Chat Questions Flashcards by Sophia Timm

Which A fib rate control drug improves mortality

BBs increase survival benifit with CAD and CHF for a fib rate control patients

Better than CCB or Digoxin for this

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AEs of Oseltamivir

Vomiting
Headache
Neuropsych SIs in children

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Which A fib rate control agent has symptomatic benifit with HFrEF

Digoxin

BBs are mortality benifit with CAD/CHF
CCBs are contraindicated in HF

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Which BBs are contraindicated in a patient with asthma

Carvedolol
Propanolol

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A 62-year-old man with AF and heart failure is planned for rate control. Which drug is contraindicated?

CCBs– contraindicated in HF

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Which medication has a black box warning for increased mortality in patients with permanent AF and heart failure?

Dronederone

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Which medication is not to be used in patients who are sensitive to QTc prolongation, treating their AF

Dofetilide and sotalol (Class 3 antiarrhythmics)– they are QTc prolonging, at risk for TdP

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What is the recommended first line Tx in young patients who have symptomatic paroxysmal AF or HFrEF

Ablation

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Which agents cannot be given in structural heart disease for symptomatic AF

Propafenone and flecanide (pill in pocket), higher sudden death

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In AF, which 2 cases do you favor rate control in

1) Chronic A fib (not responsive to rhythym control)
2) Pregnancy

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Which patients do you use the CHADSVASc score for

Pts who undergo A fib
Pts who have paroxysmal AF
Pts undergoing cardioversion or ablation

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A 68-year-old with CAD and stage-2 hypertension (BP 155/90 mm Hg on lisinopril) wants an oral agent for severe nasal congestion during a cold. Which OTC product is most appropriate?

Ipatropium bromide- inhibits secretions but doesn’t vasoconstrict
- Or, use saline rinse
- Can use Corticosteroid sprays too (Possibile utility for nonallergic rhinitis)

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Which supplement has the strongest clinical evidence for helping flu symptoms specifically?

A. Ginseng
B. Zinc
C. Elderberry
D. Garlic

Elderberry— Immune modulating, reduces flu symptoms

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A 45-year-old man on warfarin asks which supplements could potentially increase his bleeding risk. Which do you caution him about?

A. Garlic
B. Ginseng
C. Elderberry
D. Vitamin C

Garlic and Ginseng

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Which natural remidy reduces severity and incidence of cold or flu

Ginseng

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Which herbal do you need to avoid if you have a ragweed or chrysanthemum hypersensitivity

Echinacea

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Which supplement reduces duration but not incidence of colds

Vitamin C

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For children who have strep but cannot take PCN, what is the next alternative?

Cephalexin
Azithromycin

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What is the bacterial treatment for rhinosinusitis (preferred and IV)

Preferred: Augmentin
Alternate: Doxy, levo, moxifloxacin

IV: Unasyn, levo/moxifloxacin, ceftriaxone

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Otitis externa treatments

Ciprofloxacin, Ofloxacin
Neomycin/Polymyxin B

Corticosteroids

Acetic acid

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A 50-year-old woman with well-controlled asthma tests positive for influenza. She started coughing yesterday. Which antiviral is contraindicated?

Zanamavir

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A 55-year-old woman is hospitalized for COVID-19 with increasing oxygen needs but no mechanical ventilation. What agent should be started?

Remdesivir can be started if hospitalized
Dexamethasone if hypoxic

CHECK ALT AND AST

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Which patients require Warfarin rather than a DOAC

Rheumatic Mitral Stenosis
Mechanical Valve replacement
APS

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Dabigatran reversal agent

idarucizumab

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Factor Xa inhibitor agent

Andexanet alfa

Idarucizumab

Reversal agent for Dabigatron

A patient walks in with Atrial Flutter w RVR. What do you treat them with

IV metoprolol or CCB (diltazam, verapamil) If that doesnt work, Amio or digoxin Cardiovert if unstable ANTICOAGULATE if >48 HRS

What does a CURB-65 score of 2 indicate

Admit to treat pneumonia 0-1 is outpt 2 is admit 3 is treat inpatient PSI port also looks at this

What does a CHADSVASc score of 3 indicate

It indicates the patient must be on anticoagulants, have high stroke risk from A fib 0 (M) / 1 (F) = no anticoagulants 1 (M) / 2 (F) = consider 2 (M) / 3 (F) = absolutely anticoagulate

What does well's score indicate

if the patient should have a D-dimer ordered/workup for PE

What does the NEWS/PESI score look at

If the patient should be discharged or admitted with a PE If tachycardic/tachypnic/AMS don't send home.

