Brainscape's Knowledge GenomeTM

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


See full index

BCPS > Acute Care Cardiology > Flashcards

Acute Care Cardiology Flashcards

1
Q

TIMI Score - What does it mean and what is a high score?

A

Thrombolysis in myocardial infarction - good at predicting a 30 day and 1 year mortality in patients with NSTE-ACS. High score is 3 or more and have greater benefit from LMWH, GP IIb/IIIa inhibitors and invasive strategies.

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

GRACE risk model

A

Predicts in hospital and post discharge mortality in patients with MI, greater than 140 you will want to treat with invasive strategies, less than ischemic strategies are adequate

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

NSTEMI

A

ST depression and T wave inversion - non specific changes but with positive biomarkers such as troponin

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

STEMI

A

ST segment elevation > 1mm above baseline on ECG, positive biomarkers

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

First thing you should do when suspicion of ACS

A

obtain ECG and aspirin within 10 minutes

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

Difference between UA and NSTEMI

A

NSTEMI will have + troponin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

STEMI treatment overview

A

immediate reperfusion with PCI or fibrinolysis - primary PCI within 90 minutes is the goal, if cannot be done in 120 minutes then door to needle time of 30 minutes for fibrinolysis

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

What adjunctive treatment with primary PCI

A

heparin or bival

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

when to do PCI or CABG?

A

high risk, early invasive approach or intermediate risk (ischemia gu8ided approach) with positive stress test

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

What are patients with NSTE - ACS treated on

A

treated on the risk of TIMI or GRACE score (higher, more likely to treat with LMWH or intervention), if low or intermediate score (< 4 for TIMI and < 140 for GRACE) you should treat with ischemic strategies

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

initial anti-ischemic and analgesic therapies

A

MONA-B

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

Morphine for ACS - frequency and what does it do

A

morphine 1-5 mg IV every 5-30 minutes - analgesia and decreased pain sympathetic adrenergic tone, induces vasodilation and preload/afterload reduction. slows the absorption of the antiplatelet therapy

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

Oxygen for ACS - when to give

A

only give if sao2< 90%, helps w pain

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

Nitroglycerin for ACS- use and CI

A

helps with coronary vasodilation and severe pulmonary edema, spray or SL tab every 5 mins for 3 doses, IV NTG if persistent chest pain, HF, or HTN, CI w/ sildenafil in 24 hours or tadalafil in 48 hours

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

Aspirin - what does it do and what to give if allergy

A

inhibits the platelet activation, clopid if asa allergy- mortality reducing!!!

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

beta blocker - which ones??

A

initiated in 24 hours if patients do not have signs of HF or low output, or asthma, or reactive airway disease, or second or third degree heart block, use CMB beta blockers in HFrEF - IV beta blocker could be harmful if patient has risk factors for shock (low BP, age >70, SBP<120, HR>110)

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

Who receives ASA and P2Y12 in ACS??

A

ALL patients, minority benefit from GP IIb/IIIa

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

what antiplatelet can you give if NSTE-ACS ischemic guided?

A

ASA, Clopid, Tica

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

what antiplatelet can you give if STEMI primary PCI?

A

ASA, clopid, prasugrel

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

what antiplatelet can you give if NSTE-ACS invasive?

A

ASA, clopid, prasugrel, ticagrelor

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

what antiplatelet can you give if STEMI + Fibrinolytic?

A

ASA, Clopid

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

when should patients stop taking ASA after ACS?

A

never - take it forever

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

when should patients stop taking DAPT?

A

after 12 months

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

what patients is prasugrel CI in?

A

history of stroke or TIA

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

when would you chose tica over clopid?

A

patients who are <75 yo with invasive NSTE or sTEMI

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

When would you chose prasugrel over clopid?

A

not at high risk of bleed, and PCI (think PCI = prasugrel!)

