Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX STUDY > Stable Ischemic HD, ACS, and HF > Flashcards

Stable Ischemic HD, ACS, and HF Flashcards

1
Q

cardiac stress test medications

A

adenosine, dipyridamole, dobutamine or regadenoson (Lexiscan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Non-drug treatment for SIHD

A

BMI 18.5-24.9
waist circumference of < 35 in in females and < 40 in males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

drug regimen for SIHD

A

aspirin 81 mg and beta blockers (clopidogrel if allergy to aspirin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

when do you suggest clopidogrel + aspirin

A

history of bare metal stent placement (DAPT 1 month), drug-eluting stent (DAPT 6 month) or CABG (DAPT 12 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

alternatives when beta-blockers are contraindicated in patients

A

CCB (both DHP and non-DHP), long-acting nitrates, ranolazine (in addition or instead of)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SIHD preventative medications

A
  • SLNG for immediate relief
  • high intensity statin
    -antihypertensives with HTN, HF, and DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how long should aspirin be used in patients with SIHD

A

indefinitely - use non-enteric coated chewable aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clopidogrel

A

avoid use with omeprazole and esomeprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ranolazine

A

not for acute treatment of chest pain
has little to no effect on HR and BP
QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

nitroglycerin

A

hypotension, headache, tachyphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ISDN + hydralazine

A

preferred combo for HFrEF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

nitrates

A

do not use with PDE-5s and riociguat
-avanafil in the past 12 hours
-sildenafil or vardenafil in the past 24 hours
- tadalafil in the past 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

NG TL Spray

A

do not shake
spray onto or under the tongue
do not inhale the spray or try to swallow
do not spit or rinse mouth for 5-10 min after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Unstable angina (UA)

A

chest pain
negative cardiac enzymes
none/transient ischemic changes in ECG
partial blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

NSTEMI

A

chest pain
positive cardiac enzymes
none/transient ischemic changes in ECG
partial blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

STEMI

A

chest pain
positive cardiac enzymes
ST-segment elevation on ECG
complete blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

NSTEMI-ACS

A

can be treated with medications alone or with PCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

STEMI

A

PCI or fibrinolytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Time to PCI

A

90 minutes (door to balloon time) or within 120 minutes of first medical contact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Time to fibrinolytic

A

30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MONA-GAP-BA

A

MONA: morphine, oxygen, nitrates, asa
GAP: GPIIb/IIIa antagonists, anticoagulants, P2Y12 inhibitors
BA: beta-blockers, ACEi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when not to use IV nitroglycerin in ACS

A

SBP < 90 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when should beta-blockers be given post ACS?

A

within 24 hours to increase long term survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

P2Y12 inhibitors

A

prodrugs that irreversibly bind to the P2Y12 receptor
*not ticagrelor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Clopidogrel

A

LD: 300-600 mg (600 mg PCI)
MD: 75 mg
-bleeding risk (stop 5 days prior to surgery) di not use with omeprazole or esomeprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Prasugrel

A

LD: 60 mg (no later than 1 hour after PCI)
MD: 10 mg (5 mg < 60 kg)
-dispense in original container
-do not initiate if CABG is likely - stop at least 7 days prior to elective surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Ticagrelor

A

LD: 180 mg
MD: 90 mg BID x 1 year then 60 mg BID
- do not exceed 100 mg of ASA
-avoid use when CABG likely, stop 5 days before any surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

SSRIs and SNRIs

A

increase the risk of bleeding when used with P2Y12

29
Q

GIIb/IIIa receptor antagonists

A

Abciximab (ReoPro), Eptifibatide (Integrillin)
-bleeding, thrombocytopenia

30
Q

PAR-1 antagonist

A

Vorapaxar (Zontivity)

31
Q

Fibrinolytics

A

cause fibrinolysis by binding to fibrin and converting plasminogen to plasmin
-used only for STEMI

32
Q

Alteplase (Activase) | Tenecteplase (TNKase)

A

contraindications: active internal bleeding, hx of a recent stroke, ICH, severe controlled HTN

33
Q

Secondary prevention: ASA

A

indefinitely (81 mg/day) unless contraindicated

34
Q

Secondary prevention: P2Y12 inhibitor

A

-medical therapy: ticagrelor or clopidogrel with asa 81 mg for at least 12 months
-PCI-treated patients: clopidogrel, prasugrel, or ticagrelor with asa for 12 months

35
Q

Secondary prevention: BB

A

3 years - continue indefinitely in patients with HF or if needed for management of HTN

36
Q

Secondary prevention: ACEi

A

indefinitely in patients with EF < 40%, HTN, CKD, or diabetes; consider for all I patients with no CI

