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TOP 300 drugs - NAPLEX > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Prasugrel (Effient) C/I

A

Hx of TIA/Stroke

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2
Q

Time: fibrinolytics

A

Within 30 mins of admission

If at a hospital incapable of PCI and no other facility within 120 minutes

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3
Q

Eptifibatide: brand name

A

Integrilin

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4
Q

Ticagrelor (Brilinta) and aspirin

A

ASA doses > 100mg limit effectiveness of Brilinta

Loading doses of both okay to give however

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5
Q

Avoid which medications in ACS

A

NSAIDS (except ASA)

Naproxen has the lowest risk

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6
Q

When to start ACEI after MI

A

1 day

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7
Q

When may you consider moderate intensity instead of high intensity statin post-ACS?

A

Patients 75yrs +

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8
Q

Plavix: loading + maintenance dose

A

Loading dose: 300-600 mg
Maintenance: 75 mg daily

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9
Q

Risk factors for ACS

A
  1. Age (men > 45 years of age, women > 55 years of age or with an early hysterectomy)
  2. Family history of coronary events before age 55 years (men) or before age 65 years (women)
  3. Smoking
  4. Hypertension
  5. Dyslipidemia
  6. Diabetes
  7. Known CAD
  8. Chronic angina
  9. Excessive alcohol use
  10. Sedentary lifestyle.
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10
Q

Brilinta common, unique ADR

A

Dyspnea

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11
Q

Ticagrelor (Brilinta) dosing

A

90 mg BID then 60 mg BID after 1 year

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12
Q

Fibrinolytics MoA

A

Binds to fibrin
Converts plasminogen to plasmin

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13
Q

Nifedipine IR and acute ACS

A

Inc. mortality risk

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14
Q

Intrinsic pathway

A

Contact activation (minor)

aPTT (monitoring)

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15
Q

Extrinsic pathway

A

Tissue factor activation (activated by tissue damage/trauma)

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16
Q

UFH/LMWH MoA

A

Potentiate actions of antithrombin (inactivating Xa and IIa)

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17
Q

Warfarin MoA

A

Inhibit factors II, VII, IX, and X by inhibiting Vit K synthesis

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18
Q

Bivalirudin MoA

A

IIa (Thrombin) inhibitor

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19
Q

What does Thrombin do?

A

converts Fibrinogen to fibrin (stable clot)

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20
Q

When is warfarin preferred over DOACs?

A
  1. Moderate-severe mitral valve stenosis
  2. Mechanical heart valve
  3. Antiphospholipid syndrome
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21
Q

Fondaparinux (Artixtra) MoA

A

Selective inhibition of factor Xa

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22
Q

Hematoma with LMWH or DOAC

A
  • LMWH: don’t rub after injection!
  • Both: can have epidural or spinal hematoma in patients given neuraxial anesthesia or a spinal puncture
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23
Q

UFH dosing: VTE ppx

A

5000 units Q8H SC

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24
Q

UFH dosing: ACS/STEMI treatment

A

60 units/kg IV bolus then 12 units/kg/hr infusion

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24
Q

UFH dosing: VTE Tx

A

80 units/kg IV bolus then 18 units/kg/hr infusion

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25
Q

What weight to use when dosing UFH?

A

TBW

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26
Q

UFH: ADRs

A

Bleeding, thrombocytopenia, HIT, hyperkalemia, Osteoporosis (long-term), alopecia

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27
Q

UFH: monitoring

A
  1. aPTT or anti-Xa (check 6 hrs after initiation then Q6H until therapeutic)
  2. Platelets, Hgb, HCT daily (Dec in platelets > 50% = possible HIT)
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28
Q

UFH: aPTT therapeutic range

A

1.5-2.5x control

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29
Q

UFH vs LMWH difference in MoA

A

LMEWH has greater selectivity for the Xa binding

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30
Q

LMWH dosing: VTE ppx

A

30 mg SC BID or 40 mg daily
CrCl < 30: 30 mg daily

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31
Q

LMWH dosing: VTE/ UA/NSTEMI tx

A

1mg/kg SC BID or 1.5 mg/kg SC daily (only inpatient)

