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BCPS > Cardiology > Flashcards

Cardiology Flashcards

1
Q

After reperfusion with fibrinolytics for a STEMI, how long should anticoagulation therapy continue for?

A

48 hours or up to 8 days

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2
Q

What is part of long term management after ACS?

A

DAPT (ASA + ticagrelor, prasugrel or clopidogrel)
B blockers for 3 years
ACE
Potentially aldosterone receptor blockers if already on ACE/beta blocker
High intensity statin

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3
Q

What comprises the TIMI score?

A

65 year old, 3 or more risk factors for CAD, ST deviation, 2 or more anginal events in previous 24 hours, use of ASA in previoius 7 days, elevated cardiac biomarkers, prior coronary stenosis 50%

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4
Q

Which patients are indicated for ischemia guided therapy?

A

TIMI 0 or 1

Low likelihood of ACS with negative troponins

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5
Q

Which patients are indicated for GP IIb/IIIa inhibitors?

A

High risk features (elevated troponins) may/may not have inadequate clopidogrel or ticagrelor pretreatment

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6
Q

What is an optimal anticoagulation treatment for STEMI patients with a high risk of bleeding?

A

Bivalirudin and GPIIb/IIIa

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7
Q

Which ACS indication is bivalirudin not indicated?

A

Post-Fibrinolytic therapy

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8
Q

When should fibrinolytic therapy be indicated?

A

> 120 min after medical contact

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9
Q

How long should clopidogrel and ticagrelor be discontinued before ELECTIVE CABG?

A

Clopidogrel/ticagrelor: 5 days

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10
Q

What prerequirement is there before initiating inotropic therapy in HF patients?

A

Make sure PCWP is 15-18 mm Hg which gives adequate filling pressures

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11
Q

What agents can be used as refractory therapy to diuretics in HF?

A

Vasodilators like nitroglycerin and nitroprusside

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12
Q

What are indications to use milrinone or dobutamine in HF?

A

Used primarily to manage hypoperfusion with adequate filling pressures

Dobutamine: hypotensive
Milrinone: if using B blocker

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13
Q

What can be used for REGULAR narrow complex tachycardia?

A

Adenosine

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14
Q

What can treat wide complex ventricular tachycardia?

A

IV procainamide, amiodarone, lidocaine (2nd line)

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15
Q

What antiarrhythmics should be avoided due to QTC prolonging?

A

Procainamide, sotalol, dofetilide, ibutilide, dronedarone

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16
Q

What contraindication is there for Class Ic antiarrhythmics (propafenone, flecainide) for AF conversion/maintenance?

A

HF or post-MID to increase risk of sudden death

17
Q

What medication considerations should you make when implanting an ICD?

A

Beta blockers are mainstay therapies and effective in reducing SCD

18
Q

What medications are best for HF patients with arrhythmias?

A

Amiodarone and dofetilide

AVOID class Ia, Ic and dronedarone

19
Q

What medications are best for acute MI patients with arrhythmias?

A

Amiodarone and dofetilide

AVOID class Ia and Ic (CAST: showed mortality with dofetilide)

20
Q

Which antiarrhythmics are more indicated for maintenance THAN chemical conversion of arrhythmias?

A

Sotalol and dronedarone

21
Q

Which IV hypertensives should be avoided in those with MI or HF?

A

MI: nicardipine, hydralazine (reflex tachycardia)

HF: Esmolol, labetalol, clevidipine, nicardipine

22
Q

What IV hypertensives should be avoided in elevated ICP?

A

Sodium nitroprusside, nitroglycerin, hydralazine

23
Q

What are the CI for sodium nitroprusside?

A

Renal and hepatic failure due to cyanide toxicity

24
Q

What are the CIs for Enalaprilat?

A

Pregnancy, renal artery stenosis and angioedema

25
Q

What agents are preferred for a patient with sympathetic crisis and hypertensive crises?

A

Nicardipine, fenoldopam, clevidipine

AVOID unopposed B-blockade

26
Q

What is the target dose for sacubitril/valsartan for HF?

A

Sacubitril 97 mg/valsartan 103 mg

27
Q

How long should a patient be anticoagulated for before and after cardioversion?

A

Stable > 48 hour of afib

3 weeks before cardioversion

Anticoagulate 4 weeks after

28
Q

What are monitoring parameters for amiodarone?

A

LFTs, thyroid, pulmonary function tests, opthalmic, skin toxicities, neurologic

29
Q

What comprises of CHADSVasc?

A 
Congestive HF
Hypertension
Age > 75 yo (2)
Diabetes
Stroke (2)
Vascular dx
Age 65-74 
Female
30
Q

At what INR should you convert warfarin to rivaroxaban, apixaban, dabigatran and edoxaban?

A

Rivaroxaban: INR 3
Apixaban: INR 2
Dabigatran: INR < 2
Edoxaban: <2.5

31
Q

What are the BP goals of DM patients with urine albumin > 30 mg/24 hr?

32
Q

What is the max dose of niacin when concomittant used with statins?

A

1 g/day due to muscle toxicity

33
Q

What agent does abcixmab and eptifibatide must be combined with for an MI?

BCPS (19 decks)

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