Journal Gems Flashcards
What is the role of Canagliflozin in patients with T2DM and CKD? (CREDENCE Trial)
Lowers rates of renal failure, and improves CV outcomes
What is the role of ARNIs in HFpEF?
NO ROLE
No CV / hospitalisation benefit shown in trials
What is the strongest risk factor for contrast-induced AKI?
Pre-existing CKD
What type of contrast agents should be used to minimise risk of contrast-induced AKI?
Low-osmolality and iso-osmolality agents
What is the current recommendation for prevention of contrast-induced AKI in those at risk?
IV isotonic saline pre and post large contrast loads for those at risk
Cease nephrotoxins if able
What is the current recommended approach for non-culprit lesions in patients undergoing PCI for STEMI?
- Primary PCI of the culprit lesion.
- Proceed with PCI of non-culprit lesions immediately after primary PCI in
- those with evidence of ongoing ischemia
- those in cardiogenic shock who do not significantly improve after PCI of the infarct-related artery - If stable after primary PCI but have non-culprit lesions that are potential causes of residual myocardial ischemia
- return to cath lab prior to discharge or within the first month after discharge to perform PCI of significant non-culprit lesions (as long as not planned for CABG/valve surgery)
- > Guided by FFR
In new onset symptomatic AF, what are the possible approaches to timing of cardioversion?
In patients presenting to the emergency department with recent-onset, symptomatic atrial fibrillation, waiting 48 hours was noninferior to early cardioversion in achieving a return to sinus rhythm at 4 weeks.
What are key options for management of HCM that is obstructive and resulted in HF?
Surgical septal myectomy
OR
Alcohol septal ablation
What interventional option is available for patients with secondary mitral regurgitation, who are still symptomatic despite optimal medical therapy?
Transcatheter mitral-valve repair (Mitra-Clip) -> shown to have lower rate of hospitalization for HF, and lower all-cause mortality within 24 months of follow-up than medical therapy alone (but significant device related complications)
What are the broad indications for catheter ablation in VT in a structurally normal heart?
In the absence of structural heart disease, catheter ablation is indicated if monomorphic ventricular tachycardia:
- causes symptoms
- or antiarrhythmic drugs are ineffective.
What is the role of Fractional Flow Reserve in angiography?
Fractional flow reserve (FFR) is the clinical standard for the invasive physiologic assessment of the hemodynamic significance of intermediate stenoses.
For intermediate stenoses where there is a question of whether revascularization should be carried out, and there are no prior useful noninvasive physiologic data to guide decision making, FFR should be measured before the decision to implant a stent.
What did ISAR-REACT 5 trial show with regards to optimal antiplatelet choice in ACS?
Rates of death, myocardial infarction, or stroke significantly lower in prasugrel group compared with ticagrelor. Bleeding rates were similar
What is the MOA of ezetimibe?
Ezetimibe blocks the Niemann–Pick C1-like 1 cholesterol transfer protein to inhibit intestinal and biliary cholesterol absorption, leading to an increase in the expression of hepatic LDL receptors
What is the role of ezetimibe in lipid management?
Ezetimibe is used in patients =
- who cannot tolerate statins
- who have severe primary hypercholesterolemia
- who have insufficient reduction in LDL cholesterol levels when taking the maximum tolerated statin dose
**Because no outcomes trial has shown benefit with ezetimibe when used in isolation, those who take ezetimibe because of statin intolerance should continue to take the maximum tolerated statin dose
Which groups of older men and women, aside from those with a diagnosis of osteoporosis, should be initiated on antiresorptive therapy for fracture prevention?
- Postmenopausal women with T-scores between -1.0 and -2.5 at high fracture risk as per FRAX.
- > A reasonable threshold to define high risk is a 10-year probability of hip fracture or combined major osteoporotic fracture of ≥3.0 or ≥20 percent, respectively.
- Men ≥50 years with T-scores between -1.0 and -2.5 who are at high risk for fracture as per FRAX tool
What did the EXTEND trial show with regards to time window for thrombolysis in stroke?
In ischaemic stroke, among patients selected via CT perfusion to have significant salvalgeable tissue in the ischaemic penumbra, thrombolysis between 4.5 and 9 hours post onset/time of waking had significant benefit in neurological outcomes
What novel combination of molecular targeted therapies has been shown to be efficacious as first line therapy in CLL among high-risk / older patients?
Ibrutinib (an inhibitor of Bruton’s tyrosine kinase) + venetoclax (inhibitor of B-cell
lymphoma 2 protein)
What is Voxelotor?
What is its potential role?
Voxelotor is an HbS polymerization inhibitor
Among those with sickle cell disease, voxelotor may significantly increase hemoglobin levels and reduce markers of hemolysis.
These findings are consistent with inhibition of HbS polymerization and indicate a disease-modifying potential.
What should generally be the first line anti-HTN agent in those with COPD?
Thiazides
How should glucocorticoid be replaced in an adrenal crisis?
Prompt administration of IV hydrocortisone, given as a 100-mg bolus, followed by 200 mg every 24 hours, administered as a continuous infusion or as frequent intravenous (or intramuscular) boluses (50 mg) every 6 hours
Subsequent doses tailored to the clinical response
Which antibiotic has been shown to be more effective than metronidazole in anaerobic lung infection?
Clindamycin
What treatment has been shown to be of benefit in emergently-intubated patients for reducing risk of aspiration pneumonia?
24 hours of antibiotic therapy
What is nintedanib?
What are the indications for nintedanib treatment?
Most common AE?
Nintedanib is an intracellular multi-kinase inhibitor
Uses: IPF, Systemic sclerosis-associated interstitial lung disease
AE -> diarrhoea
Which class of anti-HTN may have favourable effects on asthma?
CCBs -> possible favourable effects on smooth muscle contraction