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PEBC > Cardio > Flashcards

Cardio Flashcards

1
Q

Chronic stable angina sees ____ changes in ECG and ___ changes in troponin

A

no changes in ECG or troponin

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2
Q

unstable angina ECG and troponin

A

ST depression, no changes in troponin

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3
Q

what is the differentiating factor between ACS and nagina pectoris

A

ACE lasts >5 min + not relieved by NTG

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4
Q

what is the acute sx tx for stable angina

A

NTG up to 3x

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5
Q

what is the chronic symptom tx for stable angina

A

BB (often 1st line, esp in HF), DHP-CCBs (FANN - 1st line for uncomplicated ptx)

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6
Q

BB + ____ CCBs = avoid due to risk bradycardia, AV node block, fatigue

A

NDHP

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7
Q

to decrease mortality for stable angina, what should be started? what should be stopped?

A

ACEi/ARB, ASA (clopi if ASA intol), HD statin to target LDL <1.8
Stop HRT and NSAIDs

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8
Q

what should be started for treatment of NTEMI or unstable angina?

A

BMONAH

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9
Q

if a NSTEMI or UA patient is high risk, what should be considered?

A

angioplasty

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10
Q

what should be started within 24hrs post NSTEMI, UA, STEMI

A

ACEi

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11
Q

what should be started for treatment of STEMI?

A

MONAH (BB once hemodynamically stable)

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12
Q

How long should anticoagulation be done in STEMI

A

start heparin in ER, continue for 48hrs or d/c at end of PCI procedure

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13
Q

what are some indications for PCI in STEMI

A

PCI facility available, cardiogenic shock, >75yrs, CI to thromboysis

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14
Q

if a thrombolysis is done for STEMI, what should be given after?

A

ACE, DAPT (ASA + clopi) F 1 yr, heparin for 48hrs, DVT prophylaxis until ambulatory

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15
Q

what are some post STEMI/NSTEMI management drugs?

A

ACEi, BB, HD statin
DAPT F1yr (clopi for thrombolysis, ticagralor for PCI)

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16
Q

which heparin is prefered in severe renal impairment

A

UFH

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17
Q

which LMWH is the DOC for STEMI w/ fibrinolysis

A

enoxaparin

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18
Q

which anticoagulant is the DOC for STEMI + PCI

A

UFH

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19
Q

which anticoagulant is the DOC for NSTEMI/UA as part of BMONAH

A

enoxaparin

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20
Q

which antiplatelets are reversible

A

clopi and prasugrel

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21
Q

clopi, ticagralor are metabolized by which CYP enzymes

A

clopi = 2C19
ticagralor = 3A4

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22
Q

what is an AE of clopidogrel

A

rash

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23
Q

what is an AE of ticagralor

A

dyspnea

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24
Q

what are the 2 high potency statins

A

rosuvastatin, attorvastatin

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25
Q

if a patient develops HIT and severe renal impairment, what is the best choice for anticoagulation in DVT?

A

argatroban- no renal adjustment required

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26
Q

PE sx

A

dyspnea, pleuritic pain, cough, syncope, tachypnea

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27
Q

what is elevated in PE and DVT

A

ESR/CBW and D dimer

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28
Q

what is heparin induced thrombocytopenia

A

low platelet blood counts due to heparin tx which predisposes pts to thrombosis (thrombin generation)

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29
Q

what is type 1 HIT + how to tx + onset

A

nonimmune mediated, onset 1-4d, observation only

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30
Q

what is type 2 HIT, onset, how to correct

A

immune mediated + platelets fall 30%
onset 5-10d after start of heparin
stop heparin + start alternative nonheparin anticoagulant agent (DOAC, fondaparinux, bivalirudin)
tx fro at least 4 wks if no thrombosis, 3mths if thrombosis

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31
Q

what is initial tx for VTE

A

any of the following; fondaparinux, apixaban, rivaroxaban, UFH, LMWH

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32
Q

what is ongoing tx for VTE if there is no malignancy

A

DOACs, warfarin

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33
Q

what is ongoing tx for VTE if there is malignancy

A

LMWH or DOACs

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34
Q

what are the LMWHs

A

dalteparin and enoxaparin

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35
Q

when to use UFH

A

severe renal impairment, high risk bleed who may require rapid reversal, recently received thrombolytic tx

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36
Q

what is the antidote for LMWH and UFH

A

protamine sulphate (not complete reversal in LMWH)

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37
Q

why is LMWH preferred to UFH

A

is more predictable anticoagulation dose response, loss HIT, less routine monitoring and major bleed risk

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38
Q

warfarin is metabolized by CYP ___(3)

