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Pharmacotherapeutics - Final > Cardiology Cases Wrap Up > Flashcards

Cardiology Cases Wrap Up Flashcards

1
Q

INR goal for pt w.o artificial valve (non-mechanical)

A

2.0-3.0

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2
Q

INR goal for pt w. artificial valve (mechanical)

A

2.5-3.5

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3
Q

when can you use the term “coumadin failure”

A

only if pt was on therapeutic dose when fail occurred

otherwise, it’s subtherapeutic fail

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4
Q

t/f: a single coumadin dose can affect INR

A

t!

need to know what dose pt was on when INR was obtained

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5
Q

best AC for severe renal dz or ESRD

A

warfarin

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6
Q

AC for pt w. mechanical valve

A

warfarin

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7
Q

2 cons of warfarin

A

narrow therapeutic index -> must check INR
many food/ddi

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8
Q

3 benefits of DOACs over warfarin

A

fewer interactions
less ICH/fatal bleeding
bridging not needed (rapid onset/offset)

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9
Q

4 cons of DOACs

A

expensive
some lack or have expensive reversal agents
higher rate of GIB
not approved in ESRD

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10
Q

warfarin has a higher rate of __ bleeds

DOACs have a higher rate of __ bleeds

A

warfarin: ICH/fatal
DOACs: GIB/non fatal

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11
Q

what are the 4 doac’s

A

dabigatran (pradaxa)
rivaroxaban (xarelto)
apixaban (eliquis)
edoxaban (savaysa)

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12
Q

dabigatran is a __ inhibitor, whereas the other 3 doac’s are __ inhibitors

A

dabigatran: direct thrombin
others: Xa

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13
Q

jaynstein’s go to doac

A

apixaban (eliquis)

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14
Q

CHADSVASC

A
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15
Q

afib rate control: strict vs lenient vs exertional

A

strict: < 80
lenient: < 110
exertional: < 115

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16
Q

options for chronic rate control in afib (2)

A

bb
ccb (non dihydropiridines -> diltiazem, verapamil)

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17
Q

2 conditions that digoxin is used for

A

HFrEF
afib

only for pt w. inadequate rate control w. bb and/or ccb

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18
Q

which ac’s have reversal agents

A

warfarin
dabigatran (pradaxa)
rivaroxaban (xarelto)
apixaban (eliquis)
edoxaban (savaysa)

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19
Q

reversal agent for dabigatran

A

praxbind

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20
Q

andexxa is the reversal agent for (3)

A

rivaroxaban (xarelto)
apixaban (eliquis)
edoxaban (savaysa)

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21
Q

5 s.e of hctz

A

hypo’s:
hyponatremia
hypokalemia
hypomagnesemia
hypochloremic alkalosis

plus hyperglycemia and hyperuricemia

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22
Q

caution w. hctz in what 2 conditions

A

gout
DM

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23
Q

which mucinex is contraindicated w. htn

A

mucinex d - the d is pseudoephedrine (can cause htn)

regular mucinex is ok

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24
Q

2 common s.e of norvasc (amlodipine)

A

peripheral edema
fatigue

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25
Q

bp goal for htn + dm

A

< 130/80

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26
Q

ideal classes of meds for htn + dm (3)

A

diuretics
acei/arb
ccb

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27
Q

what ccb are best for htn + dm

A

dihydropiridines (amlodipine/novasc)

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28
Q

life threatening s.e of amlodipine

A

angina/MI
hypotn
pulmonary edema

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29
Q

use amlodipine w. extreme caution in what 2 conditions

A

AS - can cause MI
CHF - can decrease afterload

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30
Q

ccb work best for htn for what patient population

A

AA

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31
Q

life threatening s.e of ACEI (6)

A

angioedema
cholestatic jaundice -> fulminant hepatic necrosis
hyperkalemia
ARF
hypotn
severe hypersensitivity

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32
Q

angioedema manifesting as abdominal pain may occur more often in what pt pop

A

AA

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33
Q

common s.e of ACEI (4)

A

hyperkalemia
elevated Cr
dizzy
cough

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34
Q

life threatening s.e of bb (4)

A

AV block
bradycardia
CNS dpn
hypotn

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35
Q

common s.e of bb (4)

A

hypotn
bradycardia
dizzy
worsen raynaud or peripheral vascular dz

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36
Q

life threatening s.e of hctz (2)

A

severe lyte disturbance
angle-closure glaucoma

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37
Q

common s.e of ARBs (3)

A

cough
hyperkalemia
elevated Cr

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38
Q

life threatening s.e of ARBs (4)

A

angioedema
hyperkalemia
hypotn
renal fxn decline

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39
Q

t/f: if a pt has a cough w. lisinopril, you should try losartan

A

t!

