DRUGS - ain't nobody got time for that, what do I give??

Question 1

Angina

Answer 1

nitrates
BB (classic angina only)
CCB

Question 2

NSTEMI

Answer 2

RIGHT NOW:
aspirin & clopidogrel
nitroglycerin
heparin/LMWH
NO FIBRINOLYTICS
direct thrombin inhibitors
LATER:
BB
aspirin
clopidogrel (1 yr)
manage HTN & lipids
ACEi

Question 3

STEMI

Answer 3

RIGHT NOW:
aspirin & clopidogrel
nitroglycerin
heparin/LMWH
FIBRINOLYTICS
LATER:
BB
aspirin
clopidogrel (1 yr)
manage HTN & lipids
ACEi

Question 4

CHF - basic firstline approach

Answer 4

loop diuretic +
ACEi
and then
BB
aldosterone antagonist e.g. spironolactone

Question 5

CHF - if ACEi or BB isn’t tolerated

Answer 5

vasodilators:
nitrates (relax veins = decrease preload)
hydralazine (relax arteries = decrease afterload)

Question 6

CHF - do not give these to patient with CHF

Answer 6

CCBs verapamil, diltiazem

Question 7

CHF - these CCBs are ok to give a patient with CHF if you must give them for some other indication

Answer 7

nifedipine, amlodipine

Question 8

CHF - acute, hospital setting

Answer 8

dobutamine

Question 9

CHF - severe, or to help with ventilation

Answer 9

dopamine, epinephrine

Question 10

Sinus bradycardia

Answer 10

atropine will increase HR

Question 11

Paroxysmal supraventricular tachycardia

Answer 11

1. adenosine will interrupt episode if mechanical measures (Valsalva maneuver, splashing cold water on the face, carotid massage) do not work
2. CCB
3. IV BB

Question 12

Wolff-Parkinson-White syndrome

Answer 12

acute episode: antiarrhythmics e.g. amiodarone

longterm: CCB, BB

Question 13

Atrial fibrillation

Answer 13

1. anticoagulation: indefinite warfarin or dabigatran

2. rate control: antiarrhythmics

Question 14

Atrial flutter

Answer 14

1. anticoagulation: indefinite warfarin or dabigatran

2. rate control: antiarrhythmics

Question 15

Ventricular tachycardia

Answer 15

Sustained: amiodarone, BB
Nonsustained: BB

Question 16

Premature ventricular contractions

Answer 16

ONLY IF PATIENT IS SYMPTOMATIC: BB for underlying disease

Question 17

Long QT syndrome

Answer 17

congenital: BB
acquired: IV BB, IV magnesium

Question 18

HTN

Answer 18

JNC7: thiazide, then ACEi/ARB
JNC8: nonblack - TH, ACEi/ARB, CCB
black - TH, CCB
CKD - ACEi/ARB

Question 19

Hypertensive emergency

Answer 19

CURRENT: nicardipine, labetalol

Dr. Schneider: nitroprusside sodium, nitroglycerine, labetalol, nifedipine, clonidine, captopril

Question 20

Endocarditis, before you know the specific organism

Answer 20

Vancomycin + ceftriaxone

Question 21

Myocarditis

Answer 21

ACEi
+
BB if LV EF < 40%

Question 22

Pericarditis

Answer 22

~NSAIDs and aspirin for pain
~colchicine for refractory or recurrent cases
~if SEVERE: steroids

Question 23

Rheumatic fever

Answer 23

Abx prophylaxis for FIVE YEARS

~erythromycin or penicillin

Question 24

Chronic arterial insufficiency

Answer 24

antiplatelets (aspirin, clopidogrel)

pentoxifylline (decreases blood viscosity)

Question 25

Chronic venous insufficiency

Answer 25

horse chestnut seed (buckeye) extract

PKM slides

Question 26

DVT

Answer 26

heparin right away, transition to warfarin for at least 3 months, maybe for life