DRUGS - ain't nobody got time for that, what do I give?? Flashcards
Angina
nitrates
BB (classic angina only)
CCB
NSTEMI
RIGHT NOW: aspirin & clopidogrel nitroglycerin heparin/LMWH NO FIBRINOLYTICS direct thrombin inhibitors LATER: BB aspirin clopidogrel (1 yr) manage HTN & lipids ACEi
STEMI
RIGHT NOW: aspirin & clopidogrel nitroglycerin heparin/LMWH FIBRINOLYTICS LATER: BB aspirin clopidogrel (1 yr) manage HTN & lipids ACEi
CHF - basic firstline approach
loop diuretic + ACEi and then BB aldosterone antagonist e.g. spironolactone
CHF - if ACEi or BB isn’t tolerated
vasodilators:
nitrates (relax veins = decrease preload)
hydralazine (relax arteries = decrease afterload)
CHF - do not give these to patient with CHF
CCBs verapamil, diltiazem
CHF - these CCBs are ok to give a patient with CHF if you must give them for some other indication
nifedipine, amlodipine
CHF - acute, hospital setting
dobutamine
CHF - severe, or to help with ventilation
dopamine, epinephrine
Sinus bradycardia
atropine will increase HR
Paroxysmal supraventricular tachycardia
- adenosine will interrupt episode if mechanical measures (Valsalva maneuver, splashing cold water on the face, carotid massage) do not work
- CCB
- IV BB
Wolff-Parkinson-White syndrome
acute episode: antiarrhythmics e.g. amiodarone
longterm: CCB, BB
Atrial fibrillation
- anticoagulation: indefinite warfarin or dabigatran
2. rate control: antiarrhythmics
Atrial flutter
- anticoagulation: indefinite warfarin or dabigatran
2. rate control: antiarrhythmics
Ventricular tachycardia
Sustained: amiodarone, BB
Nonsustained: BB
Premature ventricular contractions
ONLY IF PATIENT IS SYMPTOMATIC: BB for underlying disease
Long QT syndrome
congenital: BB
acquired: IV BB, IV magnesium
HTN
JNC7: thiazide, then ACEi/ARB
JNC8: nonblack - TH, ACEi/ARB, CCB
black - TH, CCB
CKD - ACEi/ARB
Hypertensive emergency
CURRENT: nicardipine, labetalol
Dr. Schneider: nitroprusside sodium, nitroglycerine, labetalol, nifedipine, clonidine, captopril
Endocarditis, before you know the specific organism
Vancomycin + ceftriaxone
Myocarditis
ACEi
+
BB if LV EF < 40%
Pericarditis
~NSAIDs and aspirin for pain
~colchicine for refractory or recurrent cases
~if SEVERE: steroids
Rheumatic fever
Abx prophylaxis for FIVE YEARS
~erythromycin or penicillin
Chronic arterial insufficiency
antiplatelets (aspirin, clopidogrel)
pentoxifylline (decreases blood viscosity)
Chronic venous insufficiency
horse chestnut seed (buckeye) extract
PKM slides
DVT
heparin right away, transition to warfarin for at least 3 months, maybe for life
