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Clin Med Comprehensive > Cardio therapeutics > Flashcards

Cardio therapeutics Flashcards

1
Q

What are high intensity statins?

A

Atrovastatin 40-80mg

Rosuvastatin 20-40mg

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2
Q

What are moderate intensity statins?

A

Atrovastatin 10-20mg
Rosuvastatin 5-10mg
Simvastatin 20-40mg
Pravastatin 40-80mg

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3
Q

What are low intensity statins?

A

Simvastatin10mg
Pravastatin 10-20mg
Lovastatin 20mg

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4
Q

What monitoring needs to be done for statins?

A

fasting lipid panel 4-12 wks after initiation and reassess every 3-12 mo

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5
Q

How do PCSK9 inhibitors work?

A

bind to PCSK9 to block from downregulating LDL-R (will increase LDL-R)

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6
Q

What is evolucumab?

A

PCSK9 inhibitor

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7
Q

How do you treat CAD?

A

PCI (balloon tip catheterization), GABG (vein graft), stabilization

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8
Q

Treatment for stable angina

A

Nitroglycerine (NTG) a vasodilator that brings more blood to the heart
or CABG or PCI if not working

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9
Q

How long does NTG take to work?

A

5 min if angina not gone then repeat (if 3 x and no relief call 911)

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10
Q

Risks and complications of PCI

A

inflammatory response, thrombosis, MI, restenosis

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11
Q

What are the long acting nitrates?

A

Isosorbide dinitrate/mononitrate
Nitropaste
Transdermal nitro patch

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12
Q

What are follow up assessments for stable angina?

A
  1. changes in phys activity
  2. changes in freq of angina
  3. possible adverse effects of therapy
  4. adherance
  5. knowledge about CAD
  6. changes in comorbid conditions
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13
Q

How often do you see a patient with stable angina?

A

4-6 mo in first year then yearly
ECG if change in pattern
annual stress test for high risk pateints

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14
Q

Treatment of coronary vasospasm or variant angina

A

Cath lab to make sure variant not STEMI

Nitro if pain returns (can use IV drip)

Aspirin Plavix
Statins
Heparin and Integrillin

Chronic tx: Ca channel blockers, long acting nitrates

AVOID non selective βblockers

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15
Q

What is the effect of ivabradine?

A

used for CHFdec HR, acts on SA node

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16
Q

What is the best anti-arrhythmic option for patient with stable sustained ventricular tachycardia?

A

Amiodarone

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17
Q

You diagnose an 80 yo patient with new onset of complete heart block. What is your next recommendation?

A

pacemaker

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18
Q

You diagnose a 76 year old female with paroxysmal atrial fibrillation. She has DM and hypertension. She is on a beta blocker and her heart rate is 80 bpm during episodes. What should you do to protect her against strokes?

A

Apixaban

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19
Q

You diagnose a patient with WPW. He has recurrent AVRT. What is your recommendation?

A

Catheter Ablation

20
Q

What is the difference between a vasopressor and an inotrope?

A

vasopressor works primarily on the vascular system and inotrope has effect on contractility of myocardium

21
Q

What is treatment for anaphylactic shock?

A

epinephrine

22
Q

What is initial vasopressor of choice for shock?

A

NE (levophed) helps with BP

23
Q

What is treatment for pulm HTN and shock?

A

Milinone

24
Q

What is treatment plan for hypovolemic shock?

A

fluid resuscitation and control fluid loss

25
Q

What is treatment for hemorrhagic shock

A

fluid resuscitation and find bleeding source, control and correct coagulopathy

26
Q

What is treatment for septic shock

A

ID and drain infection , supportive care, fluid resucitation and vasopressors (phenylephrine, NE< vasopressin)

27
Q

What is treatment for cardiogenic shock?

A

obstructive: cath lab

heart failure: diuresis, afterload reduction and inotropic support

28
Q

What is the treatment for bradycardia?

A

correct underlying prob, pacemaker

29
Q

What is the treatment for tachycardia?

A

correct underlying problem, vagal maneuvers, drugs, cardioversion/defib, catheter ablation, surgery

30
Q

What is electrical cardioversion?

A

electrical current discharged across chest to allow sinus node to regain pacemaker control

31
Q

Why do you need a pacemaker?

A

symptomatic brady

32
Q

What pacemaker do you use for normal AV conduction sinus brady?

A

AAI(R)

33
Q

What pacemaker do you use for abnormal AV conduction sinus brady with abnormal atrial fn?

A

VVI(R)

34
Q

What pacemaker do you use for abnormal AV conduction sinus brady with normal atrial fn?

A

DDD(R)

35
Q

Treatment for atrial septal defect

A

Prevent pulmonary vascular disease
Direct suture closure, pericardial septal patch, septal occluded device
monitor for return of normal RA/RV morphology

36
Q

Treatment for ventricular septal defect

A

Half close spontaneously by age 2
Closure indicated if sx of CHF
Surgical or percutaneous

37
Q

Treatment for aortic stenosis

A

Balloon valvuloplasty

Surgical revision or replacement

38
Q

Treatment for pulmonic stenosis

A

Transcatheter ballon valvuoplasty

Usually followed by regression of rap hypertrophy

39
Q

Treatment of Coarctation of Aorta

A

Prostaglandin to keep ductus arteriosus open (good pre pre-ductal)
Excision and reanastamosis or balloon and stent

40
Q

Treatment of Tetralogy of Fallot

A

Temporary: connect aorta and pulm artery to encourage mvt of blood to pulm artery

Surgical closure of VSD

41
Q

Treatment of Transposition of the Great Vessels

A 
Prostaglandin infusion
Transcatheter infusion (puncture hole in intraventricular septum)
Arterial switch
42
Q

When do we use pphx for bacterial endocarditis?

A

Unrepaired cyanotic heart disease (TF, TGV)
Post-repair w/ prosthetic or device for 6 mo
Post-repair w/ residual defects at site of prosthetic patch or device (indefinitely)
Surgery, catheterization, dental procedures

43
Q

What is abx pphx for bacterial endocarditis?

A

Amoxicillin single dose po the evening before

Ampicillin single dose IM/IV

Clindamycin po

Cephalexin po

44
Q

Treatment of Stable Angina

A

Nitroglycerin (vasodilator)

Sublingual tablet 0.3 or 0.4 up to 0.6

LT nitro, β blockers

CABG or PCI if nothing is working

F/u 4-6 mo then yearly

45
Q

Treatment of variant angina

A

Cath lab to make sure variant not STEMI

Nitro if pain returns (can use IV drip)

Aspirin Plavix
Statins
Heparin and Integrillin

Chronic tx: Ca channel blockers, long acting nitrates

AVOID non selective βblockers

46
Q

Treatment of Unstable Angina & NSTEMI

A

High Risk: coronary angiography→PCI or CABG

Med management: Morphine, O2, Nitro, Aspirin, UFH, LMWH, Heparanoids, direct thrombin inhibitor
Integrelin as soon as diagnosed

W/in 1st 24 hrs β-blocker or CCB, ACE-I, Statin, D/C NSAIDS (except Aspirin)

47
Q

Treatment of Acute Myocardial Infarction

A 
Aspirin 325 mg daily
12 lead EKG
O2 2-4 L/min NC
NTG
Fibrinolytics (clot buster)
β blocker
Morphine
Cardio consult/cath lab
PCI
Monitor 24 hrs
Smoking cessation, cardiac rehab

Aspirin, β blocker and statin continued

Clin Med Comprehensive (9 decks)

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