Cardiovascular

Question 1

LDL calculation

Answer 1

LDL = TC - HDL - TG/5

Question 2

Goal LDL, HDL, triglycerides

Answer 2

LDL < 100
HDL > 40 (women) or > 50 (men)
Triglycerides < 150

Question 3

Drugs that increase LDL and TGs

Answer 3

Diuretics, efavirenz, cyclosporine, tacrolimus, atypical antipsychotics, proteas inhibitors

Question 4

Drugs that increase LDL

Answer 4

Fibrates, fish oils

Question 5

Drugs that increase triglycerides

Answer 5

IV lipids, propofol, clevidipine, bile acid sequesterants

Question 6

Statin MOA

Answer 6

Inhibit HMG-CoA –> block cholesterol production

Question 7

Statins that must be taken in the evening

Answer 7

Fluvastatin, lovastatin, simvastatin

Question 8

Statins that interact with CYP3A4

Answer 8

simvastatin, lovastatin (kind of atorvastatin)

Question 9

Statin intensities

Answer 9

High – rosuvastatin 20-40, atorvastatin 40-80
Moderate – rosuvastatin 5-10, atorvastatin 10-20, simavstatin 20-40

Question 10

Ezetimibe MOA

Answer 10

Inhibits cholesterol absorption

Question 11

PCSK9 Inhibitor MOA

Answer 11

Prevents LDL receptor degredation (increases LDL degredation)

Question 12

Percent cholesterol lowering with cholesterol meds

Answer 12

High-intensity statin: 50%
Moderate-intensity statin: 30-49%
Ezetimibe: 25%
PCSK9: 60%

Question 13

Do not use statins with what other cholesterol medication?

Answer 13

Gemfibrozil

Question 14

When taken with simvastatin, what increases risk of myagia?

Answer 14

Red yeast rice, niacin, fenofibrate

Question 15

When should isosorbide dinitrate doses be schedules?

Answer 15

~7 hours apart (BID dosing)

Question 16

Bidil

Answer 16

isosorbide dinitrate/hydralazine

Question 17

Drugs to avoid with heart failure

Answer 17

Tumor necrosis factor inhibitors, DPP4s, anthracyclines, itraconazole, NSAIDs

Question 18

CPK cut off for rhabdomyolysis

Answer 18

> 10,000

Question 18

Slow acetylators of procainamide are at increased risk of what?

Answer 18

Accumulation and toxicity

Question 19

carvedilol to Coreg CR dosing

Answer 19

3.125 mg BID = 10 mg CR

Question 20

Fluid restriction in HF

Answer 20

1.5-2 L per day

Question 21

What lab abnormalities increase risk of digoxin toxicity?

Answer 21

Hypokalemia, hypomagnesemia, hypercalcemia

Question 22

Action potential

Answer 22

Na in, K out and Ca in, K out
Antiarrhythmics stop Na in and K out

Question 23

When to use QTc

Answer 23

HR > 60

Question 24

Conduction pathway

Answer 24

SA node --> atria (contract) --> AV node (slows) --> bundle of his --> right and left branches --> spread through purkinje fibers (ventricles contract)

Question 25

P wave and T wave

Answer 25

Atria contracting, ventricles relaxing

Question 26

Each class of antiarrhythmics

Answer 26

I (Na blockers), II (beta blockers), III (K blockers), IV (Ca blockers)

Question 27

Which drugs are class I antiarrhythmics

Answer 27

Quinidine, procainamide, lidocaine, mexiletine, flecainide, proafenone

Question 28

Which drugs are class III antiarrhythmics

Answer 28

Amiodarone, dronaderone, sotalol, ibutilide, dofetalide

Question 29

Which antiarrhythmics are contraindicated in heart failure

Answer 29

Flecainide, propafenone (class Ic), dronaderone, diltazem/verapamil

Question 30

Which antiarrhythmics are preferred for heart failure

Answer 30

Amiodarone, dofetalide

Question 31

Which arrhythmias are lidocaine and mexiletine useful for

Answer 31

Ventricular arrhythmias only

Question 32

Which antiarrhythmics are contraindicated in MI

Answer 32

Flecainide, propafenone (class Ic)

Question 33

Side Effects of amiodarone

Answer 33

pulmonary toxicity, blue skin, hypotension, DILE, hypothyroidism

Question 34

Amiodarone and digoxin together

Answer 34

Decrease digoxin (and warfarin) dose by 50% when adding amiodarone

Question 35

Which antiarrhythmics must be started in the hospital

Answer 35

Sotalol, dofetalide

Question 36

Digoxin MOA

Answer 36

Na-K-ATPase blocker (suppresses AV node conduction, decreaes HR) Positive inotrope, negative chronotrope

Question 37

Digoxin typical dose and therapeutic level

Answer 37

0.125-0.25 mcg daily, 0.8-2 ng/mL (draw 12-24 hours after dose)

Question 38

Digoxin renal dosing

Answer 38

Decrease dose or frequency if CrCl < 50

Question 39

Digoxin PO to IV

Answer 39

Decrease dose by 25% when converting PO to IV

Question 40

Adenosine MOA

Answer 40

Adenosine receptor agonist

Question 41

First-line treatment for Afib rate control

Answer 41

Beta blocker or non-DHP CCB

Question 42

Second-line treatment for Afib rate control

Answer 42

Digoxin (add on or montherapy in those who do not tolerate first-line)

Question 43

Cardioversion drugs

Answer 43

Amiodarone, dofetalide, flecainide, ibutilide, propafenone

Question 44

Afib ryththm maintenance drugs

Answer 44

Dofetalide, dronaderone, flecainide, propafenone, sotalol