis)
edoxaban (savaysa)
19
Q
reversal agent for dabigatran
A
praxbind
20
Q
andexxa is the reversal agent for (3)
A
rivaroxaban (xarelto)
apixaban (eliquis)
edoxaban (savaysa)
21
Q
5 s.e of hctz
A
hypo’s:
hyponatremia
hypokalemia
hypomagnesemia
hypochloremic alkalosis
plus hyperglycemia and hyperuricemia
22
Q
caution w. hctz in what 2 conditions
A
gout
DM
23
Q
which mucinex is contraindicated w. htn
A
mucinex d - the d is pseudoephedrine (can cause htn)
regular mucinex is ok
24
Q
2 common s.e of norvasc (amlodipine)
A
peripheral edema
fatigue
25
bp goal for htn + dm
< 130/80
26
ideal classes of meds for htn + dm (3)
diuretics
acei/arb
ccb
27
what ccb are best for htn + dm
dihydropiridines (amlodipine/novasc)
28
life threatening s.e of amlodipine
angina/MI
hypotn
pulmonary edema
29
use amlodipine w. extreme caution in what 2 conditions
AS - can cause MI
CHF - can decrease afterload
30
ccb work best for htn for what patient population
AA
31
life threatening s.e of ACEI (6)
angioedema
cholestatic jaundice -> fulminant hepatic necrosis
hyperkalemia
ARF
hypotn
severe hypersensitivity
32
angioedema manifesting as abdominal pain may occur more often in what pt pop
AA
33
common s.e of ACEI (4)
hyperkalemia
elevated Cr
dizzy
cough
34
life threatening s.e of bb (4)
AV block
bradycardia
CNS dpn
hypotn
35
common s.e of bb (4)
hypotn
bradycardia
dizzy
worsen raynaud or peripheral vascular dz
36
life threatening s.e of hctz (2)
severe lyte disturbance
angle-closure glaucoma
37
common s.e of ARBs (3)
cough
hyperkalemia
elevated Cr
38
life threatening s.e of ARBs (4)
angioedema
hyperkalemia
hypotn
renal fxn decline
39
t/f: if a pt has a cough w. lisinopril, you should try losartan
t!
40
t/f: if a pt has angioedema w. lisinopril you should try losartan
hell no! why would you think you can do this you idiot?!
jk... i thought you could too
41
what class of drug is clonidine
alpha blocker
42
common s.e of clonidine (6)
xerostomia
drowsy
ha
fatigue
dizzy
transient skin rash
43
3 life threatening s.e of clonidine
bradycardia
cns dpn
hypotn
44
which ccb is extended release
diltiazem
45
4 common s.e of diltiazem
peripheral edema
ha
bradycardia
dizzy
46
4 life threatening s.e of diltiazem
av block
bradycardia
sjs
hypotn
47
moa of hydralazine
vasodilator
48
indication for hydralazine
acute htn episodes (usually inpt setting)
not really used for long term control
49
t/f: you should treat asymptomatic htn acutely in the op setting
f!
don't do it
just address stricter control of long term meds
50
common s.e of hydralazine (6)
earache
tachy
palpitations
angina
n/v
diarrhea
51
3 life threatening s.e of hydralazine
lupus-like syndrome
blood dyscrasia
MI
52
2 contraindications for hydralazine
CAD
peripheral neuritis
53
what was our plan for pt w. htn and gout (4)
d/c hctz and mucinex
add lisinopril
continue norvasc
increase metformin
54
when do you use the 10 year ascvd risk to decide if your pt needs statin as primary prevention
if ldl is > 100
55
basic ascvd risk guidelines for statin as primary prevention (2)
7.5 or higher - 10% risk = statin
if LDL 190 or higher
56
statins reduce cv risk __%
20-30
57
how should you dose statin as secondary prevention
highest dose pt can tolerate
lifelong high intensity statin regardless of ldl
58
2 high dose statins
atorvastatin (lipitor) 40-80
rosuvastatin (crestor) 20-40
59
t/f: doubling of statin dose produces double decrease in ldl
f! - only additional 6% decrease
60
what should you consider if you are thinking about doubling your pt's statin dose
adding a second med instead
61
when do LFTs need to be monitored for pt on statin (3)
before initiation
annually
any dose increase
62
2 contraindications for statins
liver disease (don't forget AUD)
pregnancy
63
common s.e of statins (5)
photosensitivity
arthralgias
GI upset
nasopharyngitis
elevated LFTs
64
4 life threatening s.e of statins
rhabdo
arf
hepatotoxic
hemorrhagic stroke
65
3 rf for statin related myopathy
small body frame
multisystem diseases
multiple meds
66
what do you think when you see: new onset renal failure, dark urine, confusion
rhabdo
67
t/f: cpk monitoring is recommended for pt on statin
f!
