Pericarditis

Question 1

ibuprofen dose

Answer 1

600-800 mg po q8h

Question 2

aspirin dose

Answer 2

650-1000 mg po q8h

Question 3

indomethacin dose

Answer 3

25-50 mg po q8h

Question 4

ketorolac dose

Answer 4

15-30 mg IV/IM q6h

Question 5

duration of NSAID therapy

Answer 5

until symptom resolution followed by 2-4 weeks tapering

Question 6

when is aspirin preferred

Answer 6

MI-associated pericarditis

Question 7

when is ketorolac preferred

Answer 7

it’s an alternative NSAID for NPO or severe pain

Question 8

maximum duration of therapy for ketorolac

Answer 8

5 days due to negative renal and cardiac effects

Question 9

NSAID side effects

Answer 9

GI toxicity (ulcer, gastritis), bleeding, consider addition of omeprazole

Question 10

colchicine dose

Answer 10

0.6 mg po bid (once daily if older than 70 or weigh less than 70 kg)

Question 11

colchicine adverse effects

Answer 11

diarrhea, nausea, vomiting

Question 12

duration of therapy for colchicine

Answer 12

3 months for first pericarditis episode, 6 months if recurrent

Question 13

when is colchicine dose adjusted

Answer 13

renal, older than 70, weigh less than 70 kg

Question 14

prednisone dose

Answer 14

0.2-0.5 mg/kg po daily with a taper schedule

Question 15

when is prednisone used

Answer 15

ONLY for patients who failed first line therapy or have a contraindication to aspirin/NSAID therapy

Question 16

anakinra dose

Answer 16

1-2 mg/kg sq daily (max 100 mg daily)

Question 17

anakinra adverse effects

Answer 17

infection, injection reaction, antibody development, neutropenia

Question 18

rilonacept dose

Answer 18

320 mg once sq then 160 mg sq weekly

Question 19

rilonacept adverse reactions

Answer 19

infection, URI, injection reaction, antibody development

Question 20

when are IL-1 blockers used

Answer 20

there is data for their use in recurrent pericarditis

Question 21

azathioprine dose

Answer 21

1 mg/kg/day po (max 3 mg/kg/day)

Question 22

methotrexate dose

Answer 22

10-15 mg po weekly

Question 23

mycophenolate dose

Answer 23

1000 mg po bid

Question 24

IVIG dose

Answer 24

400-500 mg/kg/day IV, daily x 5 days for one cycle

Question 25

drugs causing pericarditis

Answer 25

dantrolene, doxorubicin, hydralazine, isoniazid, immune checkpoint inhibitors, methysergide, pergolide, phenylbutazone, phenytoin, procainamide

Question 26

symptoms of pericarditis

Answer 26

chest pain is sharp, rapid onset, clear relationship to breath inspiration/coughing/hiccups, relieved when sitting up or leaning forward

Question 27

physical exam findings for pericarditis

Answer 27

sinus tachycardia, fever, pericardial rub audible on left sternal border

Question 28

ECG findings for pericarditis

Answer 28

PR segment depression with ST segment elevation

Question 29

lab findings for pericarditis

Answer 29

troponin may be positive, inflammatory markers are WBC, ESR, CRP

Question 30

diagnosis of pericarditis

Answer 30

must meet 2 of 4 following criteria: chest pain, pericardial rub PR segment depression w/ ST segment elevation, new or worsening pericardial effusion

Question 31

acute pericarditis

Answer 31

<4-6 weeks

Question 32

incessant pericardititis

Answer 32

> 4-6 weeks without remission

Question 33

recurrent pericardititis

Answer 33

new signs and symptoms after a symptom free period of 4-6 weeks

Question 34

chronic pericarditis

Answer 34

> 3 months

Question 35

pericarditis complications

Answer 35

pericardial effusion, constrictive pericarditis, cardiac tamponade

Question 36

when hospital admission is required

Answer 36

fever >38 C (100.4 F), subacute onset, large pericardial effusion, cardiac tamponade, lack of response to initial therapy for at least a week, myopericarditis, immunosuppression, trauma, oral anticoagulant therapy

Question 37

prednisone tapering if dose >50 mg

Answer 37

taper 10 mg/day every 1-2 weeks

Question 38

prednisone tapering if dose 25-50 mg

Answer 38

taper 5 mg/day every 1-2 weeks

Question 39

prednisone tapering if dose 15-25 mg

Answer 39

taper 2.5 mg/day every 1-2 weeks

Question 40

prednisone tapering if dose <15 mg

Answer 40

taper 1.25 mg/day every 1-2 weeks