Treatments Flashcards
(108 cards)
0
Q
What is the treatment for rheumatic fever with carditis?
A
IM pen g every 4 weeks for 10 years or until 21
1
Q
What is the treatment for rheumatic fever without carditis?
A
IM pen G every 4 weeks for 5 years or until 21 years old
2
Q
What is the treatment for rheumatic fever with carditis and persistent valvular HD?
A
IM pen G q 4 weeks for 10 years or until 40
3
Q
What is the diagnostic criteria for infective endocarditis?
A
Duke’s criteria
4
Q
How do you diagnose an AV fistula?
A
Doppler ultrasound
5
Q
What is the treatment of AVF?
A
Surgery
6
Q
What is the treatment for stable chronic angina?
A
Beta blocker CCB (if Bb alone is not working) Nitroglycerin Aspirin Statin
7
Q
What is first line treatment for HTN?
A
Hydrochlorothiazide
8
Q
What is used for angina if Bb are contraindicated?
A
CCB
9
Q
When is ranolazine used?
A
When patients are on Bb, CCBs, and nitrates, but still have recurrent symptoms of angina
10
Q
What is the treatment for a-fib in an unstable (hypotension, AMS) patient?
A
DC cardioversion
11
Q
What is the rule for anti coagulation in A-fib?
A
Anticoagulate if over 48 h
Anticoagulate with CHADS2 score greater than 2
12
Q
What is the CHADS2 score?
A
CHF - 1 HTN - 1 Age over 75 -1 Diabetes -1 Previous stroke -2
13
Q
What’s the rule for cardioversion in Afib?
A
Only if:
New onset (stable and less than 48 h or unstable)
TEE done
After 3-6 weeks of anti coagulation therapy
14
Q
What is used for rate control in Afib?
A
Bb
CCB
Digoxin
15
Q
When is digoxin used for rate control in A-fib?
A
When the patient also has CHF or if they can’t tolerate bb or CCB
16
Q
What is the treatment for patients with A-fib over 48 h who are stable?
A
Rate control for 3-4 weeks and anticoagulation
17
Q
What is the treatment for SVT?
A
Carotid sinus massage
Adenosine - slows AV nodal conduction and interrupts the reentry pathway
18
Q
What is the treatment for AAA less than 5 cm?
A
Observe
19
Q
How do you diagnose AAA?
A
Abdominal US
20
Q
Who should be screened for AAA?
A
Men 65-75 who smoked
21
Q
What is the treatment for AAA over 5.5 cm?
A
Surgical repair
22
Q
What is the treatment of PAD?
A
Exercise to develop collateralz
Aspirin, Cilostazol, thromboxane inhibitors
23
Q
What are the indications for surgical treatment of aortic stenosis?
A
Syncope Angina Dypsnea Poor LV systolic function LVH greater than 15 mm Valve area less than .6 cm squared Abnormal response to exercise
24
What is the first step in treating symptomatic bradycardia?
IV atropine
25
What is the diagnostic test of choice for aortic dissection?
CT angiography
26
What can be done if CT Angio is contraindicated in aortic dissection?
MRA or TEE
27
What is the treatment for aortic dissection?
IV labetolol
28
What is the treatment for a Type A dissection?
Surgery! Plus IV labetolol
29
When should vasodilators be considered in the management of aortic dissections?
After beta blockers only if bp still needs to be lowered
30
What is the best nonpharm treatment of HTN in an obese patient?
Weight loss (5-25 points per 10 kg loss)
31
What is the best nonpharm treatment of HTN in an nonobese patient?
DASH diet (8-14)
32
What is the third best nonpharm treatment for lowering bp?
Exercise 30 minutes daily (4-9 points)
33
What is the treatment for Prinzmetal's angina?
Nitrates or CCB
34
How do you diagnose vasovagal syncope?
Upright tilt table test
35
How do you diagnose cardiac syncope?
Holster monitor for arrythmias
36
What is diagnostic of carotid sinus hypersensitivity syndrome?
