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OTC > Notes 465-cardio > Flashcards

Notes 465-cardio Flashcards

1
Q

when to treat low risk framingham patients

A

ldl 5 or more or genetic dyslipidemia

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2
Q

when to treat mod risk framingham patients

A

ldl 3.5 or more, or apo b 1.2 or more, or non hdl 4.3 or more

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3
Q

which cholesterol lowering agent should not be used in diabetes

A

niacin- hyperglycemia and reduced insulin sensitivity

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4
Q

hypertensive urgency

A

should be reduced within hours (more than 180 over 130 and target organ changes)

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5
Q

hypertensive emergency

A

need immediate BP reduction

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6
Q

what should you tell a patient who takes reading at 180 or higher? 200?

A

180- retake- stressed? coffee? etc if legit, tell make appt to see doc soon, but if target organ damage ie signs of vision impairment or feeling funny otherwise more urgent. 200? schedule urgent appt after checking technique

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7
Q

when do you start therapy for HTN

A

if stage one (140-159/90-99) and no risk factors, can do lifestyle at first. If target organ damage or over 160 must start therapy now

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8
Q

how much does one bp drug typically lower on own

A

10/5

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9
Q

how long for BP drug max effect

A

about three weeks

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10
Q

when is HCTZ not effective anymore

A

CrCl less than 30

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11
Q

when should you get K and SCr tested after starting ace/arb

A

within 3 months, earlier if high risk. Really within 1-2 weeks of starting it is best but not typically seen

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12
Q

3 classes that have shown benefit in isolated systolic HTN

A

thiazides, ARBs, DHP CCB

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13
Q

age over ___, lower BP target of less than 150/90 used

A

80 yo

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14
Q

beta blockers in pheochromocytoma

A

can result in unopposed vasconstriction- CI

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15
Q

first line HTN therapy without compelling indication

A

thiazide, ace/arb (non black), BB (under 60), long acting CCB

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16
Q

HTN with CAD first line? stable angina? recent MI?

A

CAD-ACE/ARB, stable angina-CCB or BB. recent MI_-BB and ACE

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17
Q

HTN with HF? second line?

A

ACE and BB. Isosorbide dinitrate and hydralazine second line if first option not tolerated

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18
Q

HTN recent after stroke?

A

ACE and thiazide

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19
Q

HTN CKD

A

ACE or ARB

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20
Q

HTN with diabetes- with and without kidney/CV disease

A

without- any first line in non compelling indications. With- ace or arb

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21
Q

why aren’t alpha antag recommended as first line in HTN

A

not shown to be as effective as others

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22
Q

drugs for supraventricular tachycardias

A

non DHP CCB, BB

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23
Q

drugs for ventricular arrhytmias

A

1A, 1B, 1C, 3

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24
Q

when is amiodarone used, AE

A

ventricular arrhythmia and sxatic AFib, AE peripheral neuropathy, corneal microdeposits, thyroid dysfx, pulmonary tox, hepatic tox, QT, GI, photosens, irreversible blue gray skin discoloration (use sunblock)

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25
Q

what is CHADs 2 for and each letter

A

risk of stroke in AFib- recent CHF, HTN, age 75 or older, DM< hx of stroke or TIA is 2 points

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26
Q

drugs used for rate control in afib

A

CCB or BB

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27
Q

when to use digoxin in afib

A

patients who are sedentary with LV systolic dysfx, or not responding/CI to BB CCB

28
Q

amiodarone in afib

A

only be used for rate control in exceptional cases

29
Q

OAC in AFIB

A

recommended for CHADs 1 or more, and age 65 or older fro MOST patients. If less than 65 and no chads risks but CAD, can use aspirin 81mg. If none, don’t need any antithrombotic (free of CAD, chads risk and under 65)

30
Q

when would warfarin be used in AFIb

A

mechanical prosthetic valve, Cr cl of less than 15 (even less than 30 they recommend it), or rheumatic mitral stenosis, other indications for warfarin

31
Q

what is pill in pocket strategy

A

for afib- propafenone or flecainide intermittently or as booster to terminate an episode

32
Q

NOAC CI

A

mitral stenosis (rheumatic and non), mechanical heart valve

33
Q

only drug used in PVCs

A

beta blockers safe and effective. If heart otherwise normal though, requires no therapy

