Day 6 Cardiology Flashcards
Signs and symptoms of PAD?
How to measure ABI?
ABI measures?
Not common, hair loss, thickened nails, pallor, edema, cyanosis, cool skin temperature, ulceration/gangrene.
Measure SBP in resting state and exercise in brachial artery and tibial/pedis artery. Take the highest of the 2 ankle in each leg, divide by highest of the 2 arm readings.
.91-1.3 normal, .4-.9 is mild to moderate,
Nonpharmacologic treatment of PAD?
Aspirin treatment of PAD?
Cliostazol treatment of PAD?
Supervised exercise program(1st line),Risk factor modification(smoking, hyperlipidemia, diabetes management, hypertension), antiplatelet therapy, Avoid Vasoconstriction.
Can use, does not increase walking distance of stop the PAD.
PDE inhibitor that suppresses platelet aggregation and is also a direct arterial dilator, increase pain free walking, CI’D in HEART FAILURE PATIENTS
Pentoxifylline treatment of PAD?
How to treat ALI?
How else can you treat it? If you have critical leg ischmemia with PAD how do you treat?
causes Red blood cells to deform and slip through artery
Alteplase is most commonly used agent, Don’t use IV dose
Stents, Arthrectomy, Cryoplasty. UFH
What drugs decrease O2 demand?
What drugs increase O2 supply?
What are the types of angina?
Badrenergic antagonists, Some CA2 entry blockers, organic nitrates, Ca entry blockers.
Vasodilators, Statins, Anti-thrombotics.
Stable angina, unstable angina, variant angina(printzmetal or vasospastic)
Is nitroglycerin 1st line for immediate relief of acute angina?
MOA of Nitrates?
Dose of Sl nitrate? When to call 911? Counseling points?
Yes
Vasodilation lowers O2 demand. Can cause coronary artery dilation which raises O2 supply. Improves collateraly flow to ischemic regions.
0.4 mg (1 tab), q5 min, 3 tabs in 15 minutes(max). If no relief after 1st dose or if not completely resolved after 3 doses. Store in original container, protect, watch expiration date. IV normally used for ACS or ongoing hypertension.
What to know about long acting nitrates?
BBW for nitrates?
CI’s for nitrates?
3rd line treatment for angina prophylaxis, can be combined with beta-blocker and/or CCB. Tolerance develops so be nitrate free 10-14 hours.
Don’t give with PDE. Can cause hypotension, reflex tachycardia, headache, syncope flushing.
Significantly hypotensive, extreme bradycardia or tachycardia, PDE-5 inhibitor.
What to know about beta blockers?
Beta blockers MOA?
Beta blockers dosing?
1st line for chronic agina, ideal for patients with coexisting HTN, post-MI, ventricular arrythmias, improves exercise tolerance in patients with CAD, not for variant angina.
Activates 3 different receptors. B1(heart, kidneys)(lowers HR and lower contracility and lower o2 demand, remodeling, wall tension), B2(arterial smooth muscle), a1(arterial smooth muscle).
Star low, go slow. Titrate to goal HR 50-60 BPM. Do not abruptly withdrawal and taper at least 2 days.
Beta blocker A/E’s?
D/I’s of beta blockers?
CI’s for beta blockers?
Fatigue, depression, hypotension, bradycardia, heartblock, worsening symptoms of PAD, bronchospasm, altered glucose metabolism.
Anti hypertensives, Anti arrythemics, anti diabetics, beta 2 agonists, non-dihydropine CCB’s, NSAIDS.
Severe asthma or COPD(normally this is a CI but in the setting of CAD or ACS, the benefit of a beta blocker outweighs the risk). Severe hypotension, severe bradycardia, 2nd or 3rd degree AV block,, bronchospasm, severe HF, prolonged PR interval.
What to use if Beta blockers are Ci’d? Is this the drug of choice in variant angina?
Which CCB’s have the most vasodilation?
Which CCB’s have the most effect on HR(low AV node conduction and low mycdardial contractility?
CCB’s. Yes!
Dihydropydidines. Most potent peripheral vasodilation
Nondihydro’s, avoid in combo with Beta Blockers,
Which are the long acting CCB’s?
A/E’s of the dihydropyridine?
A/E’s of nondihydropyridine?
Amlodipine, Felodipine.
Hypotension, reflex tachycardia, peripheral edema, headache
Hypotension, Bradycardia, Heart Block, Worsening HF, Constipation(verapamil)
D/I’s of CCB’s?
C/I’s of CCB’s?
Ranolazine MOA?
Antihypertensives,antiarrythmics(non-dhp),betablockers(non-dhp)
Severe hypotension, severe bradycardia(non-dhp), 2nd or 3rd degree AV block(non DHP), Significant LV dysfunction
inhibits late sodium current, no effect on HR and BP Use is limited due to QT prolongation.
Ivabradine things to know?
Antiplatelet therapy things to know?
ABC’s of CAD?
Approved for HF, no effect on BP, inhibitor of if current of pacemaker cells in the SA node, lowers HR(lower O2 demand), prolonged diastole(increased O2 supply). Most common A/Es is Phosphenes(bright spots after rubbing eyes).
Prevents disease progression and future cardiac events. Should start aspiring daily, if CI’d then use clopidogrel.
Aspiring and Anti anginal therapy, Beta blocker and Blood pressure, Cigarette smoke and Cholesterol, Diet and Diabetes, Exercise and Education.
