Cardiology (Hauschild)

Question 1

Where is heparin derived? Which type of product is available today? Now discontinued?

Answer 1

1. Derived from mucosal tissues of slaughtered animals
2. Pork heparin is used
3. Beef heparin is no longer available (mad cow, higher cost, more thrombocytopenia)

Question 2

Why does DVT have a higher bolus?

Answer 2

1. Higher clot burden (DVT is large compared to coronary artery clot)
2. Pt may have used up more AT III

Question 3

What does bailout in PCI mean?

Answer 3

Sluggish flow

Guidewire gets caught

Question 4

How must abciximab (ReoPro) be stored?

Answer 4

Refrigerated

Question 5

After abciximab (ReoPro) admixture is prepared, how long stable?

Answer 5

12 hours

Question 6

What type of shock should be on your differential 1 day post cath? Why?

Answer 6

1. Hypovolemic shock
2. Secondary to retroperitoneal bleed
3. With femoral cath site, retroperitoneal puncture is possible
4. Blood, fluids, then pressors are secondary

Question 7

What is a TIMI score (non-cath)?

Answer 7

Estimates mortality for patients with UA and NSTEMI

Question 8

What is a good / bad TIMI flow score?

Answer 8

1. Bad = 0

2. Good (desired result post cath) = 3

Question 9

How do BB contribute to HTN control outside of decreased HR and contractility?

Answer 9

Block renin

Question 10

What is a theoretical agent that prevents nitrite tolerance and allows for 24 hour nitrate coverage? (Per Hauschild)

Answer 10

Hydralazine

Question 11

What are the classes of diuretics? (5)

Answer 11

1. Loop
2. Thiazide
3. K sparing
4. Aldosterone antagonists
5. Vasopressin antagonist

Question 12

When is the full antihypertensive effect of thiazides seen?

Answer 12

1. 6 weeks

2. HTN should be considered to be solved as outpatient

Question 13

Which has a longer t1/2 hydrochlorothiazide or chlorthalidone?

Answer 13

Chlorthalidone

Question 14

What is a common cause of hyperkalemia that is often over looked?

Answer 14

1. Hypomagnesium

2. Low mag alters the ability to regulate K

Question 15

What effect do thiazides have on Ca?

Answer 15

Increase Ca

Question 16

What cardiovascular medications can cause impotence?

Answer 16

1. Thiazides

2. Beta blockers

Question 17

What trials have traditionally shown mortality benefit with aldosterone antagonists in heart failure?

Answer 17

1. RALES (NYHA class IV)

2. EPHESUS (low EF,HFrEF)

Question 18

Why does spironolactone contribute to gynecomastia?

Answer 18

1. Spironolactone is structurally similar to estrogen

2. Hits the same receptor

Question 19

What are the aquaretics?

Answer 19

1. Conivaptan (Vaprisol) IV
2. Tolvaptan (Samsca) PO
3. Vasopressin antagonists

Question 20

What are options for warfarin reversal?

Answer 20

1. Kcentra, dosed based on INR
2. FFP, takes longer adds a lot of fluid
3. Vit k, takes longest 12-24 hours, cheapest and easiest

Question 21

Can dabigatran capsules be opened and administered?

Answer 21

No. this will greatly increase absorption and will cause harm

Question 22

What is an example of when bridging is used?

Answer 22

1. DVT or PE
2. Think heparin drip
3. Enoxaparin is used with treatment dosing

Question 23

When is a reason to utilize insulin glargine BID dosing?

Answer 23

Doses above 90-100 units (1 mL)

Dose BID to avoid injecting >1mL subQ

Question 24

When should ACEI be initiated post MI?

Answer 24

After 24 hours

Can cause harm in the initial period

Question 25

When is amiodarone considered a first line agent for rhythm control in afib (normally second line)?

Answer 25

Afib secondary to structural disease (the guideline diagram) from HF

Question 26

What is platelet factor PF4?

Answer 26

Protein released by activated platelets
Promotes clotting
Inhibits antithrombin III