A

2C9, 1A2, 3A4

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39
Q

what are some reversal agents for warfarin

A

vit K, octaplex, fresh frozen plasma

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40
Q

how to bridge warfarin

A

LMWH/UFH for at least 5 days + until INR at least 2 for 2 days in a row

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41
Q

what is dabigatran dosing

A

<80yrs: 150mg BID
=>80yrs or >75yr + =>1RF for bleed: 110mg BID po

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42
Q

what is the reversal agent for dabigatran

A

idarucizumab

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43
Q

how to switch from warfarin to apixaban or dabigatran

A

stop warfarin, start A or D when INR <2

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44
Q

how to switch from warfarin to edoxaban or rivaroxaban

A

stop warfarin, start E or R when INR <2.5

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45
Q

how to switch from UFH to DOAC

A

stop UFH infusion, start DOAC immediately (edoxaban = wait 4hrs)

46
Q

how to switch from LMWH to DOAC and vice versa

A

start other at time of next scheduled dose

47
Q

how long should anticoagulation tx be for after VTE or PE

A

3 months

48
Q

which anticoagulants are preferred in pregancy

A

LMWH (preferred), UFH also safe

49
Q

which anticoagulants are safe in post partum

A

warfarin, LMWH, UFH (not DOACs)

50
Q

which anticoagulants are not safe in pregnancy

A

warfarin and DOACs

51
Q

concurrent use of ____ and warfarin results in falsely elevated INR

A

argatroban

52
Q

after orthopedic surgeries, what anticoagulants may be given as VTE prophylaxis + how long

A

LMWH, DOACs, fondaparinux, ASA 81 for 14-35d postop

53
Q

after nonorthopedic surgeries, what anticoagulants may be given as VTE prophylaxis + how long

A

LMWH, UFH at least until discharge

54
Q

which is not safe in postpartum: warfarin or DOACs

A

DOACs

55
Q

which DOACs should be avoided if CrCL <15

A

DARE

56
Q

what DOACs should be avoided if CrCL <30

A

dabigatran (ARE = renal adjustment)

57
Q

which DOAC must be taken w/ food

A

rivaroxaban

58
Q

reduce dabigatran dose to 110mg BID if

A

> 80yrs old or >75yrs + 1 RF for bleed

59
Q

when to reduce edoxaban dose to 30mg?

A

if wt <60kg

60
Q

which anticoagulant is not appropriate in both STEMI + PCI or severe renal impairment

A

fondaparinux

61
Q

what is the HAS-BLED score stand for

A

HPTN, abnormal kidney or liver, hx stroke, hx bleed, hx labile INR, elderly >65yrs), drugs (NSAIDs, ASA)

62
Q

in what kind of AF is warfarin 1st line

A

valvular AF or mod-severe mitral stenosis or presence of mechanical heart valve

63
Q

when should you use OAC in AF pts

A

if =>65yrs, stroke, TIA, DM, HPTN, HF

64
Q

when should you use only antiplatelet tx in AF pts

A

if only CAD or PAD

65
Q

in elective PCI without high risk features for thrombosis, what is the tx?

A

clopidogrel + OAC for 1-12mths post PCI, then just OAC

66
Q

in ACS w/ PCI or elective PCI w/ high risk features of thrombosis, what is the tx?

A

triple tx w/ ASA + clopi + OAC for 1d-1mth, then just clopidogrel + OAC for up to 12mths post PCI, then just OAC

67
Q

in ACS (unstable angina) without PCI, what is the tx?

A

OAC + clopidogrel for 1-12mths post ACS, then just PAC

68
Q

in persistent AF, what is the preferred start?

A

rate control (BB, ND-CCB)

69
Q

when in AF is the preferred start rhythm control?

A

if recently dx AF <1yr, highly symptomatic or significant QoL impairment, multiple recurrences, difficulty achieving rate control, arrhythmia induced cardiomyopathy

70
Q

what is used for rhythm control if LVEF =<40%? what if it is >40%

A

<40%: amiodarone only
>40% = amiodarone or sotalol

71
Q

what may be used for rhythm control if pt does not have HF, but has CAD

A

sotalol, amiodarone, dronedarone

72
Q

how to use the pill in pocket antiarrhythmic drug tx?

A

start w/ IR AV nodal blocker (diltiazem, verapamil, or metoprolol) 30 min before a class 1c antiarrhythmic (flecainide or propafenone)

remain seated for 4hrs or until episode resolves

73
Q

what needs to be monitored for amiodarone tx

A

TSH at baseline and q3-6mths
CXR yearly due to pulmonary fibrosis
LFTs q6mths

74
Q

HFrEF is mainly due to

A

not pumping enough, CAD problem

75
Q

HFpEF is mainly due to

A

not filling enough, HPTN problem

76
Q

which of the following HF meds are CI for T1DM; SGLT2i, BB, ARNIs

A

SGLT2i (empa/dapaglifloxin

77
Q

T or F: ARNIs do not have a dry cough AE

A

T

78
Q

what is the washout period from ACE to ARNI

A

36hrs

79
Q

which 2 meds may reduce hospitalizations in HFpEF

A

candesartan and ARNI

80
Q

which diuretic should be used if pt w/ HFrEF has sulfonamide allergies

A

ethanoynric acid

81
Q

what to do in acute decompensation of HF

A

high dose loop diuretics (furosemide), start BB once stable or continue if already on

82
Q

when to use ivabradine in HF

A

for HFrEF if HR >70 bpm despite quad tx and are in sinus rhythm

83
Q

BB are CI in

A

> 1st degree heart block without a pacemaker

84
Q

how to treat HFpEF patients?

