Thyroid, ACS, dyslipidemia, HF, HTN

Question 1

definition of fever

Answer 1

consistently over 38’c

Question 2

drugs that may help with weight loss

Answer 2

bupropion, glp1 agonists, orlistat

Question 3

elevated TSH means

Answer 3

hypothyroidism

Question 4

sx of hypothyroid

Answer 4

fatigue, impaired memory, constipation, cold intolerance, changes in skin or hair (dry), HTN, bradycardia

Question 5

how many weeks after hypo thyroid tx does it take to reach a new steady state? how often are dose adjustments made?

Answer 5

6 weeks, q4-6weeks

Question 6

what should women who are being treated for hypothyroidism do when they have a confirmed positive pregnancy test

Answer 6

increase dose by 2 tablets per week, and further adjust based on TSH levels. Requirement may increase by up to 30% in preg.

Question 7

is thyroid hormone safe in preg

Answer 7

yes- and important to ensure healthy preg and normal fetal development

Question 8

subclinical thyroid means

Answer 8

either elevated or low TSH but normal thyroid hormones- they are sometimes treated

Question 9

graves disease, toxic nodule, goitre, iodine excess, and thyroid cancer are all examples of

Answer 9

hyperthyroidism

Question 10

hashimotos, iodine deficiency are examples of

Answer 10

hypothyroidism

Question 11

sx of hyperthyroid

Answer 11

weight loss, palpitations, diarrhea, heat intolerance, anxiety, opthalmopathy, tachycardia, warm/moist skin, goitre, etc

Question 12

tx for hyperthroid

Answer 12

radioactive iodine, methimazole, propylthiouracil, BB for sx- propran and nadolol can decrease conversion of T4 to T3 too

Question 13

SE of methimazole and propylthiouracil

Answer 13

both decrease production of thyrid hormones- SE rash, agranulocytosis, allergy, rarely hepato/renal tox (methimazole better for hepatotox)

Question 14

use of antithyroid meds during pregnancy

Answer 14

propylthouracil for first (if can’t, methimazole okay but has increased risk congenital malformations), methimazole better 2nd/3rd due to increased risk hepatotox with propyl is you can switch without disrupting thyroid control

Question 15

breastfeeding and hyperthryoid

Answer 15

methimazole preferred- propyl can be used if CI or not tolerated (but serious risk of hepatotox)

Question 16

risks of not treating hyperthyroid

Answer 16

cardiomyopathy, cardiac arrhythmias, osteoporosis

Question 17

what rare SE can methimazole and propylthiouracil cause? How should you caution patients/

Answer 17

rare neutropenia can develop gradually. May occur suddenly- tell patients to contact doc immediately if sx of infection occur (if rash/fever/sore throat occur d/c med)

Question 18

what to council on with thyroid and treatment

Answer 18

that if over treated, can end up looking like the other spectrum and what those sx may be

Question 19

with levothyroxine, how should it be taken

Answer 19

separated from calcium and iron by 6 hours

Question 20

_____ is the preferred LMWH until renal fx is less than

____

Answer 20

enoxaparin, 30, then use heparin

Question 21

what is contraindicated in patients with STEMI

Answer 21

CCB- increase morbidity and mortality- can be used cautiously to relieve ischemia or achieve rate control in a fib is BB CI. Monitor heart rate closely if used

Question 22

in stroke, how soon do you need to present to get alteplase

Answer 22

4.5 hours-but should be ASAP. HC recommends within 3

Question 23

T/F- ASA is ust as effective as warfarin in 2’ stroke prevention in patients with normal sinus rhythm

Answer 23

T

Question 24

At what clearances are rivarox, dabig, and apix CI at?

Answer 24

riva and dabig less than 30, apix less than 15

Question 25

when do you start anticoag therapy in stroke?

Answer 25

only after determined not hemorrhagic

Question 26

when should ASA be started in stroke?

Answer 26

right away if alteplase isn’t used, or 24 hours after alteplase is used *not ever for intracranial hemorrhage

Question 27

when do you double the framingham risk score? what is FRS?

Answer 27

family history of premature CV disease.. gives 10 year risk of cardiovascular disease

Question 28

benefit of binding resins for cholesterol, and one major downside

Answer 28

reduce LDL and can slightly increase HDL, strong safety record, good for preg/breastfeeding and children, major down is can increase TG

Question 29

what agent is best for HDL - what limits its use?

Answer 29

niacin- SE: hepatotoxic (slow release even worse), flushing

Question 30

hyperlipidemia in pregnancy

Answer 30

advisable to discontinue all lipid lowering agents except binding resins, even though statin appear likley safe. Reassure patients stopping for pregnancy won’t significantly affect their risk

Question 31

common SE of ezitimibe (and how does it work)? When is it not recommended?

Answer 31

inhibits cholesterol absorption, low potential for DI. Not in mod-severe liver dysfx. Common SE= pain in joints (arthralgia), diarrhea, fatigue dizzy, H/A

Question 32

common SE with fibrates, when can’t they be used, when is a good time to use?

Answer 32

upper GI disturbances, myalgia. Good for diabetic dyslipid. Not for renal or hepatic dysfx.

Question 33

what is different about gemfibrozil

Answer 33

can’t be used with statins whereas others just caution use and increased risk rhabdo, may increase repaglinide and rosiglitazone

Question 34

which statins are metabolized by what enzyme?

Answer 34

ALS= 3a4. fluva/rosuv=2c9, prava- not 450 at all so low pot for DI

Question 35

common SE with resins, how to take

Answer 35

GI (constipation, bloating, flatulence, increase TG). Take 1 hour before or 4-6hours after concurrent meds (might reduce their abso)

Question 36

what does doubling a statin dose do in general

Answer 36

lower LDL further 6%

Question 37

define systolic HF

Answer 37

LVEF less than or equal to 40%

Question 38

starting therapy for all patients with HF reduced EF, and what do you add on if no improvement or inadequate sx management

Answer 38

ace and BB, add aldosterone antag, then digoxin or [hydralazine+isosorbide dinitrate if can’t tolerate ace/arb

Question 39

when should you measure SCr, K and BP when starting arb/ace

Answer 39

baseline, 7-14days after therapy started, and 7-14 days after any increase (this is how long should be between titrations as well)

Question 40

what increase in SCr can you expect on starting ACE therapy

Answer 40

30%

Question 41

how quickly should beta blockers be titrated

Answer 41

q2-4w

Question 42

what diuretics are required in most HF patients

Answer 42

loop

Question 43

at what renal fx do thiazides have limited benefit

Answer 43

CrCl less than 50

Question 44

when should the last dose of diuretic be taken in the day

Answer 44

ideally take in AM, but if BID take before 4pm to reduce diuresis HS

Question 45

different between eplerenone and spironolactone

Answer 45

epler doesn’t produce gynecomastia, but has similar risk of hyperkal and renal dysfx

Question 46

omega 3 for heart health

Answer 46

modest reduction of CV events with low dose omega 3 PUFA (polyunsaturated fatty acid) ie 1g/day can be used. Caution as 3g or more daily is associated with increased bleed risk. Choose ration of EPA and DHA of 1:1.2 as this is what has been studied

Question 47

Which CCB should be avoided in HF

Answer 47

diltiazem and verapamil due to negative inotropic effects

Question 48

what is the only antiarrhythmic drug that should be used in HF

Answer 48

amiodarone. Recall digoxin is a rate control agent but can be used in HF as well. All other antiarrhymthics avoid

Question 49

how to treat HF preserved EF

Answer 49

focus on risk factors