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

dose of clopid before a PCI or NSTE early invasive or ischemic guided

A

600mg followed by 75 daily

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

dose of PRA before a PCI

A

60mg followed by 10mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

dose of TIC before a PCI or NSTE invasive

A

180 followed by 90 BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

cyp enzyme with what P2Y12

A

clopidogrel - 2c19, increased bleeding with NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

clopid thoughts

A

not the best preferance for PCI, less bleeding risk than PRA and TICA, pro drug, LD 600mg, 5 day surgery hold time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

PRA thoughts

A

prodrug, 7 day surgery hold time, higher risk than with clopid, TIA/CVA boxed warning, ACS with PCI preferred, lowest half life, 60mg LD 10mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

TICA thoughts

A

give this one in NCSTE invasive, 180 LD and 90 BID, not a prodrug but reversible (only one), 3-5 day surg hold time, ACS managing or with PCI, warning of ASA> 100mg, severe hepatic disease is a CI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

cangrelor fun facts

A

do not give if with prasugral or clopidogrel because it has irreversible inhibition, associated with dyspnea, allows for a quick high degree of platelet inhibition with resolution of normal platelet function with one hour of ending the treatment, used as a bridge therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

IV GP IIb/IIIa inhibitors - when to give???

A

give to high risk patients with NSTE-ACS treated with UFH and pretreated with clopid or ticagrelor - most studies give GP and UFH - double bolus eptifbatide and high dose bolus tiro are clase I options for invasive strategies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

crcl adjustment for eptifbatide

A

crcl < 50 dec by 50% avoid in HD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

crcl for tirofiban

A

if crcl <60 then reduce by 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

dose of eptifbatide

A

180 mcg/kg if PCI; 2 mcg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

dose of tiro

A

PCI - 25 mcg/kg over 3 mins then 0.15 mcg/kg/min for 18 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

anticoag choice: STEMI PPCI

A

UFH, bival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

anticoag choice: fibrinolytic therapy

A

UFH, LMWH, fonda

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

anticoag choice: NSTE, early invasive strategy

A

enox, bival, UFH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

anticoag choice: NSTE, ischemic guided

A

enox, fonda, UFH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How long is UFH continued

A

48 hours or until PCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what is good about UFH?

A

not renally cleared!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

UFH dose

A

60u/kg, then 12u/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

fonda half life

A

17 hours - the longest of all of them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

dosing of fonda

A

2.5 mg SQ for the duration of the hospitaliztion or until the PCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

when is fonda CI

A

<30ml/min, no risk of HIT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

bival dosing PCI

A

0.75 mg/kg bolus, 1.75 mg/kg/hour IV - can extend to 4 hour infusion (primarily reserved for patient with HIT and PCI)

51
Q

enox in PCI

A

ok to use, as they generally have adequate anticoagulation, if last dose < 8 hour use the 0.3 mg/kg IVB, use 30mg/kg

52
Q

renal considerations for enox, fonda, bival

A

enox < 30 1mg/kg daily, fonda < 30 CI, bival < 30 reduce to 1mg/kg/hour and HD to 0.25 mg/kg/hr

53
Q

what anticoags are recommended with fibrinolytic?

A

enox, UFH, fonda

54
Q

how long should patients recieve anticoag after fibrinolytic?

A

48 hours, up to 8 days

55
Q

max enox dosing?

A

100mg for the first two doses of 1mg/kg for a pci, and 75mg for patients >75

56
Q

fonda with PCI dose

A

2.5 mg followed by 2.5 mg/day in 24 hours

57
Q

tenecteplase dosing

A

< 60 kg: 30 mg IVP, 60-69 kg 35 IVP, 70-79 40mg IVP, 80-89kg 45 IVP >/ 50 kg 50 IVP

58
Q

CI of fibrinolytic therapy

A

relative: DOAC, peptic ulcer, HX of ischemic stroke 3 mo before, CPR > 10 mins, pregnancy, dementia, vascular puncture, recent internal bleeding (2-4 weeks), BP>180/110 on presentation or history of poorly controlled HTN. absolute: hemorrhagic stroke, ischemic stroke, active internal bleed, aortic discection, trauma, spinal injury, uncontrolled htn

59
Q

who should continue bblockers indefinetly?

A

patients with EF< 40%

60
Q

who should contine ACEI indefinetly?

A

all patients with EF<40% or less and with HTN, DM, or CKD

61
Q

DAPT score (what favors prolonging?)

A

> / 2 favors prolonging DAPT

62
Q

who should recieve an aldosterone receptor blocker

A

who are recieving an ACEI and beta blocker after MI and who have LVEF < 40%

63
Q

CI for aldosterone

A

< 30, hyperkalemia

64
Q

who should get a statin??

A

everyone in the first 24 hours

65
Q

how should treat pain??

