Cardiovascular Flashcards
LDL calculation
LDL = TC - HDL - TG/5
Goal LDL, HDL, triglycerides
LDL < 100
HDL > 40 (women) or > 50 (men)
Triglycerides < 150
Drugs that increase LDL and TGs
Diuretics, efavirenz, cyclosporine, tacrolimus, atypical antipsychotics, proteas inhibitors
Drugs that increase LDL
Fibrates, fish oils
Drugs that increase triglycerides
IV lipids, propofol, clevidipine, bile acid sequesterants
Statin MOA
Inhibit HMG-CoA –> block cholesterol production
Statins that must be taken in the evening
Fluvastatin, lovastatin, simvastatin
Statins that interact with CYP3A4
simvastatin, lovastatin (kind of atorvastatin)
Statin intensities
High – rosuvastatin 20-40, atorvastatin 40-80
Moderate – rosuvastatin 5-10, atorvastatin 10-20, simavstatin 20-40
Ezetimibe MOA
Inhibits cholesterol absorption
PCSK9 Inhibitor MOA
Prevents LDL receptor degredation (increases LDL degredation)
Percent cholesterol lowering with cholesterol meds
High-intensity statin: 50%
Moderate-intensity statin: 30-49%
Ezetimibe: 25%
PCSK9: 60%
Do not use statins with what other cholesterol medication?
Gemfibrozil
When taken with simvastatin, what increases risk of myagia?
Red yeast rice, niacin, fenofibrate
When should isosorbide dinitrate doses be schedules?
~7 hours apart (BID dosing)
Bidil
isosorbide dinitrate/hydralazine
Drugs to avoid with heart failure
Tumor necrosis factor inhibitors, DPP4s, anthracyclines, itraconazole, NSAIDs
CPK cut off for rhabdomyolysis
> 10,000
Slow acetylators of procainamide are at increased risk of what?
Accumulation and toxicity
carvedilol to Coreg CR dosing
3.125 mg BID = 10 mg CR
Fluid restriction in HF
1.5-2 L per day
What lab abnormalities increase risk of digoxin toxicity?
Hypokalemia, hypomagnesemia, hypercalcemia
Action potential
Na in, K out and Ca in, K out
Antiarrhythmics stop Na in and K out
When to use QTc
HR > 60
Conduction pathway
SA node –> atria (contract) –> AV node (slows) –> bundle of his –> right and left branches –> spread through purkinje fibers (ventricles contract)
P wave and T wave
Atria contracting, ventricles relaxing
Each class of antiarrhythmics
I (Na blockers), II (beta blockers), III (K blockers), IV (Ca blockers)
Which drugs are class I antiarrhythmics
Quinidine, procainamide, lidocaine, mexiletine, flecainide, proafenone
Which drugs are class III antiarrhythmics
Amiodarone, dronaderone, sotalol, ibutilide, dofetalide
Which antiarrhythmics are contraindicated in heart failure
Flecainide, propafenone (class Ic), dronaderone, diltazem/verapamil
Which antiarrhythmics are preferred for heart failure
Amiodarone, dofetalide
Which arrhythmias are lidocaine and mexiletine useful for
Ventricular arrhythmias only
Which antiarrhythmics are contraindicated in MI
Flecainide, propafenone (class Ic)
Side Effects of amiodarone
pulmonary toxicity, blue skin, hypotension, DILE, hypothyroidism
Amiodarone and digoxin together
Decrease digoxin (and warfarin) dose by 50% when adding amiodarone
Which antiarrhythmics must be started in the hospital
Sotalol, dofetalide
Digoxin MOA
Na-K-ATPase blocker (suppresses AV node conduction, decreaes HR)
Positive inotrope, negative chronotrope
Digoxin typical dose and therapeutic level
0.125-0.25 mcg daily, 0.8-2 ng/mL (draw 12-24 hours after dose)
Digoxin renal dosing
Decrease dose or frequency if CrCl < 50
Digoxin PO to IV
Decrease dose by 25% when converting PO to IV
Adenosine MOA
Adenosine receptor agonist
First-line treatment for Afib rate control
Beta blocker or non-DHP CCB
Second-line treatment for Afib rate control
Digoxin (add on or montherapy in those who do not tolerate first-line)
Cardioversion drugs
Amiodarone, dofetalide, flecainide, ibutilide, propafenone
Afib ryththm maintenance drugs
Dofetalide, dronaderone, flecainide, propafenone, sotalol
