Cardiology II Flashcards
What is the recommended treatment for VTE in those without cancer?
DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) preferred over VKA
What is the recommended treatment for VTE in those with cancer?
DOACs (apixaban, rivaroxaban, edoxaban) preferred over VKA
What are treatment options for VTE?
-Rapid-acting injectable anticoagulant transitioned to warfarin
-Rapid-acting injectable anticoagulant transitioned to dabigatran or edoxaban
-Sole treatment with rivaroxaban or apixaban
How much overlap should there be with a rapid-acting injectable anticoagulant and warfarin for VTE treatment?
At least 5 days and until INR > 2
What is the VTE treatment dose of enoxaparin?
1.5 mg/kg SQ once daily or 1 mg/kg SQ BID
(if CrCl < 30, 1 mg/kg SQ daily)
What is the VTE treatment dose for dabigatran?
150 mg PO BID initiated after at least 5 days of initial treatment with LMWH
What is the VTE treatment dose for rivaroxaban?
15 mg PO BID x 21 days then 20 mg daily
10 mg daily after 6 months
What is the VTE treatment dose for apixaban?
10 mg PO BID x 7 days then 5 mg BID
2.5 mg BID after 6 months
How long is anticoagulation needed for a provoked VTE?
3 months
How long is anticoagulation needed for unprovoked VTE?
Indefinitely (unless high bleeding risk)
What is the SQ dosing for UFH?
333 units/kg followed by 250 units/kg every 12 hours
What is the NVAF dose for dabigatran?
-150 mg PO BID if CrCL > 30
-75 mg PO BID if CrCl 15-30
What is the NVAF dose for rivaroxavan?
-20 mg PO daily if CrCl > 50
-15 mg PO daily if CrCl 15-50
What is the NVAF dose for apixaban?
-5 mg PO BID if CrCl 15 or more
Reduce dose to 2.5 mg BID if two of the following:
-Age 80+
-Weight 60 kg or less
-SCr 1.5+
What action should be taken if INR is 5-10?
Hold one or two doses
What action should be taken if INR is 10+?
Hold warfarin and given vitamin K 2.5 mg PO
What are physical exam findings of HF?
-S3 gallop
-Rales
-Ascites
-Hepatojugular reflux
-Cardiac enlargement
-Edema
-Displaced apical pulse
What is NYHA Class III HF?
-Marked limitation of physical activity
-Comfortable at rest but less than ordinary activity results in fatigue, palpitation, or dyspnea
What is NYHA Class IV HF?
-Unable to carry on any physical activity without discomfort
-Symptoms present at rest
Which medications used for HFrEF have been shown to reduce mortality?
-ACE-I/ARB
-ARNI
-Beta Blockers
-MRAs
-Nitrates
-SGLT-2 Inhibitors
What is needed when switching from an ACE-I to ARNI?
36 hour washout period to minimize risk of angioedema
Which beta blockers are beneficial for HFrEF?
-Metoprolol succinate
-Carvedilol
-Bisoprolol
When are MRAs recommended in the treatment of HFrEF
LVEF 35% or less
OR
LVEF 40% or less post-MI
When should a MRA be avoided?
-eGFR < 30
-SCr > 2.5 in males or > 2 in females
-K > 5