CrCl < 30: 1 mg/kg SC daily

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32
Q

LMWH dosing: Tx of STEMI in < 75 yr old

A

30 mg IV bolus then 1 mg/kg SC dose, followed by 1 mg/kg SC BID

CrCl < 30: 30mg IV bolus plus a 1 mg/kg SC dose followed by 1 mg/kg SC daily

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33
Q

LMWH dosing: Tx of STEMI in ≥ 75 yr old

A

0.75 mg/kg SC BID (no bolus). (Max 75 mg for the first 2 SC doses only)

CrCl < 30: 1mg/kg SC daily

Use total body weight for dosing

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34
Q

What weight do you use for dosing LMWH

A

TBW

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35
Q

When is monitoring (Anti-Xa) recommended for LMWH?

A

Pregnancy, renal insufficiency, extremes of body weight and age

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36
Q

Is aPTT used to monitor LMWH?

A

NO
only for UFH

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37
Q

When do you draw anti-Xa lvl for LMWH?

A

4 hrs post first SC dose

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38
Q

HIT: 4 T’s

A

Thrombocytopenia: unexplained > 50% drop in PLTs
Timing: 5-10 days after start of UFH
Thrombosis: new or suspected or confirmed thrombosis
Other causes: rule our other probable causes

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39
Q

Management of HITT

A
  1. Stop Heparin & LMWH
  2. Stop warfarin and give Vit K
  3. Argatroban
  4. Do not start warfarin therapy until the platelets have recovered to > 150,000 cells/mm3
  5. PCI required? Bival preferred
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40
Q

When is Eliquis dosed 2.5 mg BID?

A

If patient has 2+ of the following: age > 80 yrs, Body weight < 60 kg or SCr > 1.5 mg/dL

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41
Q

Treatment of DVT/PE : Eliquis

A

10mg BID x7 days then 5mg BID

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42
Q

Eliquis: Boxed warning

A

All pts receiving neuraxial anesthesia (Epidural, spinal) or undergoing spinal puncture are at risk of hematomas & subsequent paralysis

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43
Q

Edoxaban specific C/I

A

CrCl > 95

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44
Q

When are DOACs NOT recommended?

A

Prosthetic heart valves or antiphospholipid syndrome

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45
Q

Xarelto: AFib dosing

A

CrCl > 50 mL/min: 20 mg PO daily
CrCl 15-50 mL/min: 15 mg PO daily

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46
Q

Xarelto: treatment of DVT/PE

A

15mg BID x21 days then 20mg PO daily with food

CrCl < 30: avoid use

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47
Q

Edoxaban: treatment of DVT/PE dose

A

start after 5-10 days of parenteral anticoagulation

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48
Q

Fondaparinux: contraindications

A

Severe renal impairment (CrCl < 30)

49
Q

DOACs D/I

A

Substrates of CYP3A4 and PgP

50
Q

From warfarin to another oral anticoagulant, stop warfarin and convert to: READ

A

Rivaroxaban when INR is < 3
Edoxaban when INR is ≤ 2.5
Apixaban when INR < 2
Dabigatran when INR < 2

51
Q

Conversion between dabigatran to warfarin

A

Start warfarin 1-3 days before stopping dabigatran (determined by renal function - refer to package labeling)

52
Q

Pradaxa notes

A

Discard w/in 4 months of opening
Swallow capsules whole
When treating DVT/PE, start 5-10 days after parenteral anticoagulation

53
Q

Bivalrubin: notes

A

Safe with active HIT or Hx of HIT
No antidote

54
Q

Protein C and S

A

Natural anti-coagulants

55
Q

When is the lower starting dose for warfarin recommended? (5 mg)

A

Elderly
Malnourished
Taking drugs that inc. level
Liver disease
Heart failure
High risk of bleeding

56
Q

Warfarin: substrates

A

CYP2C9 (major)

57
Q

Warfarin: C/I

A

Pregnancy (Except with mechanical heart valves)