A

may use ARNI/ARB/ACI for HPTN
candesartan and ARNI may reduce hospitalizations
loop diuretic may be used if reducing fluid retention

85
Q

what is the tx algo for ischemic stroke?

A

within 4.5hrs? - yes = see if meets t-PA criteria + start alteplase (tenectaplase alt)
doesn’t meet criteria = EVT
>4.5hrs or not eligible for EVT = admit to stroke unit

86
Q

T or F: EVTs can be performed in pts who have had alteplase tx

A

T

87
Q

in tPA tx, ASA 160mg should be admin at least ___ hrs after alteplase, once _____________

A

24hrs
CT excludes intracranial hemorrhage

88
Q

what is the target door to alteplase time

A

<60min

89
Q

what is the tx BP fo pre-t-PA tx

A

SBP <185, DBP <110

90
Q

which 3 agents are preferred to lower BP pre-t-PA

A

labetalol, hydralazine, NTG patch

91
Q

during t-PA tx, if SBP > ____ or DBP > _____ for 2 or more readings, continue IV labetalol/ hydralazine/ nitro patch and add enalapril IV if needed

A

SBP >180
DBP >105

92
Q

if the patient is not already on antiplatelet tx prestroke + not going to receive alteplase _____ should be done once CT excludes hemorrhage, then ________

A

AS 160mg loading dose, then LD ASA for secondary prevention

93
Q

in acute, high risk TIA or minor ischemic stroke pts who are not at high risk of bleed, ________ may be considered for ________ followed by ___________ as post TIA management

A

DAPT w/ ASA and clopidogrel for 3-4wks, then ASA monotx

94
Q

in pts receiving alteplase, how long must you wait before starting antiplatelet tx

A

24hrs post thrombolysis CT scan excludes intracranial hemorrhage

95
Q

what medications should be started after stroke for secondary prevention

A

statins LDL <1.8
ACEi + thiazide diuretic once stable
antiplatelet tx

96
Q

what antihypertensive class should be avoided in blacks

A

ACEi/ARBs

97
Q

which combo is preferred: ACE + DHP CCB or ACE + thiazide/ thiazide like diuretic

A

ACE + DHP CCB

98
Q

what is classified as a high risk patient for HPTN

A

=>50yrs and SBP >130 and => CV RF such as:
1. clinical or subclinical CVD
2. CKD (nondiabetic nephropathy, proteinuria, eGFR <60)
3. est 10yr global CV risk =>15%
4. =>75yrs

99
Q

what is the target time for fibrinolysis

A

<30 min (ideally 90 min, ok 120min)

100
Q

what is the time frame for t-PA

A

<4.5hrs

101
Q

how to do perioperative warfarin management if high thromboembolic risk

A

bridging w/ LMWH for 3 days pre-op + stop 24hrs before, warfarin stopped 5 days pre-op, get INR value 24hrs before surgery

102
Q

how to do emergent warfarin reversal

A

IV vit K + octaplex (reversal starts in 2hrs, full in 24hrs)

103
Q

what to do if INR is <0.5 out of range for warfarin

A

see if you can identify cause, may increase or hold by 0.5-1 dose, then repeat INR in 1-2 wks

104
Q

what is the target LDL for LDL =>5 on statin + what to add if not at target after max dose statin

A

LDL 50% reduction or =<2.5
if not = + ezetimibe

105
Q

what is target LDL for DM and CKD + what to add if not at target after max statin dose

A

LDL =<2.0
if not = + ezitimibe

106
Q

what is the target LDL for ACSVD + what to add if not at target after max statin dose

A

LDL <1.8
if LDL 1.8-2.2 = + ezetimibe
if LDL >2.2 = + PCSK9i

107
Q

what is the most potent LDL lowering agent

A

LCSK9i (evolocumab, alirocumab)

108
Q

what is the most potent TG lowering agent

A

fibrates

109
Q

which dyslipidemia agents are not associated w/ myalgias

A

cholestyramine and bile acid sequestrants

110
Q

which statins are metabolized by 3A4

A

SAL

111
Q

which statins are metabolized by 2C9

A

RF

112
Q
A

PEBC (9 decks)

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