A

NOT with NSAIDs or COX2 inhibitors - higher risk of AE w/ CI, treat with apap, tramadol, narcotics

66
Q

what vax should be given to patients with CV

A

pneumo vax if > 65 and patients with high risk (smokers and asthma)

67
Q

antiplatelet discontinuation in patients with CABG

A

d/c GP I/II 204 hours, clopid/tica 3-5 days, prasugrel 7 days, urgent cabg - clopid/tica 24 hours before

68
Q

what is the preferred anticoag in AF

A

doac, warfarin DOC in patients with mechanical heart valve

69
Q

preferred P2Y12 in AF

A

clopidogrel, avoid prasugrel, tica may be ok - dc at 1 year in most patients

70
Q

older patient considerations with ACS

A

CABG>PCI, enox should be 0.75 mg/kg Q12H (not to exceed 75 mg for first 2 dfoses, bival instead of GII/III

71
Q

acute decomponsated heart failure - med related

A

nonadherence, excessive alcohol/drugs, recent ionotropic agents

72
Q

acute decomponsated heart failure - disease related

A

fluid restriction, MI, uncorrected high blood pressure, pulmonary embolus, AF or other arrhythmias, infections, acute CV disorders

73
Q

diagnosis of acute decomponsated heart failure

A

BNP is useful to support the diagnosis and establish the prognosis for ADHF (excluded when < 100 pg/ml for BNP and < 300pg/mL NT-proBNP) - may be elevated with older age, female, renal dys, cardio pulmnonary PEs, NT-proBNP preferred in patients with ARNI

74
Q

ADHF - diuretic therapy

A

recommended in patients with fluid overload, sodium restriction, ultrafiltration

75
Q

ADHF- inotropic therapy

A

considered to relieve patients of symptoms and help patients with LVEF esp if SBP <90, symptomatic hypotension, no response to or intolerance of IV vasodilators - may be considered in patients with fluid overload

76
Q

ADHF- vasodilator

A

considered in addition of IV loop diuretics to improve symptoms in patients with pulmonary edema or hypertension (better than ionotropic drugs when needing something in adjunct to diuretics)

77
Q

warm and dry

A

PCWP 15-18, CI > 2.2 - optimize guideline directed therapy (PO meds)

78
Q

warm and wet (pulmonary or peripheral conjestion)

A

PCWP > 18, CI > 2.2, IV diuretics that equals or exceeds preadmission dose +/- IV vasodilators for rapid relieve of pulmonary congestion or arterial in the absence of hypotension, adjunctive

79
Q

Cold and dry (hypoperfusion +/- orthostasis)

A

PCWP 15-18 and CI<2.2, if SBP<90 ionotrope, if SBP>90 IV vasodilator +/- IV vasopressor

80
Q

cold and wet (congestion and hypoperfusion)

A

IV diuretics + >/ 90 IV vasodilator
SBP < 90 IV ionotrope +/- IV vasopressor

81
Q

digoxin serum concentration

A

0.5-0.8, dig withdrawl has been associated with worse outcomes

82
Q

loop diuretics ADHF

A

most common diuretic in ADHF, lasix 40mg PO = lasix 20mg IV = bumex 1mg IV or PO = torsemide 20mg PO

83
Q

thiazides ADHF

A

add on only, weak

84
Q

acetazolamide ADHF

A

adjunct to loops, IV 500 AD

85
Q

diuretic resistance

A

ceiling effect of lasix 160-200 of IV lasix, add a second with a different mech - metolazone (30 min before loop) or chlorothiazide 250-500mg

86
Q

adverse effects of diuretics

A

electrolyte depletion, worsening renal function

87
Q

Vasodilators in ADHF

A

use when wet patient PWCP > 18, use with diuretics, use in preference to ionotropic therapy when adequate BP (ex: nitropresside and nitroglycerin)

88
Q

venodilators

A

limits ischemia and helps preserve the cardiac tissue, produces rapid symptomatic benefit by reducing pulmonary congestion,

89
Q

nitroglycerin

A

used for those with hypertension, coronary ischemia, and mitral regugitation - tachyphylaxis may develop within 24 hours and may develop resistance - avoid inpatients with symptomatic hypotension - preferential venous vasodilator, greater than arterial vasodilator, arterial vasodilator at high doses

90
Q

nitroprusside

A

alternative in patients with elevated SVR and low CO, used in patients without end organ damage, reverse pulmonary hpertension, avoid use inpatients with actived ischemia/ACS because of risk for coronary steal syndrome - avoid in patients with symptomatic hypotension, balanced arterial and venous dilation

