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BCACP > Cardiology II > Flashcards

Cardiology II Flashcards

1
Q

What is the recommended treatment for VTE in those without cancer?

A

DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) preferred over VKA

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2
Q

What is the recommended treatment for VTE in those with cancer?

A

DOACs (apixaban, rivaroxaban, edoxaban) preferred over VKA

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3
Q

What are treatment options for VTE?

A

-Rapid-acting injectable anticoagulant transitioned to warfarin
-Rapid-acting injectable anticoagulant transitioned to dabigatran or edoxaban
-Sole treatment with rivaroxaban or apixaban

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4
Q

How much overlap should there be with a rapid-acting injectable anticoagulant and warfarin for VTE treatment?

A

At least 5 days and until INR > 2

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5
Q

What is the VTE treatment dose of enoxaparin?

A

1.5 mg/kg SQ once daily or 1 mg/kg SQ BID
(if CrCl < 30, 1 mg/kg SQ daily)

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6
Q

What is the VTE treatment dose for dabigatran?

A

150 mg PO BID initiated after at least 5 days of initial treatment with LMWH

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7
Q

What is the VTE treatment dose for rivaroxaban?

A

15 mg PO BID x 21 days then 20 mg daily
10 mg daily after 6 months

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8
Q

What is the VTE treatment dose for apixaban?

A

10 mg PO BID x 7 days then 5 mg BID
2.5 mg BID after 6 months

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9
Q

How long is anticoagulation needed for a provoked VTE?

A

3 months

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10
Q

How long is anticoagulation needed for unprovoked VTE?

A

Indefinitely (unless high bleeding risk)

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11
Q

What is the SQ dosing for UFH?

A

333 units/kg followed by 250 units/kg every 12 hours

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12
Q

What is the NVAF dose for dabigatran?

A

-150 mg PO BID if CrCL > 30
-75 mg PO BID if CrCl 15-30

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13
Q

What is the NVAF dose for rivaroxavan?

A

-20 mg PO daily if CrCl > 50
-15 mg PO daily if CrCl 15-50

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14
Q

What is the NVAF dose for apixaban?

A

-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+

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15
Q

What action should be taken if INR is 5-10?

A

Hold one or two doses

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16
Q

What action should be taken if INR is 10+?

A

Hold warfarin and given vitamin K 2.5 mg PO

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17
Q

What are physical exam findings of HF?

A

-S3 gallop
-Rales
-Ascites
-Hepatojugular reflux
-Cardiac enlargement
-Edema
-Displaced apical pulse

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18
Q

What is NYHA Class III HF?

A

-Marked limitation of physical activity
-Comfortable at rest but less than ordinary activity results in fatigue, palpitation, or dyspnea

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19
Q

What is NYHA Class IV HF?

A

-Unable to carry on any physical activity without discomfort
-Symptoms present at rest

20
Q

Which medications used for HFrEF have been shown to reduce mortality?

A

-ACE-I/ARB
-ARNI
-Beta Blockers
-MRAs
-Nitrates
-SGLT-2 Inhibitors

21
Q

What is needed when switching from an ACE-I to ARNI?

A

36 hour washout period to minimize risk of angioedema

22
Q

Which beta blockers are beneficial for HFrEF?

A

-Metoprolol succinate
-Carvedilol
-Bisoprolol

23
Q

When are MRAs recommended in the treatment of HFrEF

A

LVEF 35% or less
OR
LVEF 40% or less post-MI

24
Q

When should a MRA be avoided?

A

-eGFR < 30
-SCr > 2.5 in males or > 2 in females
-K > 5

25
Q

When are nitrates recommended in the treatment of HFrEF?

A

African Americans with NYHA class III-IV

26
Q

What is the therapeutic range for digoxin for HF?

A

0.5-0.9 ng/mL

27
Q

When is ivabradine recommended in the treatment of HFrEF?

A

LVEF 35% or less
AND
HR 70+

28
Q

When should ivabradine be avoided?

A

-AF
-Third-degree heart block
-Severe hepatic impairment

29
Q

Which medication has been shown to reduce CV death in patients with HFpEF?

30
Q

What is the definition of paroxysmal AF?

A

AF that is intermittent and terminates within 7 days or less

31
Q

What is the definition of persistent AF?

A

AF that is continuous and lasts more than 7 days

32
Q

What is the definition of long-standing persistent AF?

A

AF that is continuous for more than 12 months

33
Q

When is rate control indicated for AF?

A

-No symptoms to minimal symptoms
-Persistent or permanent AF

34
Q

What is the goal of rate control therapy?

A

HR < 100-110

35
Q

What medications may be used as rate control therapy for AF?

A

-Beta blockers
-Non-DHP CCBs
-Digoxin
-Amiodarone
-Dronedarone (contraindicated in patients with any NYHA class HF)

36
Q

When is rhythm control indicated for AF?

A

-Symptomatic patients despite adequate rate control
-Hemodynamically unstable condition
-Patients w/ HF

-Not an option for permanent AF

37
Q

What is the preferred treatment for non-sustained VT?

A

Beta blockers or amiodarone

38
Q

What type of antithrombic prophylaxis is recommended for a biprosthetic aortic valve?

A

Aspirin (50-100 mg/day)

39
Q

What type of antithrombic prophylaxis is recommended for a biprosthetic mitral valve?

A

Warfarin (INR 2-3) x 3 months then aspirin

40
Q

What type of antithrombic prophylaxis is recommended for a mechanical aortic valve?

A

Warfarin (INR 2-3)

41
Q

What type of antithrombic prophylaxis is recommended for a mechanical mitral valve?

A

Warfarin (2.5-3.5)

42
Q

What are the classic signs/symptoms of aortic stenosis?

A

-HF
-Syncope
-Angina

43
Q

What antithrombic therapy is recommended post-TAVR?

A

Aspirin 50-100 mg + clopidogrel 75 mg/day for at least 3 months

44
Q

What is the first-line treatment for angina secondary to aortic stenosis?

A

Beta blockers

45
Q

What is the second-line treatment for angina secondary to aortic stenosis?

46
Q

Which medications used to treat PAH have a REMS program?

A

-Ambriesentan (birth defects)
-Bosentan (hepatotoxicity and embryo-fetal toxicity)
-Macintentan (birth defects)
-Riociguat (embryo-fetal toxicity)

BCACP (20 decks)

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