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Thera XI > 03 Cardiovascular Review Helen > Flashcards

03 Cardiovascular Review Helen Flashcards

1
Q

What BP is considered HTN crisis?

A

> 180/120

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2
Q

What are the initial drug choices for Stage 1 HTN w/o compelling indications?

A

Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination

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3
Q

What are the initial drug choices for Stage 2 HTN w/o compelling indications?

A

2-drug combination for most (usually thiazide-type diuretic and ACEI, or ARB, or BB, or CCB)

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4
Q

What is the formula to calculate LDL?

A

LDL = TC - TG/5 - HDL. Invalid if TG > 400

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5
Q

What is the primary lipid goal?

A

Almost always LDL, however if TG > 500 –> risk of pancreatitis and TG becomes primary lipid goal at that point

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6
Q

What did the THRIVE study show?

A

Compared niacin/laropiprant (anti-flushing agent) to statin. No risk reduction with niacin combo but had increased risk of nonfatal but serious SE

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7
Q

What are the primary coagulation factors targeted for Unfractionated Heparin (UFH)?

A

Primarily inhibits Xa and IIa (1:1 ratio)

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8
Q

What are the primary coagulation factors targeted for Low Molecular Weight Heparin (LMWH)?

A

Xa&raquo_space; IIa (3:1 ratio). Enoxaparin, Dalteparin

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9
Q

What are the primary coagulation factors targeted for Specific Indirect Xa Inhibitors?

A

Xa. Fondaparinux

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10
Q

What are the primary coagulation factors targeted for Specific Direct Xa Inhibitors?

A

Xa. Rivaroxaban, Apixaban

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11
Q

What are the primary coagulation factors targeted for DTIs?

A

Specific IIa Inhibition. Argatroban, Lepirudin, Divalirudin, Dabigatran

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12
Q

What are the primary coagulation factors targeted for VKA?

A

II, VII, IX, X. Warfarin

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13
Q

What is Dabigatran (Pradaxa) approved for?

A

Non-Valvular AF!!! Inactivates both free and fibrin-bound thrombin. Does not require routine lab monitoring

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14
Q

What is Rivaroxaban (Xarelto) approved for?

A

Approved for Non-Valvular AF and VTE (pvt + tx). No direct effect on platelet function. Does not require routine monitoring

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15
Q

What are the contraindications for Rivaroxaban (Xarelto) use?

A

Patients with CrCl < 30 and severe liver disease, bleeding risk, pregnancy and lactation

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16
Q

What is Apixaban (Eliquis) approved for?

A

Non-Valvular AF

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17
Q

When should Apixaban (Eliquis) be avoided?

A

CrCl < 25. Severe hepatic impairment (Child-Pugh C)

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18
Q

What is the dosing of Apixaban (Eliquis) like?

A

5mg PO BID. 2.5mg PO BID if two of the following: > 80 yo, < 60kg, SCr > 1.5

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19
Q

What did the ARISTOTLE trial show?

A

Apixaban vs. Warfarin. Apixaban was more favorable

20
Q

What needs to be remembered about Dabigatran, Rivaroxaban, and Apixaban?

A

New oral anticoagulants are currently NOT approved for patients with valvular disease

21
Q

What is the general ACS approach?

A

Initial evaluation + initial therapy (MONA) PRN –> GO after the clot (antiplatelet + Antithrombin) + Antianginal to decrease HR, contractility, preload, afterload (BB, CCB, nitrate) –> Disease modification (ACEI, Statin +/- Aldosterone blocker)

22
Q

What is usually used when going after the clot?

A

Two antiplatelets +/1 P2Y, GP IIb/IIIa. Anticoagulation. +/- thrombolytics (STEMI) or PCI/CABG

23
Q

What is antiplatelet therapy like for DES (Drug Eluting Stents)?

A

ASA (high dose) for AT LEAST 3-6 months (3 after sirolimus/everolimus eluting stent, 6 after paclitaxel eluting stent) then low dose indefinitely. PLUS. P2Y at least 12 months

24
Q

What is antiplatelet therapy like for BMS (Bare Metal Stents)?

A

ASA high dose for AT LEAST 1 month, then low dose indefinitely. PLUS. P2Y UP TO 12 months

25
Q

What is antiplatelet therapy like for Non Invasive?

