CardioPulm4 Flashcards
What antiarrhythmic should be used in Pt with Wolf Parkinson White who develops a-fib with rapid ventricular rate?
WPW uses accessory pathways to bypass the AV node so you would have to use antiarrhythmics like procainamide (or cardioversion if unstable). AV node blockers like BB, CCB, digoxin, and adenosine should be avoided because they increase conduction through the accessory pathways.
If a Pt presents with exertional dyspnea, orthopnea, bibasilar rales, lower extremity edema, and a normal EF on echo, this would be considered:
HfPEF (HF w/preserved ED) = Diastolic Dysfunction.
** Due to impaired myocardial relaxation or ^ LV wall stiffness/decreased compliance»_space; ^ LV End diastolic pressure.
What medications should be given to an asthmatic pt in severe acute asthma exacerbation?
Short acting B2 agonists (albuterol), ipratropium (anticholinergic), and systemic corticosteroids. If no improvement in pCO2 retention»_space; endotracheal intubation/mechanical ventilation to prevent impending respiratory collapse.
What are the major differences between a transudative vs exudative pleural effusion?
Transudavtive = imbalance between hydrostatic and oncotic pressures»_space; increased movement of fluid across capillaries into visceral pleura. Rx = treat underlying Dz.
Exudative = due to pleural and lung inflammation»_space; increased capillary and pleural membrane permeability. Need to satisfy at least 1 of the 3 Light criteria
What are the Light Criteria in Dx of exudative pleural effusion?
- Pleural fluid protein: serum protein ration > 0.5
- Pleural fluid LDH : serum LDH ratio > 0.6
- Pleural fluid LDH > 2/3 upper limit of normal for serum LDH [90x2/3=60].
** Need to satisfy at least one of these
What would you offer to an asthmatic patient with their symptoms uncontrolled with PRN short acting beta 2 agonist inhaler (albuterol)?
Give ICS - low dose inhaled corticosteroid (beclomethasone, fluticasone).
If still no improvement after ICS then add a long acting beta 2 (salmeterol).
COPD and asthma can present the same. How do you differentiate between the two and how does long term treatment differ between the two?
Most efficient way is to do spirometry before and after bronchodilator (albuterol).
Long term COPD Rx = long acting anticholinergic inhaler
Long term asthma Rx = inhaled corticosteroid
Clinical presentation of progressive dyspnea, fatigue, and elevated BNP is consistent with Dx of:
CHF. ** Elevated levels of BNP correlate with severity of LV systolic dysfunction.
BNP is a natriuretic hormone released from ventricular myocytes in response to high ventricular filling pressures and wall stress in Pt with CHF. Can normally see S3 (due to systolic dysfunction) w/^BNP as being 99% specific for CHF.
An abdominal or periumbilical bruit that lateralizes to one side can be heard in patients with ___
renal artery stenosis
For an acute exacerbation of COPD would you use glucocorticoids or corticosteroids?
Glucocorticoids (oral prednisone or IV methylprednisone) are used for COPD exacerbation.
Inhaled corticosteroids (fluticasone) are used in long term management of persistent asthma.
What is the MOA of cromolyn and zafirlukast in long term treatment of asthma?
Cromolyn = mast cell stabilizer (prevents release of histamine and leukotrienes)
Zafirlukast = leukotriene R antagonist
What are the two conditions for long term home oxygen therapy in patients with chronic hypoxemia?
- Resting PaO2 < 55mmHg, or SaO2 <88* on room air.
2. PaO2 <59 mmHg, or SaO2 < 89* in Pt with cor pulmonale, R HF, or hematocrit >55%
What 3 types of meds should you withhold if you are trying to perform a stress test in evaluation for CAD?
BB, CCB, and nitrates should be withheld at least 48 hrs before the stress test. But these meds should be continued in cases of known CAD undergoing stress testing to assess the efficacy of antianginal therapy.
What Rx would be given to treat chronic nonallergic rhinitis?
Nonallergic rhinitis = nasal congestion, rhinorrhea, sneezing, and postnasal drip without specific cause. Should treat with intranasal antihistamine (azelastine, olopatadine), intranasal glucocorticoids, or combination therapy.
Why does cold water immersion help slow HR in cases of paroxysmal SV tach?
AV Node reentrant tachycardia is a common type of PSVT. Happens because of 2 pathways (slow and fast). Premature atrial beat when fast pathway is refractory allows for reentrant mech where slow pathway goes anterograde and loops back during fast pathway.
Vagal maneuvers (cold immersion, carotid sinus massage, Valsalva)»_space; ^ parasymp tone in heart»_space; slowing in AV node and increase in AV node refractory period»_space; termination of AVNRT.
