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Pharmacy > CVD > Flashcards

CVD Flashcards

1
Q

Post-MI PCI tx

A

DAPT x1-3 years
BB x3 years
ACEi
Statin (high dose)

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2
Q

Post-STEMI no PCI tx

A

Clopidogrel x 30 days
ASA
ACEi
Nitrates for ischemia

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3
Q

Antiplatelets

A

ASA

P2Y12 Inhibitors: Clopidogrel, Ticagrelor, Prasugrel

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4
Q

DAPT

A

Dual Antiplatelet Therapy

ASA 81mg + Clopidogrel 75mg (or Ticagrelor 90mg BID)

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5
Q

PCI

A

Percutaneous Coronary Intervention
procedure used to open clogged heart arteries
pt may say they had angioplasty, catheter or stent put in

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6
Q

ASA for primary prevention

A

may use in ages 40-70yo at low risk of bleeding ie. pt doesn’t have history of bleeding, CKD, uncontrolled HTN, pt isn’t on NSAIDs, steroids, anticoagulants

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7
Q

HF triple therapy

A 
ACEi
BB
MRA (spironolactone, eplerenone)
Dapagliflozin now quadruple tx
*all reduce hospitalizations and mortality
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8
Q

HF meds if sx despite triple tx

A 
Entresto (Sacubatril/Valsartan) 
Ivabradine
Hydralazine/Isosorbide Dinitrate
Digoxin 
*all reduce hospitalizations (except digoxin) and mortality
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9
Q

Entresto

A

(Sacubatril/Valsartan)
for sx despite HF triple tx
need 36h washout from ACEi
CI in pregnancy

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10
Q

Ivabradine

A

for sx despite HF triple tx (NYHA II-III)
must be in sinus rhythm & HR >70bpm (bc it reduces HR)
AE: bradycardia, visual disturbances

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11
Q

Hydralazine/Isosorbide Dinitrate

A

for sx despite HF triple tx (NYHA III-IV) or alternative in ACE/ARB intolerant or Black pts
vasodilates, AE: hypotension, tachycardia, headache

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12
Q

Digoxin

A

for sx despite HF triple tx (NYHA III-IV)
dose based on age, wt, renal fxn & monitor levels in dehydrating illness, dose increases or toxicity
AE: delerium, n/v/d, visual disturbances

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13
Q

Statin indicated conditions

A 
clinical atherosclerosis
abdominal aortic aneurysm
diabetes mellitus
CKD
LDL>5
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14
Q

Statin targets

A

LDL<2 or 50% reduction

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15
Q

Statins with CYP3A4 DDI

A

rosuvastatin, simvastatin, lovastatin

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16
Q

Bile acid resins

A

cholestyramine, cholestipol, colesevelam
2nd line for dyslipidemia, preferred in pregnancy (statins CI in pregnancy)
AE: GI (constipation, heartburn, bloating)
DDI: malabsorption of vitamins, seperate 1h before or 4-6h after)

17
Q

Fibrates

A

gemfibrozil, fenofibrate, bezafibrate
used to lower TG or in combo with statins for dyslipidemia
AE: GI (take w food), renal dysfxn

18
Q

Niacin (B3)

A

used to lower TG and LDL
do not combine with statin
AE: flushing, hyperglycemia

19
Q

Ischemic stroke tx and secondary prevention

A

alteplase IV if <4.5h from stroke onset, otherwise antiplatelets: after ruling out hemorrhage
ASA (if not on it prior)
Clopidogrel
ASA/dipyridamole
ASA+Clopidogrel in 1st 21-30 days
anticoagulants: only if antiplatelets CI in ischemic stroke tx or for 2ndary prevention of cardiogenic stroke

20
Q

angina tx

A

nitrate spray sl q5m max 3x for all pts
CCB 1st line
BB 1st line in HF or MI
long acting nitrates 2nd line

21
Q

nitrates

A

nitrate spray sl q5m max 3x for all pts w angina
nitrates po or patch 2nd line for angina sx
10-12h nitrate free interval needed to prevent tolerance
AE: transient headache, hypotension, tachycardia, dizziness, flushing