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40
Q

t/f: if a pt has angioedema w. lisinopril you should try losartan

A

hell no! why would you think you can do this you idiot?!

jk… i thought you could too

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41
Q

what class of drug is clonidine

A

alpha blocker

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42
Q

common s.e of clonidine (6)

A

xerostomia
drowsy
ha
fatigue
dizzy
transient skin rash

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43
Q

3 life threatening s.e of clonidine

A

bradycardia
cns dpn
hypotn

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44
Q

which ccb is extended release

A

diltiazem

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45
Q

4 common s.e of diltiazem

A

peripheral edema
ha
bradycardia
dizzy

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46
Q

4 life threatening s.e of diltiazem

A

av block
bradycardia
sjs
hypotn

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47
Q

moa of hydralazine

A

vasodilator

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48
Q

indication for hydralazine

A

acute htn episodes (usually inpt setting)

not really used for long term control

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49
Q

t/f: you should treat asymptomatic htn acutely in the op setting

A

f!
don’t do it
just address stricter control of long term meds

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50
Q

common s.e of hydralazine (6)

A

earache
tachy
palpitations
angina
n/v
diarrhea

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51
Q

3 life threatening s.e of hydralazine

A

lupus-like syndrome
blood dyscrasia
MI

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52
Q

2 contraindications for hydralazine

A

CAD
peripheral neuritis

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53
Q

what was our plan for pt w. htn and gout (4)

A

d/c hctz and mucinex
add lisinopril
continue norvasc
increase metformin

54
Q

when do you use the 10 year ascvd risk to decide if your pt needs statin as primary prevention

A

if ldl is > 100

55
Q

basic ascvd risk guidelines for statin as primary prevention (2)

A

7.5 or higher - 10% risk = statin
if LDL 190 or higher

56
Q

statins reduce cv risk __%

57
Q

how should you dose statin as secondary prevention

A

highest dose pt can tolerate
lifelong high intensity statin regardless of ldl

58
Q

2 high dose statins

A

atorvastatin (lipitor) 40-80
rosuvastatin (crestor) 20-40

59
Q

t/f: doubling of statin dose produces double decrease in ldl

A

f! - only additional 6% decrease

60
Q

what should you consider if you are thinking about doubling your pt’s statin dose

A

adding a second med instead

61
Q

when do LFTs need to be monitored for pt on statin (3)

A

before initiation
annually
any dose increase

62
Q

2 contraindications for statins

A

liver disease (don’t forget AUD)
pregnancy

63
Q

common s.e of statins (5)

A

photosensitivity
arthralgias
GI upset
nasopharyngitis
elevated LFTs

64
Q

4 life threatening s.e of statins

A

rhabdo
arf
hepatotoxic
hemorrhagic stroke

65
Q

3 rf for statin related myopathy

A

small body frame
multisystem diseases
multiple meds

66
Q

what do you think when you see: new onset renal failure, dark urine, confusion

67
Q

t/f: cpk monitoring is recommended for pt on statin

A

f!

only in symptomatic pt

68
Q

2 types of stents

A

des: drug eluting stent
bms: bare metal stent

69
Q

antiplatelet recommendation for both kinds of stent

A

at least 6-12 mo of dual antiplatelet therapy (dapt): clopidigrel PLUS ASA

longer (18-24 mo) if pt has no major or moderate bleeding events

70
Q

ASA dose for DAPT

71
Q

what do you use to predict combined ischemic and bleeding risk for pt’s being considered to continue dapt therapy beyond one year

A

dapt score

72
Q

2 common s.e of plavix

A

bleeding
pruritis

73
Q

6 life threatening s.e of plavix

A

severe bleeding
TTP
agranulocytosis
SJS/TEN
aplastic anemia
pancytopenia

74
Q

when would you use 325 mg ASA

A

only for AMI and ischemic stroke

use 81 mg for daily dose

75
Q

interaction and contraindication for asa

A

interaction: nsaids
contraindication: GIB

76
Q

asa is only recommended for __ prevention

77
Q

only anti anginal med proven to improve survival and prevent re-infarction in pt who have had MI

78
Q

first line therapy for acute angina symptoms

79
Q

when are ccb used for angina

A

in combo w. bb when monotherapy is inadequate

80
Q

all bb are equally effective for angina, but which ones are recommended dt less systemic s.e profile

A

cardioselective: metoprolol, atenolol

81
Q

bb improve survival in what 2 conditions

A

prior MI
HFrEF

82
Q

bb decrease efficacy of (3)

A

thyroid meds
insulin
oral hypoglycemics

83
Q

contraindications for bb (6)

A

uncompensated HF
cardiogenic shock
2nd or 3rd degree heart block
bradycardia
COPD/asthma
hypotn

84
Q

4 life threatening s.e of bb

A

hypotn
bradycardia
syncope
av blocks

85
Q

4 common s.e of bb

A

fatigue
rash
dizzy
impotence

86
Q

contraindications for nitrates (7)

A

obstructive hypertrophic cardiomyopathy
hypovolemia
inferior MI w. right ventricular involvement
elevated ICP
cardiac tamponade
sbp < 90
ED meds w.in past 24 hr

87
Q

pt ed for nitrate patch

A

must remove for 12-24 hr (keep on from 8a-8p)

88
Q

which nitrate is used for chronic/preventive management of angina

A

isosorbide mononitrate (imdur)