58
Q

CYP2C9 inhibitors

A

Amiodarone (Half dose of warfarin when starting)
Fluconazole
Metronidazole
TMP/SMX

59
Q

Starting dose of warfarin in healthy outpatient

A

≤ 10 mg daily for the first 2 days

60
Q

Warfarin: monitoring on stable INR

61
Q

Protamine dose: heparin reversal

A

1 mg will reverse 100 units of heparin

Reverse the amount of heparin given in 2-2.5 hours

62
Q

Protamine: max dose

63
Q

Protamine dose: Lovenox reversal

A

1mg of protamine per 1 mg of lovenox

64
Q

When do you stop warfarin prior to surgery?

A

5 days prior
Those at high VTE risk, bridge with LMWH or UFH

65
Q

Risk factors for VTE (Modifiable)

A

Acute medical illness
Immobility
Medications (SERMs, drugs containing estrogen, EPO)
Obesity (BMI ≥ 30)
Pregnancy & post-partum period
Recent surgery or major trauma

66
Q

Risk factors for VTE (non-modifiable)

A

Inc. age
Cancer/Chemo
Previous VTE
Inherited or Acquired thrombophilia (Protein C/S deficiency)
Certain disease states (HF, nephrotic syndrome)

67
Q

Treatment of VTE

A

3 months

For those without cancer: Dabigatran or DOAC preferred over warfarin
For those with cancer: DOACs over all

68
Q

CHADS-VASc scoring system

A

C-CHF
H-HTN
A - age (≥ 75) 2
D- DM
S- prior stroke/TIA -2
Vascular disease (prior MI, PAD, aortic plaque) - 1
Age (65-74)
Sc- Sex category (Female = 1)

69
Q

When is anticoagulation recommended?

A

CHADS over 2 for males and over 3 for females

70
Q

Elemental Iron %

A

Gluconate - 12 %
Sulfate - 20%
Sulfate, dried - 30%
Fumarate - 33%
Carbonyl, polysaccharide, iron complex - 100%

71
Q

When do sickled RBCs burst (hemolyze)?

A

after 10-20 days

72
Q

Fetal hemoglobin (HgbF)

A

Blocks sickling of RBCs

73
Q

What organisms are people with Sickle cell particularly at risk for?

A

Strep pneumo
H. influenzae
N. meningitis

74
Q

Goal Hgb with SCD

A

≤ 10 post blood transfusion

75
Q

Infants and SCD

A

Those who test positive for SCD at birth should be on ppx PCN BID until 5 yrs old

76
Q

Hydroxyurea: when indicated?

A

≥ 3 moderate-severe pain crises in one year

77
Q

Hydroxyurea: Boxed warnings

A

Myelosuppression
Fetal toxicity
Avoid live vaccine

78
Q

Hydroxyurea: supplmentation

A

Folic acid to prevent macrocytosis

79
Q

Voxelotor: MoA

A

stimulates production of hemoglobin S (HgbS) polymerization

80
Q

Iron chelation treatment

A

Chelation therapy to remove excess iron
Oral agents: deferasirox and deferiprone
IV agent: deferoxamine (not used)

81
Q

Metoprolol tartrate IV to PO

82
Q

Carvedilol: administration

A

Take with food

83
Q

Beta-blockers: blood sugars

A
  • Can mask S/Sx of Hypoglycemia
  • Can dec insulin secretion leading to hyperglycemia
84
Q

Hypertensive crisis BP threshold

A

≥ 180/120 mmHg

85
Q

How much do you want to decrease the BP by in the first hour of a hypertensive emergency?

A

No more than 25%

86
Q

Waist circumference target

A

< 35 inches (women)
< 40 inches (males)

87
Q

Yosprala

A

Aspirin/Omeprazole

88
Q

Ranolazine: contraindications

A

Liver cirrhosis
Do NOT use with strong CYP3A4 inhibitors or inducers

89
Q

DAPT: SIHD

A

bare metal stent: at least one month
drug-eluting stent: 6+ months
post-CABG: 12 months

89
Q

Ranolazine: warnings

A

QT prolongation!

