Cardio Flashcards
Chronic stable angina sees ____ changes in ECG and ___ changes in troponin
no changes in ECG or troponin
unstable angina ECG and troponin
ST depression, no changes in troponin
what is the differentiating factor between ACS and nagina pectoris
ACE lasts >5 min + not relieved by NTG
what is the acute sx tx for stable angina
NTG up to 3x
what is the chronic symptom tx for stable angina
BB (often 1st line, esp in HF), DHP-CCBs (FANN - 1st line for uncomplicated ptx)
BB + ____ CCBs = avoid due to risk bradycardia, AV node block, fatigue
NDHP
to decrease mortality for stable angina, what should be started? what should be stopped?
ACEi/ARB, ASA (clopi if ASA intol), HD statin to target LDL <1.8
Stop HRT and NSAIDs
what should be started for treatment of NTEMI or unstable angina?
BMONAH
if a NSTEMI or UA patient is high risk, what should be considered?
angioplasty
what should be started within 24hrs post NSTEMI, UA, STEMI
ACEi
what should be started for treatment of STEMI?
MONAH (BB once hemodynamically stable)
How long should anticoagulation be done in STEMI
start heparin in ER, continue for 48hrs or d/c at end of PCI procedure
what are some indications for PCI in STEMI
PCI facility available, cardiogenic shock, >75yrs, CI to thromboysis
if a thrombolysis is done for STEMI, what should be given after?
ACE, DAPT (ASA + clopi) F 1 yr, heparin for 48hrs, DVT prophylaxis until ambulatory
what are some post STEMI/NSTEMI management drugs?
ACEi, BB, HD statin
DAPT F1yr (clopi for thrombolysis, ticagralor for PCI)
which heparin is prefered in severe renal impairment
UFH
which LMWH is the DOC for STEMI w/ fibrinolysis
enoxaparin
which anticoagulant is the DOC for STEMI + PCI
UFH
which anticoagulant is the DOC for NSTEMI/UA as part of BMONAH
enoxaparin
which antiplatelets are reversible
clopi and prasugrel
clopi, ticagralor are metabolized by which CYP enzymes
clopi = 2C19
ticagralor = 3A4
what is an AE of clopidogrel
rash
what is an AE of ticagralor
dyspnea
what are the 2 high potency statins
rosuvastatin, attorvastatin
if a patient develops HIT and severe renal impairment, what is the best choice for anticoagulation in DVT?
argatroban- no renal adjustment required
PE sx
dyspnea, pleuritic pain, cough, syncope, tachypnea
what is elevated in PE and DVT
ESR/CBW and D dimer
what is heparin induced thrombocytopenia
low platelet blood counts due to heparin tx which predisposes pts to thrombosis (thrombin generation)
what is type 1 HIT + how to tx + onset
nonimmune mediated, onset 1-4d, observation only
what is type 2 HIT, onset, how to correct
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
what is initial tx for VTE
any of the following; fondaparinux, apixaban, rivaroxaban, UFH, LMWH
what is ongoing tx for VTE if there is no malignancy
DOACs, warfarin
what is ongoing tx for VTE if there is malignancy
LMWH or DOACs
what are the LMWHs
dalteparin and enoxaparin
when to use UFH
severe renal impairment, high risk bleed who may require rapid reversal, recently received thrombolytic tx
what is the antidote for LMWH and UFH
protamine sulphate (not complete reversal in LMWH)
why is LMWH preferred to UFH
is more predictable anticoagulation dose response, loss HIT, less routine monitoring and major bleed risk
warfarin is metabolized by CYP ___(3)
2C9, 1A2, 3A4
what are some reversal agents for warfarin
vit K, octaplex, fresh frozen plasma
how to bridge warfarin
LMWH/UFH for at least 5 days + until INR at least 2 for 2 days in a row
what is dabigatran dosing
<80yrs: 150mg BID
=>80yrs or >75yr + =>1RF for bleed: 110mg BID po
what is the reversal agent for dabigatran
idarucizumab
how to switch from warfarin to apixaban or dabigatran
stop warfarin, start A or D when INR <2
how to switch from warfarin to edoxaban or rivaroxaban
stop warfarin, start E or R when INR <2.5