89
Q

moa for nitrates

A

vasodilate -> decrease preload -> reduce myocardial O2 demand

90
Q

4 common s.e of nitrates

A

HA
flushing
hypotn
syncope

91
Q

5 life threatening s.e of nitrates

A

hypotn
paradoxical bradycardia
syncope
increased ICP
ddi w. pde5 inhibitors

92
Q

antianginal drug that is not a nitrate

A

ranolazine (ranexa)

93
Q

moa for ranolazine

A

partial fatty aid oxidation inhibitor -> alters myocardial energy metabolism -> decreases cardiac work load

94
Q

how is ranolazine used for angina

A

prevention

not acute

95
Q

2 s.e of ranolazine

A

hypotn
bradycardia

96
Q

3 ddi’s to be aware of w. commonly prescribed CV drugs

A

ASA + plavix -> increased bleed risk
nitro + bb -> additive hypotn
nitro + viagra -> additive hypotn

97
Q

what are the ABCDE’s of post MI drugs

A

A: antiplatelet -> asa + plavix
B: bp control -> bb
C: cholesterol -> statin
D: diet
E: exercise

98
Q

moa for loop diuretics

A

inhibit Na and Cl resorption -> urinary excretion of Na, Cl, K

reduce peripheral vascular resistance and increase peripheral venous capacitance -> decrease LV filling pressure

99
Q

2 mc loops diuretics

A

furosemide
torsemide

100
Q

t/f: loop diuretic effect is dose dependent

101
Q

common s.e of loop diuretics (3)

A

hypokalemia
metabolic alkalosis
increased Cr

102
Q

life threatening s.e of loop diuretics (7)

A

hypokalemia
hypotn
metabolic alkalosis
ARF
hyponatremia
hypersensitivity
ototoxicity -> deafness

103
Q

tx for inpt in acute fluid overload

104
Q

IV lasix has __ the bioavailability of oral

A

twice

if on 40 mg po lasix, start 20 IV

105
Q

indication for IV lasix

A

breathing difficulty

not just peripheral edema

106
Q

when is torsemide used

A

if lasix fails

but if pt was on torsemide at home, choose torsemide inpt

107
Q

4 meds that can contribute to HF

A

NSAIDs
antiarrhythmics
CCB
hctz

108
Q

5 meds that improve mortality in HFrEF

A

spironolactone (NYHA III and/or IV)
hydralazine + nitrates
acei/arb
bb

109
Q

4 meds that do NOT improve mortality in HFrEF

A

ccb
digoxin
diuretics
nesritide (don’t worry about this mystery drug)

110
Q

benefits of digoxin (2)

A

improves functional capacity
decreases hospitalization

111
Q

moa for digoxin

A

positive inotrope -> increases contractility

112
Q

indication for digoxin

A

3rd/4th line for symptom control (fatigue, dyspnea, exercise intolerance) in pt’s already on appropriate therapy

113
Q

3 drugs that increase serum levels of digoxin

A

amiodarone
quinidine
verapamil

114
Q

never give dig to what type of HFrEF pt

A

acutely decompensated

115
Q

rf for dig toxicity (6)

A

low body wt
advanced age
renal impairment
hypokalemia
hypercalcemia
hypomagnesemia

116
Q

symptoms of dig toxicity (8)

A

GI sx
cardiac sx
AMS
anorexia
NVD
vision changes
lyte abnormalities -> hyperkalemia
arrhythmias

117
Q

how is dig cleared

118
Q

what class of drug is spironolactone

A

aldosterone receptor antagonist

119
Q

common s.e of spironolactone (5)

A

hyperkalemia
dizzy
n/v
gynecomastia
menstrual irregularities

120
Q

life threatening s.e of spironolactone (4)

A

hyperkalemia
ARF
hypotn
hepatotoxicity

121
Q

analgesic of choice in CHF pt

122
Q

3 ddi’s to be aware of in CHF pt

A

lisinopril + KCl + spironolactone -> hyperkalemia
lisinopril + bb + lasix -> hypotn
ASA + plavix -> bleeding d.o

123
Q

t/f: furosemide is superior to torsemide and bumetanide

A

f!

torsemide might actually be more potent and effective

124
Q

how does renal failure impact diuretic dosing

A

increased dosing as gfr decreases

125
Q

only contraindication for lasix

A

anuria

unless pt is on dialysis

126
Q

t/f: bb and ccb are commonly used together in HFrEF

A

no they shouldn’t be

127
Q

what’s the matter w. androgel in HFrEF

A

risk of major cv events
risk of increased HTN

128
Q

what bp med do you think of when you see abdominal cramps

129
Q

life threatening s.e of levothyroxine

A

CHF
arrhythmina
sz
SJS/TEN

130
Q

common s.e of levothyroxine

A

ha
anxiety
diaphoresis
palpitations
diarrhea
anxiety
tremor
wt loss
heat intolerance
hair loss

131
Q

can pt increase dose of lasix for acute edema in op setting

A

yep!

give them an extra dose

Pharmacotherapeutics - Final (6 decks)

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