Carotid sinus massage that creates asystole greater than 3 seconds
Or bp drop of greater than 50
37
What is the treatment for dilated cardiomyopathy?
CHF treatment with ACEi/ARBS and beta blockers
| Consider ICD if EF is less than 35%.
38
How is dilated cardiomyopathy diagnosed?
Echo showing diffuse enlargement of ventricles and hypokinesia
39
What is the treatment for PAD?
Aspirin
Statin
Supervised exercise program for 12 weeks for 30-45 minutes at least 3 times a week
40
What is the treatment for symptomatic premature atrial contractions?
Beta blockers
41
What is the drug of choice for patients with and essential tremor and HTN?
Propranolol
42
What is the treatment for acute MI?
```
ASA
beta blockers
Morphine
Nitrate
Oxygen
```
43
If a patient with an acute MI is in heart failure or cardiogenic shock what medication should not be given?
What med should be given instead provided the patient is not hypotensive?
Beta blocker
An ACEi
44
When should PCI be performed in acute MI?
Within 90 minutes
45
What is indication for tPA if patient presents with acute MI?
Greater than 90 minutes but less than 3 hours of onset of chest pain
No CI to tPA (bleeding, hemorrhagic shock/stroke, in shock, HF)
46
What are the long term treatments of MI?
```
ASA
ACEi (reduce ventricular remodeling)
Bb
High dose statin
Clopidogrel (if PCI was performed)
```
47
What is the best predictor of survival after MI.
LV Ejection fraction
48
What is the most common complication following an MI and most frequent cause of death?
Arrythmias
49
What is the TIMI score?
```
Risk score for Unstable angina or NSTEMI
Age over 65 - 1
ASA use in past 7 days - 1
Known CAD (stenosis over 50%) - 1
Greater than 3 CAD risk factors - 1
Severe angina (more than 2 episodes in the last 24 h)
ST deviation greater than .5 mm
Positive cardiac markers
```
50
What is the treatment for stable angina, unstable angina
Clopidogrel
| heparin or enoxaparin
51
What is the indication for IV heparing, angiography and possible PCI?
St changes greater than 1 mm
TIMI score greater than 3
Troponin elevation
52
What is the treatment for second degree AV block type I?
Stop the offending agent
| Atropine
53
What is the treatment of second degree AV block type II?
Pacemaker
54
What is the treatment of third degree block?
Pacemaker
55
What is th treatment of sick sinus syndrome?
Pacemaker!
56
What is the treatment for hypertensive urgency?
Oral anti hypertensives with the goal of lowering BP over 24-48h
57
What is the treatment of hypertensive emergency?
IV labetolol, hydralazine, or nicardipine without lowering BP mor than 25% over first 2 hours
58
What is the treatment of supra ventricular tachy with unstable vitals?
DC cardioversion
59
What is the treatment for long QT?
Propranolol
And pacemaker if symptomatic
Also, no vigorous exercise
60
What is the management of asx first degree heart block?
Observation
61
What is the management of symptomatic first degree heart block?
24 h holder monitor
62
When is the use of spironolactone most useful?
```
In class III and IV HF
In patients with ascites from cirrhosis
```
63
What is the treatment for stable wide complex VT?
IV Amiodarone
64
What is the treatment of unstable arrythmia?
Synchronized cardioversion
65
What is the treatment for stable SVT?
Carotid sinus massage
| Rate control
66
What do you do if you suspect a myocardial contusion?
EKG to look for dysrhythmia or LBBB
67
What is the first line treatment for HOCM?
Beta blockers because decrease heart rate and allow for more filling time as well as decree angina
68
What test would you order to detect a recurrent occlusion of the coronary vessels?
Ck-MB because it rises and falls rapidly so it may have risen again if recurrent occlusion has occurred
69
What is the first line treatment for dyslipidemia?
A trial of 12 week diet and exercise program
70
At what level LDL is drug therapy considered if the patient has CAD?
LDL over 130
71
At what level LDL should lifestyle modification be considered if the patient has CAD?