only in symptomatic pt
68
2 types of stents
des: drug eluting stent
bms: bare metal stent
69
antiplatelet recommendation for both kinds of stent
at least 6-12 mo of dual antiplatelet therapy (dapt): clopidigrel PLUS ASA
longer (18-24 mo) if pt has no major or moderate bleeding events
70
ASA dose for DAPT
81 mg
71
what do you use to predict combined ischemic and bleeding risk for pt's being considered to continue dapt therapy beyond one year
dapt score
72
2 common s.e of plavix
bleeding
pruritis
73
6 life threatening s.e of plavix
severe bleeding
TTP
agranulocytosis
SJS/TEN
aplastic anemia
pancytopenia
74
when would you use 325 mg ASA
only for AMI and ischemic stroke
use 81 mg for daily dose
75
interaction and contraindication for asa
interaction: nsaids
contraindication: GIB
76
asa is only recommended for __ prevention
secondary
77
only anti anginal med proven to improve survival and prevent re-infarction in pt who have had MI
bb
78
first line therapy for acute angina symptoms
nitrates
79
when are ccb used for angina
in combo w. bb when monotherapy is inadequate
80
all bb are equally effective for angina, but which ones are recommended dt less systemic s.e profile
cardioselective: metoprolol, atenolol
81
bb improve survival in what 2 conditions
prior MI
HFrEF
82
bb decrease efficacy of (3)
thyroid meds
insulin
oral hypoglycemics
83
contraindications for bb (6)
uncompensated HF
cardiogenic shock
2nd or 3rd degree heart block
bradycardia
COPD/asthma
hypotn
84
4 life threatening s.e of bb
hypotn
bradycardia
syncope
av blocks
85
4 common s.e of bb
fatigue
rash
dizzy
impotence
86
contraindications for nitrates (7)
obstructive hypertrophic cardiomyopathy
hypovolemia
inferior MI w. right ventricular involvement
elevated ICP
cardiac tamponade
sbp < 90
ED meds w.in past 24 hr
87
pt ed for nitrate patch
must remove for 12-24 hr (keep on from 8a-8p)
88
which nitrate is used for chronic/preventive management of angina
isosorbide mononitrate (imdur)
89
moa for nitrates
vasodilate -> decrease preload -> reduce myocardial O2 demand
90
4 common s.e of nitrates
HA
flushing
hypotn
syncope
91
5 life threatening s.e of nitrates
hypotn
paradoxical bradycardia
syncope
increased ICP
ddi w. pde5 inhibitors
92
antianginal drug that is not a nitrate
ranolazine (ranexa)
93
moa for ranolazine
partial fatty aid oxidation inhibitor -> alters myocardial energy metabolism -> decreases cardiac work load
94
how is ranolazine used for angina
prevention
not acute
95
2 s.e of ranolazine
hypotn
bradycardia
96
3 ddi's to be aware of w. commonly prescribed CV drugs
ASA + plavix -> increased bleed risk
nitro + bb -> additive hypotn
nitro + viagra -> additive hypotn
97
what are the ABCDE's of post MI drugs
A: antiplatelet -> asa + plavix
B: bp control -> bb
C: cholesterol -> statin
D: diet
E: exercise
98
moa for loop diuretics
inhibit Na and Cl resorption -> urinary excretion of Na, Cl, K
reduce peripheral vascular resistance and increase peripheral venous capacitance -> decrease LV filling pressure
99
2 mc loops diuretics
furosemide
torsemide
100
t/f: loop diuretic effect is dose dependent
t!
101
common s.e of loop diuretics (3)
hypokalemia
metabolic alkalosis
increased Cr
102
life threatening s.e of loop diuretics (7)
hypokalemia
hypotn
metabolic alkalosis
ARF
hyponatremia
hypersensitivity
ototoxicity -> deafness
103
tx for inpt in acute fluid overload
iv lasix
104
IV lasix has __ the bioavailability of oral
twice
if on 40 mg po lasix, start 20 IV
105
indication for IV lasix
breathing difficulty
not just peripheral edema
106
when is torsemide used
if lasix fails
but if pt was on torsemide at home, choose torsemide inpt
107
4 meds that can contribute to HF
NSAIDs
antiarrhythmics
CCB
hctz
108
5 meds that improve mortality in HFrEF
spironolactone (NYHA III and/or IV)
hydralazine + nitrates
acei/arb
bb
109
4 meds that do NOT improve mortality in HFrEF
ccb
digoxin
diuretics
nesritide (don't worry about this mystery drug)
110
benefits of digoxin (2)
improves functional capacity
decreases hospitalization
111
moa for digoxin
positive inotrope -> increases contractility
112
indication for digoxin
3rd/4th line for symptom control (fatigue, dyspnea, exercise intolerance) in pt's already on appropriate therapy
113
3 drugs that increase serum levels of digoxin
amiodarone
quinidine
verapamil
114
never give dig to what type of HFrEF pt
acutely decompensated
115
rf for dig toxicity (6)
low body wt
advanced age
renal impairment
hypokalemia
hypercalcemia
hypomagnesemia
116
symptoms of dig toxicity (8)
GI sx
cardiac sx
AMS
anorexia
NVD
vision changes
lyte abnormalities -> hyperkalemia
arrhythmias
117
how is dig cleared
renally
118
what class of drug is spironolactone
aldosterone receptor antagonist
119
common s.e of spironolactone (5)
hyperkalemia
dizzy
n/v
gynecomastia
menstrual irregularities
120
life threatening s.e of spironolactone (4)
hyperkalemia
ARF
hypotn
hepatotoxicity
121
analgesic of choice in CHF pt
APAP
122
3 ddi's to be aware of in CHF pt
lisinopril + KCl + spironolactone -> hyperkalemia
lisinopril + bb + lasix -> hypotn
ASA + plavix -> bleeding d.o
123
t/f: furosemide is superior to torsemide and bumetanide
f!
torsemide might actually be more potent and effective
124
how does renal failure impact diuretic dosing
increased dosing as gfr decreases
125
only contraindication for lasix
anuria
unless pt is on dialysis
126
t/f: bb and ccb are commonly used together in HFrEF
no they shouldn't be
127
what's the matter w. androgel in HFrEF
risk of major cv events
risk of increased HTN
128
what bp med do you think of when you see abdominal cramps
lasix
129
life threatening s.e of levothyroxine
CHF
arrhythmina
sz
SJS/TEN
130
common s.e of levothyroxine
ha
anxiety
diaphoresis
palpitations
diarrhea
anxiety
tremor
wt loss
heat intolerance
hair loss
131
can pt increase dose of lasix for acute edema in op setting
yep!
give them an extra dose