Not for acute treatment of chest pain

90
Q

NTEMI treatment

A

Medications alone OR
PCI

91
Q

STEMI treatment

A

Requires PCI or fibrinolytic

92
Q

PCI: timing

A

within 90 minutes of hospital arrival (optimal door-balloon time) or within 120 minutes of first medical contact (ex: ambulance)

93
Q

FIbrinolytics: timing

A

If PCI is NOT possible within 120 minutes, fibrinolytic therapy is recommended and should be given within 30 minutes of hospital arrival (door-to-needle)

94
Q

Drug treatment for ACS

A

MONA GAP BA

Morphine
Oxygen
Nitrates
Aspirin
GPIIb/IIa antagonists
Anticoagulants
P2Y12 inhibitors
Beta-blockers
ACEI

95
Q

Prasugrel (Effient) contraindication

A

Bleeding
Hx of TIA or stroke

96
Q

Ticagrelor weird ADR

A

Dyspnea (> 10%)

96
Q

Ticagrelor (Brilinta) dosing

A

90 mg PO BID for 1 yr, then 60 mg BID

**Maintenance ASA should not exceed 100mg **

97
Q

ACC/AHA HF staging system

A

A - at risk for HF but without symptoms, structural heart disease or elevated biomarkers
B - pre-HF: structural issues but without symptoms of HF
C - structural issues with symptoms
D - Advanced HF with severe symptoms or recurrent hospitalizations

98
Q

NYHA Functional class

A

I - No limitation of ordinary activity
II - Comfortable at rest, ordinary physical activity causes symptoms
III - Minimal exertion = symptoms
IV - Symptoms at rest

99
Q

Cardiac output

A

CO = SV X HR

100
Q

Cardiac index

A

CI = CO/BSA

101
Q

Natural products to help with HF

A

Omega-3 fatty acid
Hawthorn
CQ10

102
Q

Drugs that worsen/cause HF

A

DI NATION
DPP4 inhibitors
Immunosuppressants
Non-DHP CCBs
Antiarrythmics
TZDs
Itraconazole
Oncology drugs
NSAIDs

103
Q

When is Ivabradine added?

A

NYHA class II-III with HR > 70 on maximally tolerated dose of BB

104
Q

Sacubitril/valsartan target dose

105
Q

Coreg target doses

A

≤ 85 kg: 25mg BID
> 85: 50 mg BID

106
Q

Spironolactone warning

A

do not initiate for HF if K+ > 5

107
Q

Dapagliflozin: when not to initiate

A

eGFR < 25 mL/min

108
Q

Jardiance: when NOT to initiate

A

eGFR < 20 mL/min

109
Q

Loops: weird electrolytes

A

Inc. HCO3 (causing metabolic alkalosis)
Inc. UA
Inc. glucose
Inc. TG
Inc. Cholesterol

110
Q

Loops: dose conversions

A

Furosemide 40mg = Torsemide 20mg = Bumetanide 1mg = Ethacrynic acid 50 mg

111
Q

BiDil indication

A

African americans with NYHA III-IV who are symptomatic despite optimal treatment

112
Q

Digoxin: MoA

A

Inhibits Na-K-ATPase pump
Positive inotrope
Negative Chronotrope

113
Q

Digoxin: when is lower starting dose selected?

A

Renal insufficiency
Smaller
Older
Female

114
Q

Digoxin: starting dose

A

0.125-0.25 mg

114
Q

Digoxin: CrCl < 50 mL/min

A

dec dose or inc. frequency

115
Q

Digoxin: IV to PO

A

Dec. dose by 20-25% when changing from PO to IV

116
Q

Digoxin toxicity

A

Symptoms: N/V, loss of appetite, blurred/double vision, greenish-yellow halos, bradycardia, life-threatening arrhythmias

**Inc RISK with HYPOK+ HYPOmg+ and HYPERCa+

117
Q

Potassium oral solution 10%

A

10% = 20 mEq/15 mL

TOP 300 drugs - NAPLEX (12 decks)

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