Cardio

Question 1

What test are used in HF?

Answer 1

Echocardiogram
CXR: cardiomegaly
BNP: > 500 = exacerbation
Weight: salt/fluid retention
PCWP: >20 = fluid retention - give diuretic

Question 2

What do you do in Acute decompensated HF?

Answer 2

First stabalize the patient (SOB/vol overload) give o2 if <90%
If not responded to loop give NTG
if EF really low give milrinone IV
if sever HTN nitroprusside
if shock give IV vasopressors (dopamine, dobutamine)
After stabalizing the patient and upon discharge give ver low dose ARNI + BB later on

Question 3

Five must haves in HF?

Answer 3

Vasodilator (ARNI or ACEi/ARB + BB (Carvedilol, metoprolol succinate, bisoprolol), K sparing diuretics, SGLT2 ,+/- loop

Question 4

ARNI (entresto)

Answer 4

Neprilisyin inhibitor
Side effects: Hypotension Hyperkalemia Angioedema
C/I: previous angioedema, SBP < 100

Question 5

ACEi

Answer 5

Block ang 1-2
Side effects:
CAPTOPRIL
C: cough
A: angioedema
P: potassium
T: taste change
O: orthostatic hypo
P: pregnancy
R: rash
I: inc K
L: leukocytosis: captopril

Washout period 36 hours

Question 6

Beta blockers

Answer 6

Adverse effects:
BLOCKER
B: bradycardia, bronchospasm
Inc lipids, dec in libido
Orthostatic hypo
Constriction of peripheral vasculature
Hyperkalemia non selective BB
Exhaustion, emotional depression
Reduced recognition of hypoglycemia

Question 7

Digoxin brand name? Goal? Toxicity?

Answer 7

Lanoxin, lanoxicaps, digitek
Inhibits NA/K ATPase
Never use in HFpEF
Protect liquid and IV from light
Goal for CHF: 0.5-0.8 toxicity seen >2
Check levels at steady state so after 7 days up to 3 weeks with renal

Question 8

Drugs that increase digoxin toxicity?

Answer 8

VAQC
Verapamil: reduce dose by 50-70%
Amiodarone: reduce dose by 50%
Quinidine: reduce dose by 33-50%
Clarithromycin

Question 9

What meds increase K?

Answer 9

NAB K
NSAIDs
ACEi/ARB/Entresto
Bactrim
K sparing diuretics

Question 10

Meds that cause edema?

Answer 10

NSAIDs
Gabapentin
Pregabalin
Glitazones
Gliptins
CCB like amlodopine

Question 11

What is the MAP formula?

Answer 11

[SBP + 2 (DBP)]/3

Question 12

Meds that increase BP?

Answer 12

Estrogen oral contraceptives, tamoxifen
steroids also inc glucose
NSAIDs/COX2 inhibitors
All adrenergics: b agonist (albuterol)
SNRIs inc norepi effexor (venlafaxine) pristiq (desvenlafaxine) cymbalta (duloxetine), savella (milnaxipran)
Migraine meds: triptans and ergots
ADHD amphetamines
OTC/herbs
Others: epogen, tacrolimus (prograf) cyclosporine

Question 13

Which loop diuretic does not cause sulfa allergy ?

Answer 13

Ethacrynic acid (edecrin)