Exam 2 - D-I Cardio Flashcards
What is a normal QTc?
< 470 men, < 480 women
What is abnormal QTc defined as? (2)
500 ms or more, or 60 ms from baseline or more
What drugs can cause prolonged QT intervals? (6; A-F)
antiarrhythmics, antibiotics (fluoroquinolones, macrolides), antipsychotics (FGAs), antidepressants (citalopram, TCAs), antiemetics, antifungals
What are non-modifiable risk factors for Torsades de Pointes? (4)
> 65, female, genetic predisposition, cardiac disease
What are modifiable risk factors for Torsades de Pointes? (4)
diuretic treatment, electrolyte abnormalities, >1 QT-prolonging agent, organ function
What should potassium and magnesium levels be maintained at to avoid QT prolongation?
K > 4, Mg > 2
What are the treatments for Torsade de Pointes? (4)
discontinue offending agents, magnesium PUSH IF NO PULSE AND INFUSION IF PULSE, transcutaenous pacing, isoproterenol infusion
What are alternatives for isoproterenol? (2)
epinephrine, atropine
What are the treatments for hemodynamically unstable patients? (2)
cardioversion, defibrillation
What drugs can cause HF due to sodium and volume retention? (3)
NSAIDs, steroids, thiazolidinediones
What drugs can cause HF due to cardiomyopathy? (3)
chemotherapeutic agents (anthracyclines, alkylating agents), biologics (trastuzumab), alcohol
What drugs can cause HF due to negative inotropy? (2)
nDHP CCBs, BBs
What is a boxed warning for TZDs?
avoid in patients with NYHA III-IV
What are the most common topoisomerase 2B agents that can cause cardiac myocyte death? (2)
daunorubicin, doxorubicin
What is a treatment for anthracycline induced cardiomyopathy?
dexrazoxane
What are treatment-related risk factors for anthracycline induced cardiomyopathy toxicity? (5)
cumulative doses > 400 mg/m^2, dosing schedules, previous anthracycline therapy, radiation therapy, co-admin of cardiotoxic agents
What are patient-related risk factors for anthracycline induced cardiomyopathy toxicity? (4)
age, pre-existing CVD, obesity, smoking
To what dose should anthracyclines be limited to to prevent cardiomyopathy?
550 mg/m^2 max
By what mechanisms can trastuzumab induce cardiomyopathy? (4)
increased ROS, reduced NOS expression, reduced NO bioavailability, increased angiotensin II
What is a boxed warning for trastuzumab?
symptomatic and asymptomatic reductions in LVEF and development of HF
When should nDHPs be avoided?
EF < 40%
When should BBs be avoided?
acute HF exacerbations
What drugs/things can cause increased HR and contractility? (5)
cocaine, B-agonists, sympathomimetics, withdrawal of B-blockers, potent vasodilators
What drugs can cause increased coronary resistance (vasospasms)? (2)
cocaine, triptans
What drugs can cause coronary artery thrombosis/vasospasms? (5)
cocaine, triptans, OCPs, NSAIDs, estrogens
What drugs can cause increased cardiovascular risk? (6)
cocaine, OCPs, NSAIDs, estrogens, HIV agents, rosiglitazone
Explain a sympathomimetic crisis?
inhibition of reuptake of NE leading to increased NE concentrations and enhanced alpha-1 mediated vasoconstriction
What are the treatments for chest pain in a cocaine-induced MI? (2)
aspirin, benzodiazepines
What are the treatments for persistent HTN in a cocaine-induced MI? (2)
benzodiazepines, IV nitroglycerin
Explain how COX inhibition can cause MI and stroke? (2)
vascular vasoconstriction and increased platelet aggregation
What is a boxed warning for NSAIDs?
may increase risk of CV thrombotic events for those with CVD or at risk
What are risk factors for acute MI with NSAIDs? (2)
recent initiation of therapy (within 7 days), higher doses
