FamMed PPP w/ Rosh Flashcards by brandon lovin

What are the two etiologies for hyperlipidemia

What two PE findings are suggestive of this Dx

When are screening initiated for wo/men

HyperCholesterol/Triglyceridemia

Xanthomas: accumulation on Achilles
Xanthelasmas: eyelid plaques

High risk (smoking, HTN, FamHx)- M: 20-25, F: 30-35
Low risk- M: 35, F: 45

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National Cholesterol Education Program recommends screening all adults at ? age regardless of RFs

What are the 5 populations that need to have hyperlipidemia Tx

? lab order is needed if Pt develops body aches after starting statin therapy

20y/o

Diabetics between 40-75y/o
Atherosclerotic dz/ASCVD risk ≥7.5%
≥21y/o w/ LDL ≥190
<19y/o w/ familial hypercholesterolemia

Creatinine kinase

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Best med for lowering elevated LDL

Best meds for lowering triglycerides

Best meds to increase HDL

DM2 get ? two meds

Statins, Bile acid sequestrants

Fibrates, Niacin

Niacin, Fibrates

Statins, Fibrates

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MOA of statins

Two possible adverse outcomes

Pt education for taking these meds

Inhibit HMG-CoA reductase, inc LDL clearance

Rhabdo, Myositis

Take at night (Atorva/Rosuva- anytime of day)

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MOA of Niacin

Adverse effect of use

C/i to use

Inc HDL levels by decreasing clearance

Inc prostaglandins= flushing/warm skin; Pre-Tx w/ NSAID/ASA 30min prior

PUD, Liver Dz

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MOA of Fibrates

Adverse effects of use

C/i to use

Dec triglyceride synthesis w/ inc lipoprotein catabolism

Increased gallstones

Hepatobiliary Dz, Breastfeeding

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What is the only Fibrate approved for co-use w/ a Statin

Genfibrozil can’t be used w/ ? meglitinide

How is the pruritus associated w/ biliary obstruction Tx

Fenofibric acid

Repaglinide

Cholestyramine

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MOA of Bile Acid Sequestrants

Adverse effects of use

C/i to use

Binds to bile acids preventing absorption and dec LDL

Inc triglycerides
Impairs medication/fat soluble vitamin absorption

Sev hypertriglycerides, Complete biliary obstruction

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MOA of Ezetimibe

What are the indications for use

What are the adverse effects of use

Inhibits intestinal cholesterol absorption

Combo use w/ statin to dec LDLs

Inc LFTs, HA/D

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High intensity statins

Mod intensity statins

Low intensity statins

Atrova 40-80mg
Rosuva 20-40mg

Atorva 10
Rosuva 10
Simva 20-40
Prava 40
Lova 40
Fluva 40
Fluva 80
Pita 2-4mg

Simva 10
Prava 10-20
Lova 20
Fluva 20-40
Pita 1mg

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Ranges for Normal, Elevated, Stage 1 and Stage 2 HTN

MCC of Essential HTN

MCC of Secondary HTN

N: <120/80 and <80
E: 120-129 and <80
1: 130-39 or 80-89
2: ≥140/≥90

Idiopathic

Renovascular

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? are the two MCC of end stage renal dz in USA

What are the ACC/AHA HTN targets

What are the JNC-8 HTN targets

DM then HTN

<130/80

<60y/o/CKDz/DM: <140/90
≥60y/o: <150/90

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? is the only ARB that doesn’t cause hyperuricemia

MOA of Thiazide diuretics (including Metolazone)

