Cardiac Cases Flashcards
INR foal for an atrial fib patient?
2-3
INR goal for a patient with valve replacement?
2.5-3.5
T/F. Coumadin failure is defined as a VTE while a patient is taking coumadin.
False - the patient MUST be on coumadin at a THERAPUTIC LEVEL
A shit load of antibiotics have interactions with coumadin. Name 2 antibiotics that have MINIMAL interactions with coumadin.
Cephalexin and clindamycin
What is the reversal agent for coumadin?
Vitamin K
What foods are high in vitamin K?
Basically green vegetables.
Banana, chickpeas, fuit, oil, peppers, and tomatoes also have some vitamin K
What advantages does warfarin have over DOAC’s?
Cheap
Best for ESRD
Must use in valvular AF
What are the drawbacks to warfarin?
Many food and drug interactions
Narrow therapeutic window
What are the advantages of DOAC’s?
Few interactions
Less ICH and fatal bleeding events
No monitoring needed
Bridging not needed due to rapid onsent/offset
What are the drawbacks to DOAC’s?
Costly
Costly/unavailable reversal agents
Higher rate of GI bleeding
Which anticoagulants require renal dosing?
All of them
Does Coumadin have a reversal agent? If so, what is it?
Yes, Vitamin K
Does Dabigatran (Pradaxa) have a reversal agent? If so, what is it?
Yes, Praxbind
Does Rivaroxaban have a reversal agent? If so, what is it?
Yes - AndexXa
Does Apixiban (Eliquis) have a reversal agent? If so, what is it?
Yes - AndexXa
Does Savaysa have a reversal agent? If so, what is it?
No
What are the CrCl limitations to Savaysa?
Do not use in patients with a CrCl >95q
What is the CHA2DS2-VASc score?
CHF - 1 point HTN - 1 point Age >74 - 2 points DM - 1 point Stroke - 2 points Vascular disease - 1 point Age 65-74 - 1 point Sex category - female = 1 point
Score of 2 or greater indicates need for anticoagulation
What is the strict HR goal for atrial fib patients?
Lenient goal?
Strict - < 80
Lenient - <110
What is the exertional HR goal for atrial fib patients?
<115
What options are available for rate control for atrial fib?
Beta blockers, CCBs.
What are some electrolyte side effects of hydrochlorothiazide?
Hyponatremia
Hypokalemia
Hypomagnesemia
Hyperurecemia
What is the blood pressure goal in a patient with HTN and DM?
130/80
Need to keep BP high enough to perfuse kidneys
What are the ideal medications used to treat HTN in a diabetic?
Diuretics, ACEi’s/ARBs, CCBs.
A 32 year old has a blood pressure of 136/70. Should you add or change their HTN medications?
No - In the 30-59 year old age group, there is only strong evidence to reduce diastolic BP to reduce CVA, HF, and mortality risk.
What is the most common side effect of amlodipine (Norvasc)?
Peripheral edema
What is the usual starting dose for amlodipine (Norvasc)?
5mg
In what patient population are CCBs more effective in lowering BP?
Blacks
What are the life threatening side effects of amlodipine (Norvasc)?
Angina, MI, hypotension, pulmonary edema.
In what patient population are ACEi’s more effective in lowering blood pressue?
Whites
Metabolism of CCB’s occurs where?
Liver
Where does metabolism of ACEi’s occur?
Trick question - it does not get metabolized, excreted as an unchanged drug.
What are some common side effects to lisinopril?
Hyperkalemia, increased creatinine, dizziness, cough
What are some life threatening side effects of lisinopril?
Angioedema, cholestatic jaundice (can progress into fulminant hepatic necrosis), hyperkalemia, ARF, hypotension, hypersensitivity reactions.
What is the usual starting dose for lisinopril?
10mg
Is metoprolol tartrate or metoprolol succinate indicated for treatment of HF?
Succinate (long acting)