A

Low dose ASA indefinitely. P2Y UP TO 12 months

26
Q

What are the P2Y Receptor Inhibitors used?

A

Clopidogrel. Ticagrelor. Prasugrel. Ticlopidine

27
Q

Which P2Y Receptor Inhibitors need to be held 5 days before surgery?

A

Clopidogrel and Ticagrelor

28
Q

Which P2Y Receptor Inhibitors need to be held 7 days before surgery?

A

Prasugrel

29
Q

Which P2Y Receptor Inhibitors need to be held 10-14 days before surgery?

A

Ticlopidine

30
Q

Which P2Y Receptor Inhibitor is contraindicated in a patient with a history of TIA or Stroke?

A

Prasugrel

31
Q

What needs to be monitored for ALL P2Y Receptor Inhibitors?

A

Bleeding, H/H, Platelets

32
Q

What is Cangrelor?

A

Potent IV reversible and fast acting ADP receptor antagonist. Antiplatelet effects are immediate post bolus and maintained with continuous infusion. VERY short half-life, platelet function restored within 1 hour after stopping infusion

33
Q

What are some High Risk freatures?

A

Cardiac enzyme “leak”. Prolonged ongoing rest pain (> 20 minutes). Pulmonary edema. Dynamic ST changes > 1mm. New or worsening mitral regurgitation murmur. New S3 or rales. Hypotension (SBP < 90). DIABETES

34
Q

**What are the ABSOLUTE contraindications for Thrombolytics?

A

Prior ICH. Known structural cerebral vascular lesion (AVM). Known malignant intracranial neoplasm. Ischemic stroke w/in 3 months EXCEPT acute stroke w/in 3 hours. Suspected aortic dissection. Active bleeding or bleeding diathesis. Significant closed head or facial trauma w/in 3 months

35
Q

What are the Anti-Ischemics used?

A

NTG. BB. CCB. Ranolazine

36
Q

What is often used as a Statin for the disease modifying therapy?

A

Lipitor 80mg PO QD x16 weeks then to LDL goal

37
Q

What are the Aldosterone Receptor Antagonists used?

A

Spironolactone. Eplerenone

38
Q

What is the Pathophysiology of Chronic Stable Angina (CSA)?

A

Plaque build-up. Gradual obstruction of coronary artery lumen

39
Q

What is the Treatment Approach of Chronic Stable Angina (CSA)?

A

Reduce myocardial oxygen demand. Increase myocardial oxygen supply

40
Q

What is the Treatment of Chronic Stable Angina (CSA)?

A

Antiplatelet. Anti-anginal. Disease modifying

41
Q

What is the Pathophysiology of Acute Coronary Syndrome (ACS)?

A

Acute obstruction of coronary artery lumen. Acute plaque rupture (+/- vasospasm)

42
Q

What is the Treatment Approach of Acute Coronary Syndrome (ACS)?

A

Target active thrombosis. Reduce myocardial oxygen demand. Increase myocardial oxygen supply

43
Q

What is the Treatment of Acute Coronary Syndrome (ACS)?

A

MONA. Antiplatelet. Anticoagulant. Anti-anginal. Disease modifying

44
Q

What is the treatment approach for Chronic Systolic HF?

A

ALL patients w/o contraindications should be on: ACEI (or ARB) + BB –> All patients will require for fluid volume management: Loop +/- Thiazide diuretic –> To optimize symptoms and as CHF progresses: Digoxin, Spironolactone, Combo ACEI/ARB, ISDN/Hydralizine (esp in AA population) –> For refractory ischemia or HTN: Amlodipine, Long-acting nitrates

45
Q

What do you look at for Acute Decompensated HF (ADHF)?

A

If patient is warm and wet (use diuretics, Nesiritide, Vasolidators) or Cool and wet (congestion: use reduce fluids, inotropes)

46
Q

What are the only Antiarrhythmics to be used in patients with Structural Heart Disease (HF or LVH)?

A

Amiodarone! Dofetilide/Ibutilie. Ia

47
Q

What are the only Antiarrhythmics to be used in patients with Structural Heart Disease (CAD)?

A

Sotalol! III. Ia

Thera XI (16 decks)

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