S/e of use

Losartan

Dec reabsorption and Ca excretion at distal tubule

HypoNa/K, HyperUr/Ca/Glucose

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MOA of Loop Diuretics

Adverse effects of use

C/i in ? population

Inhibit water transport across LoH

HypoK/Na/Ca

Sulfa allergy

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MOA of K-sparing diuretics

S/e of use

C/i to use

Inhibit Na/water absorption, most useful combo use w/ Loops

HyperK, metabolic acidosis

Renal failure, HypoNa

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MOA of ACEI

Adverse effects of use

C/i to use

Dec pre/after load, inc vasodilation and insulin action

1st dose HOTN, HyperK Cough Angioedema

Pregnancy

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MOA of ARBS

Adverse effect of use

C/i to use

Binds/blocks angiotensin two receptors w/out increasing bradykinin levels

HyperK

Pregnancy

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MOA of Non-Dihydro CCBs

MOA of Dihydro CCBs

S/e of use

C/i to use

Vasodilators w/out cardiac effect

Affect contractility/conduction along w/ vasodilation

HA Edema Consitpaion- Verapamil

CHF, 2/3 blocks

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MOA of BB

Adverse effects of use

Ci to use

Catecholamine inhibitor, blocks adrenergic renin release

Impotence, HypoGlycemia

HOTN, HR <50, Asthma/COPD

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MOA of A-blockers

Beneficial use for ? population

Adverse effects to use

Blockade leads to arterial dilation

HTN w/ BPH

1st dose syncope, HA, weakness

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When do USPSTF screening begin and when are f/u needed

Criteria for HTN Urgency

MC c/c Sx

18y/o: q12mon,
q6mon if SBP 120-129

SBP >180 or DBP >120 w/out end organ damage

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How are HTN Urgency Tx

What is the BP goal for Tx

PO Meds:
Clonidine: A2 agonist
Captopirl
Furosemide
Labetalol
Nicardipine

≤160/100

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Define HTN Emergency

How quickly is BP lowered

What are the three exceptions to lowering BP

SBP >180 or DBP >120 w/ end organ damage

MAP dec 10-20% first hour
5-15% over 23hrs

Acute phase ischemic stroke
Aortic dissection
intracerebral HTN

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What meds are used during HTn Emergencies

What causes angina

Sxs begin to occur when ?% occlusion is present

Nicard/Clevidi-pine
Labetalol
Fenoldopam
Na Nitroprusside

Dec perfusion: inc demand along w/ dec supply

≥70%

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Time frame for angina pectoris What are anginal equivalents Who is more likely to develop an equivalent

<30min, resolves <5min w/ rest or Nitro Dyspnea, Epigastric/Shoulder pain Elderly Diabetic Obese Women

What is the initial step for Dx Angina Pectoris What is the most important non-invasive test What is the definitive Dx method

EKG w/ ST depression Stress test w Bruce protocol Angiography

How is Angina Pectoris managed outpatient What are the two revascularization techniques and what determines the method

ASA BB Nitro Statin PCI: 1 or 2 vessel Dz in non-DM w/out LAD involvement and normal EF CABG: L-main or 3 vessel Dz, or two vessel Dz in diabetics, or Pts w/ EF <40%

What are the four NYHA classifications of angina ? is the most useful non-invasive test in the Dx of CADz What are the indications to order this test

1: ASx, no limitations 2: Sx w/ mod activity 3: Sx w/ mild activity 4: Sx at rest Stress test Baseline EKG is normal

What two meds are used for a chemical stress test for Pts unable to exercise Pts need to d/c ? two meds prior to test What two meds are used for stress Echos

Adenosine: dec AV conduction Dipyridamole: dec platelet aggregation, coronary artery dilation Theophylline: adenosine receptor antagonist Caffeine Dopamine or Dobutamine (c/i w/ AS, MI <3 days or HTN)

What can trigger Rest Angina What medication may be used during angiography to aid w/ Dx How are these Pts managed and what is avoided

Prinzmetal: cocaine, pseudophedrine Ergonovine CCBs, then Nitro; No BBs

Check ? leads for P-wave morphology How is a sinus rhythm determined Normal PR interval

2, V1 Upright 1, 2, aVF; Neg in aVR .12-.2 (3-5 boxes)

How is L atria enlargement assessed How is R atria enlargement assessed Normal QRS length is ? but if shortened ? step is skipped

M-shaped in lead 2 Biphasic in V1 w/ larger terminal component Tall in lead two ≥3mm Biphasic in V1 w/ larger initial component

RVH criteria LVH Criterias

V1 R>S or R >7mm Sokolow-Lyon: V1 S + V5 R >35 (>30 women) Cornell: aVL R + V3 S >28mm (>20mm women)