37
Q

Secondary prevention: aldosterone antagonist

A

indefinitely in patients with EF < 40% and symptomatic HF or DM receiving target doses of an ACEi and BB
-CI: significant renal impairment or hyperkalemia

38
Q

Secondary prevention: statin

A

indefinitely high statin for most people (those > 75 can consider moderate or high intensity)

39
Q

HFrEF

A

EF < 40% (systolic dysfunction)
impaired ability to eject blood during systole

40
Q

HFmrEF

A

EF 41-49%

41
Q

HFpEF

A

EF > 50%

42
Q

HFimpEF

A

< 40% at baseline then > 10% increase and second F > 40%

43
Q

Lab/biomarkers of HF

A

increased BNP (normal < 100)
increased NT-proBNP (normal is < 300)
BNP and proBNP are used to distinguish between cardiac and non-cardiac causes of dyspnea

44
Q

Left-sided S/Sx

A

orthopnea: SOB when laying down
Paroxysmal nocturnal dyspnea: nocturnal cough and SOB
Bibasilar rales: crackling lung sounds heard on lung exams
S3 gallop
hypoperfusion (renal impairment, cool extremities)

45
Q

General S/Sx of HF

A

dyspnea (SOB at rest or upon exertion)
cough
fatigue, weakness
reduced exercise capacity

46
Q

Right-sided S/Sx

A

peripheral edema
ascites: abdominal fluid accumulation
JVD
HJR
hepatomegaly

47
Q

cardiac output

A

CO = HR x SV

48
Q

cardiac index

A

CI - CO/ BSA

49
Q

Drug Information NATION (drugs that cause or worsen HF)

A

DPP4-inhibitors
Immunosuppressants/TNF inhibitors
Non-DHP CCB/diltiazem and verpamil
Antiarrhythmics (class 1 agents)
Thiazolidinediones
Itraconazole
Onc drugs
NSAIDs

50
Q

Initial medications for HF (w/o CI)

A

ARNI, ACEi, or ARBs
BB
Loop diuretics

51
Q

Which HF medications decrease mortality

A

ARNI/ACEi/ARBs
BB
ARAs, SGLT-2 (NYHA II-IV)

52
Q

Secondary medications for HF in select patients

A

ARA
SGLT-2
BiDill
Ivabradine

53
Q

Which HF medications decrease morbidity

A

ARAs, SGLT-2, Bidill

54
Q

Additional medications for HF

A

Dig, vericiguat

55
Q

BB in HF

A

bisoprolol, carvedilol (IR and ER), metoprolol succinate (ER)
-only discontinue during acute decompensated HF

56
Q

carvedilol CR and IR dose conversion

A

Coreg 3.125 mg BID = Coreg CR 10 mg daily

57
Q

Loop diuretics

A
  • do not use in those with sulfa allergies
  • decrease K, Mg, Na, Cl, Ca
  • increase HCO3, UA, BG, TG, TC
  • ototoxicity
  • orthostatic hypotension, photosensitivity
  • keep at room temperature
58
Q

oral loop diuretic coversion

A

furosemide 40 mg = torsemide 20 mg = bumetanide 1 mg - ethacrynic acid 50 mg

59
Q

furosemide IV:PO

A

1:2 (20 mg IV = 40 mg PO)

60
Q

ARA in HF

A

do not initiate for HF if K > 5

61
Q

Ivabradine

A

bradycardia, increased risk of QT prolongation and ventricular arrhythmias
-side effects: bradycardia, HTN, AFib
Target: resting HR between 50-60 BPM

62
Q

digoxin level target

A

< 1 ng/mL in HF (0.5-0.9 ng/mL)

63
Q

magnesium and potassium levels in those on digoxin

A

> 2 and 4-5

64
Q

digoxin

A

-0.125-0.25 mg PO QD
-LD not used in HF
-CrCl < 50 mL/min decrease dose or freq
-decrease dose 20-25% when switching from PO to IV

65
Q

digoxin toxicity

A

blurred/double vision, greenish-yellow halos

66
Q

digoxin and amiodarone/dronedarone

A

reduce digoxin dose by 50%

67
Q

KCl ER capsules

A

capsule contents can be sprinkled on a small amount of applesauce or pudding

68
Q

KCl ER Tab

A

K-Tab, Klor-Con: swallow whole; do not chew, crush, cut or suck on tablet
Klor-Con M: can be cut in half or dissolved in water; do not chew, crush, or suck on the tablet

69
Q

KCl oral packet

A

dissolve contents in water and drink immediately

NAPLEX STUDY (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions