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Notes > Cardio > Flashcards

Cardio Flashcards

1
Q

HFrEF cutoff

A

EF < 40%

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2
Q

chemo agents that cause cardiomyopathy

A

5FU
Cytoxan high doses
anthracyclines
trastuzumab
mitoxantrone

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3
Q

HFpEF cutoff

A

> 50%

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4
Q

Five first line agents for HFrEF

A

ACE-I / ARB / ARNI
Beta Blockers
MRA (Spironolactone)
SGLT2A
Loops, then thiazides

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5
Q

HF type and problem

A

rEF = pumping problem (usually cardiac heart disease)

pEF = filling problem (usually HTN)

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6
Q

ACEI Mechanisms

A

prevents remodeling
vasodilation

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7
Q

ACEI Renal Harm

A

dilates renal arteries so if you dilate the arteries the blood flow is reduced and may temporarily harm kidneys
>30% increase is ok

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8
Q

ACEI Target Doses HFrEF

A

captopril 50mg TID
enalapril 10mg BID
lisinopril 20mg daily
Perindopril 8mg daily
ramipril 10mg daily
trandolapril 4mg daily

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9
Q

ARNI Dosing

A

97/103mg HFrEF target dose

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10
Q

ARB Dosing HFrEF

A

Candesartan 32mg daily
losartan 150mg daily
valsartan 160mg BID

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11
Q

sacubitril MOA

A

inhibits neprilysin to increases natural diuresis

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12
Q

washout period from ACE to ARNI

A

target dose ACEI requires a 36 hour washout period

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13
Q

Beta blockers used in heart failure

A

Toprol
Carvedilol
Bisoprolol

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14
Q

Beta Blocker Target Doses HF

A

Bisoprolol 10mg daily
carvedilol 25mg BID
carvedilol CR 80mg daily
toprol 200mg daily

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15
Q

Beta blocker MOA HF

A

decreased ventricular arrhythmias
decrease hypertrophy
decrease HR

carvedilol vasodilation to lower BP better

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16
Q

spironolactone EF cutoff and CrCl cutoffs, sCr cutoffs

A

EF < 35% and shouldn’t use if CrCl <30ml/min
men sCr <2.5, women sCr <2.0

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17
Q

MRA dosing and CrCl cutoffs

A

eGFR > 50:
eplerenone 50mg daily
spironol. 25mg daily or BID

eGFR<50:
eplerenone 25mg daily
spironolactone 12.5-25mg daily

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18
Q

SGLT2 eGFR cutoffs in HF

A

dapagliflozin >30
empagliflozin >20

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19
Q

SGLT2-I MOA in HF

A

diuresis
reduce arterial pressure
reduce heart hypertrophy and fibrosis

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20
Q

SGLT2-I Dosing

A

dapagliflozin and empagliflozin 10mg daily

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21
Q

Hydralazine/
Isosorbide dinitrate

A

indicated primarily for black people especially if cannot tolerate an ACE/ARB
reduced pulmonary congestion

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22
Q

hydralazine/
Isosorbide combo MOA

A

hydralazine arterial vasodilation
isosorbide venous vasodilation

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23
Q

BiDil dosing

A

37.5mg/20mg start 1 tab TID, goal 2 tab TID

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24
Q

hydralazine/Isosorbide worst ADR

A

drug-induced lupus

25
Q

medication class for HFrEF that does not improve mortality rates

A

diuretics - symptom relief only

26
Q

monitoring with loops when used for HF

A

K >4
Mag >2
bicarb for alkalosis
sCr and BUN

27
Q

starting and max doses of loops in HF

A

lasix 20-40 daily or BID, max 600mg
bumetanide 0.5-1 daily or BID, max 10mg daily
torsemide 10-20mg daily, max 200mg

28
Q

thiazides diuretics starting and max doses

A

HCTZ 25mg daily or BID, max 200
chlorthalidone 12.5-25mg daily, max 100
metolazone 2.5mg daily - 20mg
chlorothiazide 250-500mg daily or BID, max 1000mg

29
Q

loop conversions

A

furosemide 40mg = bumex 1mg = torsemide 10-20mg = ethacrynic acid 50mg

30
Q

ivabradine

A

use when all recommended agents are maxed (beta blockers esp.), reduces mortality is stable chronic symptomatic HF, in sinus rhythm and HR > 70 at rest