22
Q

traditional tx for VTE

A

LMWH (dalteparin, enoxaparin, nadroparin, tinzaparin)

LMWH or fondaparinux or UFH x5days/until warfarin INR>2

23
Q

newer tx for VTE

A

Rivaroxaban
Apixaban
LMWH x5d then Dabigatran
LMWH x5d then Edoxaban

24
Q

duration of VTE tx

A

provoked = 3mths
(obesity, surgery, hosp, cancer, thrombophilias, pregnancy, COCs)
unprovoked = 3-6mths to indefinite

25
Q

duration of VTE prophylaxis

A

at least 10-14 days for total knee replacement, total hip replacement, hip fracture surgery, high risk general/abdominal surgery

26
Q

VTE prophylaxis med options

A

LMWH or DOAC* x5d then switch to ASA

*rivaroxaban and apixaban demonstrated superiority over enoxaparin

27
Q

Warfarin

A

for VTE tx: target INR 2-3 measured q3d-q3m
preferred when DOACs unsuitable due to renal failure (CrCl<30), valvular disease, DDI (PGP, 3A4) or unstable condition
AE: bleeding, hair loss, blue fingers, skin necrosis
reversal with vit K1, prothrombin complex concentrate

28
Q

UFH

A

unfractionated heparin
IV or SC for VTE tx target aPPT 1.5-2.5xULN
preferred when unstable, planned invasive procedure, renal failure (CrCl<30), peri-thrombolytic
AE: 5% risk of HIT, hyperkalemia, osteoporosis
reversal with protamine sulfate

29
Q

LMWH

A

low molecular weight heparin
for DVT tx or prophylaxis
SC and more predictable wt based dosing than UFH
AE: 1% risk of HIT, lower risk of osteoporosis

30
Q

Fondaparinux

A

indirect factor Xa inhibitor
alternative to LMWH in VTE, can be used in HIT
SC wt based dosing
renally cleared

31
Q

DOAC

A

direct factor Xa inhibitors: apixaban, edoxaban
direct thrombin inhibitors: rivaroxaban, dabigatran
for VTE tx, prophylaxis, afib

32
Q

Amiodarone

A

most effective antiarrhythmic, used in vtach or afib (rhythm control)
AE: GI, derm, neuro, opth, thyroid abnormalities
DDI: digoxin

33
Q

Rate control

A

used for afib
target HR<100
options: BB, Digoxin (except in CAD), CCB (except in HF)

34
Q

Rate vs Rhythm control (CCS 2020 Guidelines)

A

in persistent (>7d) Afib:
rate control is 1st line
rhythm control preferred if diagnosed within 1y, highly sx, multiple recurrances, difficulty achieving rate control, arrhythmia induced cardiomyopathy)

35
Q

When is pill-in-pocket used for arrhythmia?

A

paroxysmal (<7d) AF

or symptomatic tachycardias (diltiazem, verapamil, BB)

36
Q

CCS Algorithm for Stroke Prevention in Afib

A 
OAC indicated if:
-age>65yo
-prior stroke/TIA, HTN, HF, Diabetes
ASA indicated if:
-CAD or PAD
37
Q

Afib + PCI or ACS tx
vs
Afib + PCI and ACS tx

A

Afib + PCI or ACS: OAC+Clopidogrel x1y then OAC

Afib + PCI and ACS: triple tx (ASA+OAC+Clopidogrel) x1d-6m then OAC+Clopidogrel x1y then OAC

38
Q

DOACs doses for Afib vs VTE

A

AFIB:
Dabigatran 150 BID; 110 BID if >80yo or high bleed risk
Rivaroxaban 20mg; 15mg if CrCl 30-45
Apixaban 5 BID; 2.5 BID if 2 of: SCr>133, >80yo, <60kg
Edoxaban 60; 30 if <60kg, CrCl 30-50
VTE:
Rivaroxaban 15mg BID x3w then 20mg daily
Apixaban 10mg BID x7d then 5mg BID
LMWH x5d then Dabigatran 150mg BID; 110 if >75yo high bleed risk
LMWH x5d then Edoxaban 60mg OD; 30 if <60kg, CrCl 30-50

Pharmacy (43 decks)

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