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CP Flashcards

1
Q

diffuses/poorly localized pain is likely

A

ischemic/cardiac

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2
Q

well localized pain is likely

A

musculoskeletal
GI
pulmonary

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3
Q

examples of abrupt onset CP

A 
pneumothorax
aortic dissection
esophageal
rupture/perforation
pulmonary embolism
acute MI
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4
Q

examples of gradual onset CP

A

esophageal disease

musculoskeletal complaints

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5
Q

angina episodes typically last

A

10-15 minutes

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6
Q

if pain lasts _____ or ______, it’s not ischemic

A

a few seconds (musculoskeletal or GI)

days/weeks/months

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7
Q

pain that lasts longer than ______ should make you think unstable angina or acute MI

A

15 minutes

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8
Q

pleuritic CP worse with respiration

A

pulmonary
chest wall
cardiac tamponade

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9
Q

sharp CP

A

Pulmonary
Chest wall
Neuropathic

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10
Q

burning CP

A

Neuropathic: HZV, radiculopathy, GI, ischemia

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11
Q

tearing, ripping, searing CP

A

aortic dissection

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12
Q

dull, heavy, tightness, pressure, ache squeezing

A

ischemia

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13
Q

Pericarditis is worse when _____ and better with ______

A

worse lying down

better sitting up and leaning forward

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14
Q

if pain is reproducible with palpation, it’s likely

A

musculoskeletal

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15
Q

Does relief with a GI cocktail rule out cardiac pain?

A

It’s likely a GI issue but it doesn’t distinguish it from cardiac pain

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16
Q

Diaphoresis is likely

A

ischemia

GI causes

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17
Q

N/V is likely

A

ischemia

GI causes

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18
Q

Typical angina:

A

substernal, radiates to neck/jaw/shoulders

not reproducible with palpation

worse with exertion, relieved with rest

progressive pressure or achy pain

lasts >15 mins

diaphoresis, Nausea, SOB

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19
Q

Atypical angina:

A

lateral chest wall or back

reproducible with palpation

not relieved with rest

sharp, pleuritic, positional

lasts for a few seconds or days/weeks/months

no associated symptoms

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20
Q

Order these tests for CP:

A 
CBC, CMP, Coags
Troponin, CK-MB
D dimer
BNP
CXR
EKG
CT Chest
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21
Q

Acute coronary syndrome includes

A

unstable angina
NSTEMI
STEMI

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22
Q

unstable angina is

A

reversible ischemia without injury

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23
Q

myocardial infarction is

A

myocardial ischemia with injury

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24
Q

Maintain 02 above

A

90%

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25
Who gets morphine?
severe, persistent chest pain
26
Are cardiac enzymes elevated in unstable angina?
NO | only in NSTEMI or STEMI
27
STEMI vs NSTEMI
STEMI: occlusive thrombus, transmural infract NSTEMI: non occlusive thrombus
28
NSTEMI on EKG
ST depression or T wave changes
29
STEMI on EKG
ST elevation
30
Lateral leads
I aVL V5 V6
31
Inferior leads
II III aVF
32
Anterior leads
V1 V2 V3 V4
33
STEMI initial tx
Anticoagulation Beta blocker PCI or thrombolysis
34
No NSTEMI on EKG but strong suspicion for ischemia tx
catheterization
35
Normal EKG and normal cardiac enzymes, no evidence of ischemia or infarct
Stress test or imaging
36
examples of antiplatelet therapy
Aspirin Clopidogrel abciximab/eptifibatide/tirofiban
37
Anticoagulant therapy
unfractionated heparin
38
3 Cardioselective beta blockers (B1)
Metoprolol Atenolol Nebivolol
39
MOA of diuretics
inhibits sodium reabsorption in the nephron; | reduces plasma volume and peripheral vascular resistance
40
Hydrochlorothiazide
Thiazide diuretic
41
Drugs that can treat hypertension
***Thiazides*** Aldosterone antagonist Loop diuretics
42
Triamterene
potassium sparing diuretic
43
spironolactone
aldosterone antagonists
44
bumetanide
loop diuretic
45
Drugs for heart failure
***Loop diuretic*** | Potassium sparing diuretic
46
Liver failure with ascites tx
Potassium sparing diuretic
47
Edema tx
Thiazide
48
Drugs that cause hypokalemia
Thiazides | Loop diuretics
49
Drugs that cause hyperkalemia
*** Potassium sparing diuretics Aldosterone antagonists ***
50
Can cause gynecomastia
Spironolactone
51
Can cause orthostatic hypotension and hyperuricemia
Thiazides
52
Can cause hypomagnesemia and hypocalcemia
Loop diuretics
53
Don't give ______ to a patient with sulfa allergies
Thiazides | Loops
54
Caution combining _____ with ACE, ARBs, potassium supplements
Potassium sparing diuretics (triamterene)
55
Contraindications to spironolactone
renal impairment | DM with proteinuria
56
Nitrates MOA
relaxes vascular smooth muscle, | dilates coronary arteries and decreases preload
57
Nitrates indications
``` *ACS, angina* hypertension HF Pulmonary hypertension esophageal spasm ```
58
Nitrates side effects
*headache* hypotension tachycardia dizziness
59
Nitrates contradindications
``` Systolic BP <90 Bradycardia <50 Tachycardia >100 Right ventricular infarction Use of phosphodiesterase inhibitor within 24 hours Hypertrophic cardiomyopathy Severe aortic stenosis ```
60
Beta Blocker MOA
blocks activity of catecholamines at β- adrenoreceptors, decreases heart rate, cardiac output and myocardial O2 demand
61
Non-cardioselective beta blockers (B1 + B2)
Propranolol | Nadolol
62
Beta blocker indications
*stable heart failure* *post-MI, angina* arrhythmias hypertension
63
Beta blocker adverse reactions
``` bronchoconstriction bradycardia AV block fatigue ED depression dizziness hypotension *avoid abrupt withdrawal, can cause ACS and HTN* ```
64
Relative contraindications to beta blockers
COPD Asthma Diabetics
65
Absolute contraindications to beta blockers
``` Hypotension/Cardiogenic Shock Active Bronchospasm Severe Bradycardia 2nd or 3rd Degree Heart Block Overt Heart Failure ```
66
ACE-I MOA
inhibit conversion of angiotensin I to | angiotensin II, causes vasodilation
67
Indications for ACE-I
``` *hypertension* heart failure post-MI *diabetic nephropathy* *chronic kidney disease* ```
68
Adverse reactions to ACE-I and ARBS
*cough* ACE-I ONLY *angioedema* hyperkalemia hypotension
69
Contraindications to ACE-I or ARBs
*pregnancy* history of angioedema renal artery stenosis
70
ARBs MOA
antagonizes angiotensin II AT1 receptors, causes vasodilation
71
ARBs end in _____ | ACE-Is end in ____
ARBs: "sartan" | ACE-I: "pril"
72
ARBs indications
*hypertension* *post-MI* heart failure diabetes *chronic kidney disease*
73
CCBs MOA
inhibit calcium influx into arterial smooth muscle cells, relaxes coronary smooth muscle, decreases peripheral vascular resistance
74
Dihydropyridines end in _____ | Non-dihydroyridines are called
"dipine" | verapamil or diltiazem
75
Verapamil and diltiazem are better for
rate control for afib/flutter
76
dihydropyridines are preferred for
hypertension
77
CCBs can treat
hypertension angina rate control for afib/flutter
78
adverse reactions to CCBs
*constipation* *peripheral edema* *flushing* dizziness hypotension
79
Recommended HTN drugs in pregnancy
``` Nifedipine Methyldopa (alpha agonist) ```

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