31
Q

ivabradine site of action

A

SA node reduces conduction to decrease HR

32
Q

ivabradine dosing

A

start at 5mg BID w/meals unless > 75yo
increase by 2.5mg until max 7.5mg BID
base dosing on HR if >60

33
Q

ivabradine worst side effects

A

low BP and HR
arrhythmias
transient rings or spots of light in the visual field

34
Q

digoxin place in HFrEF

A

add on after 2nd line
no increased mortality benefit
decreased hospitalizations

35
Q

digoxin dosing

A

0.125mg daily, may do every other day in some cases:
- over 70 yo
- renal dysfunction
- low lean body mass

36
Q

digoxin [x] increased by…..

A

clarithromycin, erythromycin
amiodarone (cut dose in 1/2)
dronedarone (cut dose in 1/2)
itraconazole, posaconazole
cyclosporine, tacrolimus
verapamil

37
Q

digoxin goal serum [x]

A

0.5 - 0.9 ng/ml
measure trough or 6-8 hrs after last dose

38
Q

electrolytes that increase digoxin levels

A

hypokalemia
hypomagnesemia
hypercalcemia

39
Q

signs of digoxin toxicity

A

nausea
vomiting
vision changes

40
Q

antiarrhythmics DOC for HFrEF

A

dofetilide or amiodarone

41
Q

drugs to avoid in HFrEF

A

cilostazole, itraconazole
water and Na retention:
-NSAIDs, corticosteroids, minoxidil, TZD’s
negative inotropes:
- verapamil, diltiazem - Amlodipine and felodipine ok
- antiarrhythmics (except amiodarone or dofetilide)
amphetamines
metformin - increased lactic acidosis
lyrica

42
Q

sodium goals in HF

A

<1500mg in A and B
<3000mg in C and D

43
Q

fluid restrictions in HF

A

if serum Na is low in D
may restrict to 1.5 - 2 L/day

44
Q

avoid non-DHP CCB’s if what disease state is present?

A

left ventricular systolic dysfunction

45
Q

possible DOC in Afib if uncontrolled HR and decompensated HF

A

digoxin

46
Q

cardio version of Afib and anticoag use

A

should do a TEE (prove no thrombus) OR treat with warfarin or DOAC’s x 3 weeks prior

then continue x 4 weeks after

47
Q

List of I A anti-arrhythmics, channel and site of action

A

disopyramidine
quinidine
procainamide

sodium channels

atrial and ventricular

48
Q

List of I B anti-arrhythmics, channel and site of action

A

Lidocaine
Mexilitene

ventricular only

sodium channels

49
Q

List of I C anti-arrhythmics, channels and site of action

A

Flecainide
Propafenone

sodium channels

SVT use only

50
Q

List of Class II Anti-arrhythmics

A

beta blockers

51
Q

List of Class III Antiarrythmics, channels and site of action

A

Potassium Channels, Atrial and Ventricular

amiodarone
dofetilide
dronedarone
ibutilide
sotalol

52
Q

List of Class IV anti-arrhythmics, channels, and site of action

A

verapamil
diltiazem

Ca channels

atrial and ventricular

53
Q

anti-arrhythmics that can cause torsade’s and QT prolongation

A

Class I A and C Sodium Channel Blockers

54
Q

anti-arrhythmics that cause decompensated HF

A

procainamide
disopyraminidine
I C channel blockers
dronedarone

55
Q

adjust anti-arrhythmics for renal/hepatic dysfunction

A

procainamide
lidocaine
dronedarone

56
Q

typical classes for a fib

A

IC and III

flecainide
propafenone
amiodarone
dofetilide
dronedarone
ibutilide
sotalol

57
Q

IC for a fib notes

A

should use with beta blockers or ca channel blockers for AV nodal blockade

contraindicated if structural heart disease

58
Q

amiodarone drug interactions

A

digoxin - lower by 50%
warfarin - lower by 50%
simvastatin/lovastatin - do not exceed 20/40mg
bradycardia - beta blockers, Non DHP CCB, clonidine, ivabradine

59
Q
A

Notes (12 decks)

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