Heart moves ? infarct and ? hypertrophy Define Sinus Arrhythmia If Sx, how are these Pts Tx

Away from infarct, Towards hypertrophy Beat to beat variation: inc w/ inspiration, dec w/ expiration Brady w/ Atropine first, then: Trans-pace, Epi, Dopamine

Criteria for Sinus Tach What med is used for persistent sinus tach during ACS Criteria for Sinus Brady and how are Pts w/ Sxs Tx

>100bpm w/ P-waves Metoprolol <60bpm w/ P-waves; Atropine then Epi/Trans-pacing

MCC of SSS How does this condition present and how is it Dx If unstable, how are Pts Tx How are Pts Tx long term

Sinus node fibrosis Episodic brady/tachy; EKG or Holter Atropine then, Trans-pace, Epi, Dopamine Pacemaker

How does A-flutter appear on EKG How are stable Pts managed How are unstable Pts managed

Identical saw-tooth waves at 250-350 bpms Vagal, Rate: BB/CCBs Sync'd conversion

Definitive Tx for A-flutter ? class anti-arrhythmics can be used What are the four types of Afib

Ablation 1A, 1C or 3 Paroxysmal: <7days Persistent: >7days Permanent: >12mon, refractory to conversion or no attempts Lone: no heart Dz

? syndrome can occur during Afib How are stable Pts Tx How are unstable Pts Tx

Ashman: aberrant conduction beats w/ wide QRS after short R-R cycles Rate: BB or Non-Di CCBs, Digoxin if BB/CCB c/i Synch'd conversion

How are Afib Pts definitively Tx Anticoagulate ? long prior and after conversion What are the two types of PSVT

Ablation, MAZE surgery 3wks prior, 4wks after ANRT: one normal, one accessory path within AV node; MC type AVRT: one normal, one accessory outside AV node (WPW, LGL syndrome)

What are the two different EKG presentations of PSVTs How are the two Tx

Orthodromic: narrow complex tachycardia Antidromic: regular, wide complex tachycardia Stable, narrow: vagal, Adenosine, BB CCB Digoxin Stable, Wide: Amiodarone, Procainamide Unstable: Synch'd conversion

What is the difference between WAP and MAT MAT frequently co-exists w/ ? other d/o How is MAT Tx in this population

WAP: <100bpm MAP: >100bpm COPD Verapamil; BB if LV function preserved

WPW is a AVRT variant w/ accessory pathway located ? What are the 3 EKG findings How is this wide complex Tx

Bundle of Kent Short PR Wide QRS D-wave Procainamide/Amiodarone Synch'd conversion Ablation

What EKG finding suggest AV junctional rhythms What EKG finding suggest PVCs MCC of Vtach

Inverted P-wave 1, 2, aVF Post P-wave aVR T-wave opposite direction of QRS w/ compensatory pause Ischemic heart dz

Along w/ low E+, what medication toxicity can cause V-tach How is stable, sustained Vtach Tx MCC of Vfib

Digoxin Amiodarone Lidocaine Procainamide ischemic heart Dz

Class 1 Anti-arrythmic drugs

Na channel blockers: dec Na conduction and AV node automaticity leading to membrane stabilization 1A: Procainamide Quinidine Disopyramide; Prolong repolarization and action potential 1b: Lidocaine, Tocainide; Dec conduction velocity and shortens repolarization; C/i: narrow SVT 1c: Flecainide Propafenone Ecainide; Inc QRS prolongation and dec conduction velocity w/ affecting action potential

Class 2 Anti-arrhythmic drugs

Cardio sel: AME-olol Non-Sel B1, B2: PS-olol Non-sel A, B1,2: LC-olol Dec SA/AV node conduction Non-sels can cause bronchospasms in asthma/COPD Toxicity Tx w/ glucagon

Class 3 anti-arrhythmics

Sotalol Amiodarone Ibutilide Dofetilide Prolongs action potential Amiodarone: characteristics of Class 1-4 meds w/ s/e of pulm fibrosis and thyroid d/o

Class 4 anti-arrhythmics Class 5 anti-arrhythmics Class 1 and 3 antiarrhythmics are used for while Class 2 and 4 are used for

Verapamil, Diltiazem Slows SA/AV conduction to inc PR interval and refractory period Digoxin- cardiac glycoside, dec ATP-ase 1/3: rhythm, 2/4: rate

MCC of syncope Harsh/Rumbling murmur indicates ? Blowing murmur indicates ?