Which score evaluates the risk of recurrance for PE

DASH score pt will DASH back to the ER

HAS BLED has utility to judge what

Risk of severe bleeding if on long term anticoagulant

Which patients should not be prescribed ACEs and ARBS

- Pts on NSAIDs (Increase kidney injury risk) - Pts with bilateral renal artery stenosis - Pts w angioedema

Which HTN meds do you NOT combine

Non-DHP CCBs (Diltazem, Verapamil) with BBs (Additive effects) Give DHPs (Amlodipine, nifedipine) instead

Which beta blockers are proven to improve survival in HF patients

1) Bisoprolol 2) Carvedolol 3) Metoprolol

Which ACEs improve survival in HF pts

1) Catopril 2) Enalapril 3) Lisinopril 4) Ramipril

A pt gets a UTI while on HF meds. Which medication is most likely responsible

Dapagliflozin or Empagliflozin (SGLT2 inhibitors)

When should MRAs be considered for HF pts

If EF <35% or if EF <40% with previous MI Spironolactone/Eplaronone Increase K But Improves survival Watch Serum K/Cr

Which medication do you add on for African American pts in HF

Hydralazine/Nitrate Recommend adding it on for HFrEF in African American pts Reduce mortality and improve sx AI: Headache

For a patient getting a CABG, when should you discontinue plavix or Brillenta before

Discontinue 5 days before clopidogrel/ticegralor

For a patient Post-CABG, what medications should you prescribe

Aspirin indefinitely Plavix/Ticegralor 12 monts if medical management or coronary stenting

What therapy is recommended post stenting

Dual antiplatlet therapy (ASA and Clopidogrel/ticegralor) for 12 months post PCI. Extend therapy with high-risk patients.

Treatment for Pharyngitis caused by gonorrhea

Ceftriaxone

Treatment for Pharyngitis caused by Chlamydia

Doxy or Azithro

Which medications do you use indefinitely for secondary MI prevention

1) ASA 2) ACE/ARB 3) Statins 4) MRA (if already on ACE, HFrEF, or diabetes) 5) Plavix/Brillenta ( clopidogrel, prasugruel) Use BB indefinitely if HFrEF, or 1-3 years otherwise

Someone has a MI. Which drugs are you prescribing now to prevent a secondary MI

1) ASA and Plavix for 1 year 2) ACE/ARB 3) Statin 4) BB (1-3 years) 5) MRA

When to use and not use BB after MI

USE: Start within 24 hours after ACS in all pts without contraindications, continue 1-3 years CIs: - Heart block without pacemaker - Bradycardia - HF (acute) - Shock - Bronchospasm reasess after 24 hours to start

Which Test do you have to check for ACE/ARB/ARNIs

- Serum Creatinine/Kidney Function - Serum Potassim (Kidney clearance)

Your patient is on Spironolactone. Which lab value do you want to moniter

Serum K

Testing required for ASA

- Renal testing. Typically safe to give chronically with ACEs and ARBs - Dose- dependent risks on renal system -

For patients who have PAD, if you are resolving their claudication symptoms, what medicaiton are you giving and what is the caveat?

Give Cilostosol (anti platelet) BUT DO NOT give if they have HF-- Absolutely contraindicated

What 2 drugs do you NOT give in HF

1) Cilostosol for PAD 2) CCBs 3) BBs if acute

Lab monitering for UFH

PTT Inhibits Thrombin, intrensic path

LMWH lab monitering

None needed

In a patient who had a MI and requires an anticoagulant, which do you give in case of organ dysfunction?

In case of renal dysfunction, give UFH, not LMWH or DOACs - LMWH is renally excreted, needs lower doses or avoided. - DOACs are renally cleared, so give lower dose

Lab test to moniter Warfarin

INR

Cause of skin necrosis due to warfarin

Protein C (Anticoagulant) suppression, which exceeds the suppression of procoagulant factors, causes HIT.

How is warfarin metabolized

NOT renally cleared Usually hepatically metabolized, require lower dose if hepatic impairment.

Which smoking cessation therapies is contraindicated in serious cardiovascular disease, pregnancy?

NRT

What do you give with pill in the pocket

Give with AV blocking agent like BB or CCB contraindicated with structural heart disease

What is the AIs of Varenicicline

Nausea, Headache, insomnia, abnormal dreams

Which smoking med is contraindicated in bulimia nervosa

Bupripion

Which smoking med provokes seizure

bupropion

Key side effects of bosentan and macitentan

ERA for Pulmonary Hypertension Cause tetartogenicity and hepatotexicity

Key side effects of sildenafil and tadalafil

Headache, flushing, dyspepsia PDE-5 inhibitors Viagra for PH

Key side effects of epoprostenol, treprostinil, iloprost

PCA prostanoids for PH Only use if severe, need to be continuously dosed, so route is hard

The patients who have PH and are vasoreactive qualify for which medication as treatment

CCBs (High dose) Most pts are not vasoreactive, but if they are, CCBs to treat

PE symptoms on echo and cardio exam

- RV dilation, Strain, hypokinesis - Cardiac BNP and Trop are increased

If a patient goes into cardiac arrest from acute PE, what rhythym do you see

pulseless, PEA, EKG is completely normal, blood is not pumping

Which medication for PH needs continuous dosing

PCA prostanoids epoprostenol, treprostinol, iloprost (Prostiglandin)

Which nicotine med is contraindicated in chronic rhinitis

Nasal sprays

What is used in anaphylaxis to prevent recurrance of symptoms

Corticosteroids Prevent recurrence of symptoms

Anaphylaxis treatment

1) Epi every 5-10 mins 2) diphenhydramine IM or IV 3) Corticosteroids to prevent anaphylaxis 4) bronchospasm, give albuterol 5) give fluids and vasopressors if hypotensive

What do you need to be careful of when tapering off benzos

Be careful if giving buproprion because it lowers seizure threshold

If you see HFrEF what med do you not give

CCBs or Cilostosol

Chat Questions Flashcards

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