91
Q

ionotropic agents

A

used in hypoperfusion (cold), CI <2.2,confirm adequate filling pressures before administering ionotropic therapy

92
Q

when is milrinone favored

A

to avoid tapering or d/c home b blocker, when pulmnoary artery pressures are high

93
Q

when is dobutamine favored

A

severe hypotension, brady, renal impairment, renal impairment

94
Q

dobutamine mechanism

A

beta 1 agonist, increases CO, slight peripheral vasodilation

95
Q

milrinone

A

PDE inhibitor, inhibits cAMP breakdown in heart to increase CO and vascular smooth muscle SVR

96
Q

is milrinone renal or hepatic

A

renali

97
Q

is dobutamine renal or hepatic

A

hepatic

98
Q

vasopressin antagonist

A

add on therapy to address the aggressive diuresis and not as initial or adjunctive therapy for fluid removal, strict free water restriction

99
Q

tolvaptan

A

approved for clinically significant hyponatremia associated with HF

100
Q

dose of tolvaptan and CI

A

15 mg, CYP3A4

101
Q

lidocaine mexiletine, phenytoin

A

ventricular arrhythmia Ib (fast), dec QT interval

102
Q

disopyramide, quinidine, procainamide

A

Ia (intermediate), inc QRS, inc QT, atrial and ventricular arrhythmias

103
Q

flecanide, propafenone

A

Ic (slow), inc QRS, atrial and ventricular arrhythmias

104
Q

metoprolol, esmolol, atenolol

A

class II bet blockers, dec HR, inc PR, atrial arrhthmias, ventricular arrhythmias

105
Q

diltiazem, verapamil

A

Class IV calcium channel blockers, vent and atr arrhtyh, dec HR, inc PR

106
Q

amio, dronedarone, sotalol, dofetilide, ibutilide

A

class III potassium channel blockers, inc QT, atr, ventr arrhythmias

107
Q

ventricular arrhythmias - asymptomatic treatment

A

beta blockers treatment for survivors of MI and HFrEF

108
Q

ventricular arrhythmias - symptomatic treatment

A

beta blockers considered for a therpautic trial, non DHP CCBs may be considered as an alternative to a beta blocker

109
Q

flecanide / propafenone CI

A

not recommended in ventricular contractions

110
Q

sotalol CI

A

should be used with caution in patients with CKD and avoided with prolonged QT intervals

111
Q

meds used for defibrillator implantation

A

amio, sotalol, beta blockers

112
Q

heart failure classes of agents to avoid in arrhythmias

A

avoid Ia and Ic agents - amio and dofetilide have a neutral effect on mortality in patients with LV dysfunction after an MI, dronedarone is CI in patients with symptomatic HF

113
Q

acute MI things to avoid in arrhythmias

A

1a and Ic agents (flecanide), amio and dofetalide have a neutral effect

114
Q

antidote for CCB toxicity (brady)

A

calcium

115
Q

IV drugs for hypertensive emergency

A

nitroprusside, nitroglycerin, hydralazine, enalaprilat (dont use in MI), fenoldopam, nicardipine (CI in aortic stenosis), clevidipine (caution with bblocker use, tachy, rebound htn)

116
Q

agent preferred - acute aortic dissection

A

labetalol, esmolol - beta blocker should be given before vasolilator if needed for BP control or to prevent the reflex tachy or ionotropic effect

117
Q

agent preferred- acute coronary syndromes

A

esmolol, NTG, labetalol, nicardipine - CI betablocker with pulmonary edema

118
Q

agent preferred- acute pulmonary edema

A

clevidipine, ntg, ntp, beta blockers Ci, NTG preferred

119
Q

agent preferred - eclampsia or preeclampsia

A

labetalol, nicardipine, hydralazine, required BP lowering to < 140 mmHG within the first hour - acei/arb/ntp ar CI

120
Q

perioperative HTN - preferred agent

A

clevidipine, esmolol, nicardipine, NTG

121
Q

pheochromocytomoa, post-carotid, endarterectomy

A

clevipine, nicardipine, phentolamine, requires rapid lowering of bp

122
Q

acute intracranial hemorrhage

A

nicardipine, clevidipine, labetalol (avoid hydral, ntg, ntp as they can worsen the ischemia)

123
Q

acute ischemic stroke

A

no preference of the agent

BCPS (1 decks)

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