34
Q

definition of heart failure with reduced ejection fraction aka ____

A

systolic- EF less than 40%

35
Q

how much weight is too much to gain in HF

A

2 lbs in 2 days or 5lbs in one week

36
Q

drugs to avoid in HF

A

antiarrhythmic, glitazones (fluid retention), non DHP CCB (unless with preserved EF), NSAID, BB with ISA

37
Q

name thiazide diuretics

A

metolazone, chlorthalidone, HCTZ, indapamide

38
Q

name loop diuretics

A

bumetanide, furosemide

39
Q

CI to BB

A

heart block, severe sinus bradycardia, use with caution in reactive airway disease

40
Q

how slow should you titrate BB doses

A

q2-4 weeks

41
Q

when to start aldosterone antag in HF and what to monitor and when

A

for sxatic still, monitor K closely (3d, 1 wk and monthly x3 months). eplerenone, spironolactone

42
Q

changing from an ACE to entresto (sacubitril/valsartan) in HF

A

stop ace, wait 5-7 days, then start. Whens studied with ace, saw huge increase rates in angioedema

43
Q

digoxin in HF

A

may be added if severe initial sx or sx persist, must also be on ACE and BB this is add on only

44
Q

how to treat diastolic HF

A

sxatic only really- use diuretics, ace, arbs, BB, aldosterone antag, etc. make sure to control BP, edema, arrythmias and other risk factors basically

45
Q

how to use nitro spray

A

prime if not used for a while or ever, sit, 1-2 sprays onto or under tongue q5m prn. If get to 3 call 911. Prevent sx- use 5-10 minutes before exertion, will last about 30 min.

46
Q

ACS management- 2 parts

A

sxatic anti-ischemic tx, and a reperfusion strategy

47
Q

what are the available reperfusion strategies

A

thrombolytic, PCI, CABG

48
Q

in which type of MI do you never use a thrombolytic

A

NSTEMI

49
Q

how to reperfuse in STEMI

A

thromboytic (tenecteplase, alteplase, streptokinase) within 30 minutes of hospital presentation, or PCI within 90. CABG rarely done.

50
Q

how to reperfuse NSTEMI

A

invasive (PCI-for those high risk or where sx don’t settle down and stable), or conservative (for low risk- just treat sx)

51
Q

who should thrombolytics not be used in

A

NSTEMI, previous intracranial bleed, recent stroke or head trauma in last 30 days, brain cancer

52
Q

what is PCI

A

stenting aka angioplasty

53
Q

When is a CABG done

A

tried to stent and couldn’t, SIHD, rarely in STEMI

54
Q

how long does it take each type of stent to re endothelialize (grow new skin)

A

DES- 1 year, BMS- 1 month

55
Q

adjunct antiplatelet therapy for thrombolysis in ACS

A

asa 81 indef, clopidogrel (ONLY**) for 2 weeks to one year

56
Q

adjunct antiplatelet therapy for PCI in ACS

A

asa 81mg indef, and p2y12 inh for one year (chose any)

57
Q

advantage of prasugrel over clopidogrel

A

only one step bioactivation, less DI, quicker onset, but higher rates of major bleeds

58
Q

advantage of ticagrelor over clopid

A

no bioactivation, quicker onset, lower all cause mortality, no increased major bleed, increased fatal intracranial bleed and non CABG, increased dyspnea

59
Q

antiplatelet therapy for CABG or no medical management in ACS

A

ASA 81 indef, ticagrelor or clopidogrel for one year

60
Q

anticoag in ACS

A

should be given at least 48 hours post ACS, may be continued for up to 8 days in HOSPITAL ONLY (enox, fonda, UFH)

61
Q

which BB have alpha one activity

A

carvediolol, labetalol

62
Q

when can you expect to develop tolerance to decreased exercise toelrance with BB

A

6-8 weeks. never stop taking them abruptly

63
Q

classic signs of digoxin tox

A

PVCs, bradycardia, GI, drowsy, confused, blurred vision or YELLOW GREEN HALOS

64
Q

effect of thyroid on digoxin

A

hyper enhances clearance, hypo reduces it

65
Q

how many vials of digibind are usually needed for digoxin OD

A

20

66
Q

what happens when you take amiodarone and digoxin together

A

elevated digoxin levels

OTC (21 decks)

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