LDL 100
72
At what level of LDL should lifestyle modifications be considered in a patient with 2 or more risk factors?
Greater than 130
73
At what level of LDL should medical therapy be considered in a patient with 2 or more risk factors?
LDL over 160
74
At what level of LDL should lifestyle modifications be considered in a patient with 0-1 risk factors?
LDL greater than 160
75
At what level of LDL should medical therapy be considered in a patient with 0-1 risk factors?
Greater than 190
76
What is the LDL goal for someone with CAD?
Under 100 or under 70
77
What is the LDL in someone with 2 or more risk factors for CAD?
Under 130
78
What is the goal LDL in someone with 0-1 risk factors?
Under 160
79
What are the CAD risk equivalents?
AAA
PAD
DM
symptomatic CAD
80
What is the treatment of pre hypertension?
120-139/80-89
| Lifestyle modifications: weight loss, dash diet, exercise, low sodium, low EtOH
81
What is the treatment for stage I HTN.
140-159/90-99
| Thiazide diuretics
82
What is the treatment for stage 2 HTN?
Greater than 160/100
| Two drug combo
83
What are the meds of choice for isolated systolic HTN?
Diuretics
ACEi
Dihydropyridine calcium channel blockers
84
What is the treatment of secondary HTN due to primary renal disease?
ACEi
85
What is the treatment of secondary HTN due to renal artery stenosis?
ACEi in unilateral disease
| Angioplasty or stenting
86
What is the treatment of secondary HTN due to pheochromocytoma?
Surgical removal of tumor with alpha and beta blocker
87
What is the treatment for aortic stenosis?
```
Aortic valve replacement if:
LVH greater than 15 mm
Valve area less than .6 cm squared
Abnormal response to exercise
Undergoing cabg
```
88
What is the treatment for aortic regurgitation?
Vasodilator therapy (ACEi or dihydropyridines)
89
How do you treat mitral stenosis?
Antiarrythmics (Bb or digoxin) for symptomatic relief
| Mitral balloon valvotomy and valve replacement
90
What is the treatment for mitral regurgitation ?
Antiarrythmics
Nitrates and diuretics if have left atrial enlargement
Valve replacement
91
What assesses the severity of mitral regurgitation?
Angiography
92
What is the treatment for Dressler's syndrome?
NSAIDs
| Glucocorticoids
93
Which antiarrythmics are best post-MI.
Class iB = sodium channel blockers
| Lidocaine, mexilitine, tocainamide
94
What is the treatment for Afib in a person with WPW.
Procainamide
95
What is the treatment of infective endocarditis?
If pen allergic: give IV vanc
| If penicillin sensitive strains: give IV pen g or IV ceftriaxone for 4 weeks
96
What is the recommended initial tx for stable ventricular arrythmia?
Loading dose of IV amiodarone
97
What is the treatment for rate control in A-fib?
Metoprolol or esmolol
| Verapamil or diltiazem
98
How do you initially stabilize an acute MI?
```
Oxygen
ASA (325)
Clopidogrel
Beta blocker (unless hypotension, Brady, CHF, heart block)
Nitrates
Statin
Anti coag
percutaneous coronary angioplasty within 90 minutes or thrombolysis within 120 minutes
```
99
What do you do if the patient with an acute MI continues to have pain, HTN or heart failure after initial tx?
IV nitroglycerin
100
What do you do if the patient with an acute MI continues to have severe pain?
IV morphine
101
What do you do if the patient with an acute MI continues to have unstable bradycardia ?
IV atropine
102
What do you do if the patient with an acute MI continues to have pulmonary edema?
IV furosemide
103
What should be done to asses for CAD in someone with intermediate risk?
Exercise ECG with or without myocardial perfusion imaging
104
How do you assess for CAD in someone unable to exercise?
Pharmacological stress test
105
What is the first step in assessing CAD risk in someone who has intermediate risk?
ECG
106
Who should be on clopidogrel?
Post PCI
| Patients with unstable angina or NSTEMI
107
How do you confirm an aortic dissection?
Contrast CT
| TEE