Vasovagal: prodrome of dizzy, light headed, tunnel vision Stenosis Regurg

Increasing venous return to the heart increases the intensity of ALL murmurs except ? two What two murmurs radiate What positions accentuate aortic and mitral murmurs

HOCM, MVP MR: axilla AS: carotid Aortic: sit, lean forward Mitral: lay on side

What does hand grip do for heart murmurs This murmur increases ? murmurs What effect does Amyl nitrate have on murmurs

Inc after load, dec LV emptying Outflow: AS, HOCM, MVP Dec afterload, inc LV emptying; inc AR/MR murmurs; this is why after load reducers (ACEI) are used

? is the MC valvular Dz What are the two MCC by age What would be seen on PE indicating this murmur

AS- preload depended >70: age degeneration <70: bicuspid valve Pulsus parvus et tardus: weak, delayed carotid pulse w/ narrow pulse pressure

How are Pts w/ AS managed until surgical correction What additional murmur can be heard w/ AR What two additional PE findings aid w/ Dx AR

Avoid exertion and neg inotropes: BBs, CCBs Austin Flint: Mid-late diastolic rumble at apex d/t regurg from LA into LV Bounding pulses, Wide pulse pressure

What are the 8 types of wide pulse pressures seen w/ AR

Water Hammer: rapid up/down of radial pulse Corrigan: water hammer in carotid artery Hill's: SBP popliteal > brachial, most sensitive Duroziez: femoral artery pressure= bruit Traubes: double sound at femoral w/ compression De Musset: head bob w/ pulse Muller's: pulsations seen in uvula Quincke's: finger nail pulsations

How is AR Dx How are Pts managed until surgery MCC of MS

Echo w/ cath Dec afterload: ACEI/ARB Rheumatic heart dz

What facial changes are seen on PE in Pts w/ MS What ENT syndrome can this cause What will be heard on exam

Mitral facies: flushed cheeks w/ facial pallor d/t hypoxia Ortners- recurrent nerve plasy d/t LA dilation Loud S1 (MV closure) w/ opening snap

MCC of MVP What does this sound like on PE What makes this click occur sooner/later

USA: MVP Developing: rheumatic heart dz Widely split S2 w/ displaced PMI Soon: dec preload, Late: inc preload

What med is used during MVP w/ Sxs Do Pts need endocarditis prophylaxis What causes PS

BBs No Congenital Rubella Syndrome

What additional murmur is heard w/ PR Define Carvallos Sign ? lab result makes a Dx of CHF more likely

Graham Steel: early diastolic decrescendo at LUSB, accentuated w/ inc venous return/dec w/ dec return Inc murmur w/ inspiration w/ pulsatile liver= TR BNP >100; LMOP: Fuorsemide Morphine Nitrates O2 Position- sit and dangle legs over bed to dec preload/venous return

What are the two MCC of pericarditis How is pericarditis Dx How is this Tx based on etiology

Infection: Coxsackie, Echovirus Dresslers EKG: diffuse, precordial ST elevation/PR depression, opposite in aVR NSAID/ASA; Dressler: ASA/Colchicine (avoid NSAID)

? size of abdominal aorta is considered an aneurysm What is the MC location How do un/ruptured aneurysms present

>3cm Infrarenal Un: Flank pain, abdominal bruit, pulsatile mass Rup: Flank pain w/ echymosis, HOTN, mass

How are AAA Dx When are screenings performed What sizes are indicative of repair/referral

Stable: CT w/ contrast Unstable: bedside US All men 65-75y/o w/ smoking Hx >5.4 or expands >0.5cm/6mon >4.5cm: refer 4-4.5cm: US q6mon 3-4cm: US q12mon