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Acute Cardio Flashcards

1
Q

when do you use TIMI score?

A

NSTEMI 30day and 1yr death risk

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2
Q

how to calculate TIMI score?

A

> 65 yo
3+ risk factors for CAD
prior coronary stenosis 50% or >
STEMI
angina twice in past 24 hrs
asa in previous 7 days
elevated cardiac biomarker

0-2 = low risk
3 = intermediate
4+ = high risk

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3
Q

TIMI score cutoff to see benefit of treatment

A

3 or more

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4
Q

time goals with STEMI

A

90mins PCI from first medical contact

if cannot do PCI in 120mins then door to needle of 30 mins for lytic therapy

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5
Q

reasons MONA should get rid of morphine

A

morphine may slow absorption of anticoagulants
increased risk of death
reduces time to peak antiplatelet activity

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6
Q

contraindications to Nitro drip

A

SBP < 90 or 30 less than baseline
HR < 50 or >100 w/o symptomatic HR
Right ventricular infarct
PDE5 inhibitors

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7
Q

beta blockers for HFrEF

A

toprol
carvedilol
bisoprolol

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8
Q

Which P2Y12 should not be used in strike or TIA?

A

Prasugrel

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9
Q

Which P2Y12 for ischemia guided therapy in NSTEMI?

A

Plavix or Effient

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10
Q

ACS p2Y12 dosing

A

Plavix 600mg, then 75 daily
Effient 180mg then 90mg BID
Prasugrel 60mg then 10mg daily

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11
Q

Which P2Y12 is reversible bc it’s not a pro drug?

A

Ticagrelor

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12
Q

Ticagrelor drug interactions

A

3A4 drugs
DNE 40mg simvastatin/lovastatin
Limit aspirin { 100mg
Monitor digoxin concentrations

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13
Q

Ticagrelor side effects

A

Dyspnea
Bradycardia

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14
Q

How many days do you hold plavix before surgery?

A

5 days

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15
Q

Cangrelor use setting

A

Can be used when NPO and PCI only really

Must be loading dose and infusion

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16
Q

GP IIb/IIIa inhibitors use

A

Eptifibatide (Integrilin)
Tirofiban (Aggrastat)

Last line high risk pts not treated appropriately with plavix
Treat at time of PCI, not before
Renal dose adjustments, CrCl { 60 cut in half

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17
Q

Bivalirudin

A

Direct thrombin inhibitor
Can be used with HIT history
Given by bolus and infusion at fixed rate
Continue until end of PCI

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18
Q

Anticoagulant for ischemia guided ACS therapy

A

Enoxaparin, Fondaparinux, heparin

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19
Q

Anticoagulant for PCI (invasive strategy) ACS

A

Heparin
Enoxaparin
Bivalirudin

If used Fondaparinux must give extra heparin before PCI

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20
Q

Lovenox dosing with PCI

A

1mg/kg sq 12h
If 8-12 hrs before PCI then give extra 0.3mg/kg IV enoxaparin - also if only had one sq dose before PCI

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21
Q

Time to perform PCI or switch to fibrinolytic therapy

A

120 mins
Door to needle 30min goal

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22
Q

Fibrinolytic dosing in STEMI

A

Heparin 60u, then 12u/kg/hr, 1.5-2x base
Lovenox 30mg IV, 15min later do 1mg/kg sq q12h, max 100mg first two doses
Fondaparinux 2.5mg IV then SQ next day

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23
Q

Fibrinolytic dosing in STEMI

A

Heparin 60u, then 12u/kg/hr, 1.5-2x base
Lovenox 30mg IV, 15min later do 1mg/kg sq q12h, max 100mg first two doses
Fondaparinux 2.5mg IV then SQ next day

24
Q

Fibrinolytic dosing

A

Alteplase 15mg over 2mins, then 50mg over 30mins, then 35mg over 1hr, total 100mg

Reteplase 10u, then 10u in 30 mins

Tenecteplase weight based, 30-50mg IVP

25
Fibrinolytic contraindications
Bleeding strokes Ischemic stroke in last 3mo Bleed BP over 180/110 Long CPR Pregnancy Dementia Oral anticoagulants
26
How to calculate DAPT Score
Age over 75 -2 Age 65-74 -1 1 pt for each.... Tobacco, DM, MI, small stent, drug eluting stent 2 pts each for CHF or LVEF less than 30%, PCI saphenous graft
27
DAPT Score cutoff for extended DAPT tx
2 or greater
28
anticoagulant of choice for mechanical heart valve and severe mitral stenosis
warfarin
29
medications that may affect BNP and lab preferred in this case
ARNI's prefer NT-proBNP
30
diuretic conversions based on furosemide 40mg tablet
furosemide 20mg IV torsemide 20mg PO bumetanide 1mg IV bumetanide 1mg PO
31
ceiling effect on diuretic doses
furosemide 160 - 200mg IV bumetanide 1-2mg IV torsemide 10-20mg PO
32
duration of amiodarone affects - hyperthyroidism
6 months-ish to pull out of fat and eliminate half lifes some will be kept in tissues for life
33
34
Drugs of choice for AFib over 7 days and cardioversion
Dofetilide Amiodarone Ibutilide
35
Drugs of choice in short AFib (less than 7 days)
Flecainide Propane one Dofetilide Ibutilide Amiodarone
36
QRS width to determine narrow it wide
120ms
37
38
39
hypertensive emergency vs urgency
emergency shows signs of end organ damage or worsening
40
HTN emergency goals
lower MAP by 25% first hour (no more than) then < 160/110mmHg over 2-6 hours normal range in 24-48 hrs
41
contraindications for lowering HTN emergency slowly
pheochromocytoma crisis eclampsia aortic dissection
42
HTN crisis: aortic dissection DOC
Labetalol Esmolol SBP less than 120 in 20 mins
43
HTN Crisis: Acute coronary syndrome DOC
Esmolol Nitroglycerin Can do labetalol or nicardipine
44
HTN Crisis: pulmonary edema DOC
Clevidipine Nitroglycerin Nitroprusside Beta blockers contraindicated
45
46
HTN Crisis: renal failure DOC
Clevidipine Fenoldopam Nicardipine
47
HTN Crisis: eclampsia DOC
Labetalol Nicardipine Hydralazine
48
HTN Crisis: perioperative HTN
Clevidipine Esmolol Nicardipine Nitroglycerin
49
HTN Crisis: pheo DOC
Clevidipine Nicardipine Phentolamine Make it quick lowering
50
HTN Crisis: intracranial hemorrhage
Continuous infusion Avoid hydralazine, nitroglycerin and nitroprusside
51
Cautions with clevidipine
Heart failure Beta blocker use with it Reflex tachy Rebound HTN Pancreatitis or lipid disorders
52
Nicardipine cautions
Reflex tachycardia N/V Headache Flushing Angina/MI
53
Fenoldopam cautions
Contraindicated in increased ocular and intracranial pressure
54
Nitroprusside cautions
ART line required Cyanide toxicity Contraindicated in renal and hepatic failure
55
Nitroglycerin cautions
Use in ACS or pulmonary edema Do not use if volume depleted Tachyphylaxis
56
Hydralazine caution
Slower onset and long duration means less desirable first choice in crisis Reflex tachycardia HA, flushing Contraindicated in MI, angina, elevated ICP, aortic dissection
57
Enalaprilat cautions
Lasts 12-24 hrs and doses not easily titrated Can cause renal failure and High K

Notes (14 decks)

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