Notes 465-cardio Flashcards by Kate Maranan

when to treat low risk framingham patients

ldl 5 or more or genetic dyslipidemia

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when to treat mod risk framingham patients

ldl 3.5 or more, or apo b 1.2 or more, or non hdl 4.3 or more

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which cholesterol lowering agent should not be used in diabetes

niacin- hyperglycemia and reduced insulin sensitivity

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hypertensive urgency

should be reduced within hours (more than 180 over 130 and target organ changes)

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hypertensive emergency

need immediate BP reduction

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what should you tell a patient who takes reading at 180 or higher? 200?

180- retake- stressed? coffee? etc if legit, tell make appt to see doc soon, but if target organ damage ie signs of vision impairment or feeling funny otherwise more urgent. 200? schedule urgent appt after checking technique

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when do you start therapy for HTN

if stage one (140-159/90-99) and no risk factors, can do lifestyle at first. If target organ damage or over 160 must start therapy now

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how much does one bp drug typically lower on own

10/5

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how long for BP drug max effect

about three weeks

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when is HCTZ not effective anymore

CrCl less than 30

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when should you get K and SCr tested after starting ace/arb

within 3 months, earlier if high risk. Really within 1-2 weeks of starting it is best but not typically seen

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3 classes that have shown benefit in isolated systolic HTN

thiazides, ARBs, DHP CCB

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age over ___, lower BP target of less than 150/90 used

80 yo

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beta blockers in pheochromocytoma

can result in unopposed vasconstriction- CI

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first line HTN therapy without compelling indication

thiazide, ace/arb (non black), BB (under 60), long acting CCB

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HTN with CAD first line? stable angina? recent MI?

CAD-ACE/ARB, stable angina-CCB or BB. recent MI_-BB and ACE

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HTN with HF? second line?

ACE and BB. Isosorbide dinitrate and hydralazine second line if first option not tolerated

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HTN recent after stroke?

ACE and thiazide

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HTN CKD

ACE or ARB

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HTN with diabetes- with and without kidney/CV disease

without- any first line in non compelling indications. With- ace or arb

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why aren’t alpha antag recommended as first line in HTN

not shown to be as effective as others

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drugs for supraventricular tachycardias

non DHP CCB, BB

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drugs for ventricular arrhytmias

1A, 1B, 1C, 3

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when is amiodarone used, AE

ventricular arrhythmia and sxatic AFib, AE peripheral neuropathy, corneal microdeposits, thyroid dysfx, pulmonary tox, hepatic tox, QT, GI, photosens, irreversible blue gray skin discoloration (use sunblock)

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what is CHADs 2 for and each letter

risk of stroke in AFib- recent CHF, HTN, age 75 or older, DM< hx of stroke or TIA is 2 points

drugs used for rate control in afib

CCB or BB

when to use digoxin in afib

patients who are sedentary with LV systolic dysfx, or not responding/CI to BB CCB

amiodarone in afib

only be used for rate control in exceptional cases

OAC in AFIB

recommended for CHADs 1 or more, and age 65 or older fro MOST patients. If less than 65 and no chads risks but CAD, can use aspirin 81mg. If none, don't need any antithrombotic (free of CAD, chads risk and under 65)

when would warfarin be used in AFIb

mechanical prosthetic valve, Cr cl of less than 15 (even less than 30 they recommend it), or rheumatic mitral stenosis, other indications for warfarin

what is pill in pocket strategy

for afib- propafenone or flecainide intermittently or as booster to terminate an episode

NOAC CI

mitral stenosis (rheumatic and non), mechanical heart valve

only drug used in PVCs

beta blockers safe and effective. If heart otherwise normal though, requires no therapy

definition of heart failure with reduced ejection fraction aka ____

systolic- EF less than 40%

how much weight is too much to gain in HF

2 lbs in 2 days or 5lbs in one week

drugs to avoid in HF

antiarrhythmic, glitazones (fluid retention), non DHP CCB (unless with preserved EF), NSAID, BB with ISA

name thiazide diuretics

metolazone, chlorthalidone, HCTZ, indapamide

name loop diuretics

bumetanide, furosemide

CI to BB

heart block, severe sinus bradycardia, use with caution in reactive airway disease

how slow should you titrate BB doses

q2-4 weeks

when to start aldosterone antag in HF and what to monitor and when

for sxatic still, monitor K closely (3d, 1 wk and monthly x3 months). eplerenone, spironolactone

changing from an ACE to entresto (sacubitril/valsartan) in HF

stop ace, wait 5-7 days, then start. Whens studied with ace, saw huge increase rates in angioedema

digoxin in HF

may be added if severe initial sx or sx persist, must also be on ACE and BB this is add on only

how to treat diastolic HF

sxatic only really- use diuretics, ace, arbs, BB, aldosterone antag, etc. make sure to control BP, edema, arrythmias and other risk factors basically

how to use nitro spray

prime if not used for a while or ever, sit, 1-2 sprays onto or under tongue q5m prn. If get to 3 call 911. Prevent sx- use 5-10 minutes before exertion, will last about 30 min.

ACS management- 2 parts

sxatic anti-ischemic tx, and a reperfusion strategy

what are the available reperfusion strategies

thrombolytic, PCI, CABG

in which type of MI do you never use a thrombolytic

NSTEMI

how to reperfuse in STEMI

thromboytic (tenecteplase, alteplase, streptokinase) within 30 minutes of hospital presentation, or PCI within 90. CABG rarely done.

how to reperfuse NSTEMI

invasive (PCI-for those high risk or where sx don't settle down and stable), or conservative (for low risk- just treat sx)

who should thrombolytics not be used in

NSTEMI, previous intracranial bleed, recent stroke or head trauma in last 30 days, brain cancer

what is PCI

stenting aka angioplasty

When is a CABG done

tried to stent and couldn't, SIHD, rarely in STEMI

how long does it take each type of stent to re endothelialize (grow new skin)

DES- 1 year, BMS- 1 month

adjunct antiplatelet therapy for thrombolysis in ACS

asa 81 indef, clopidogrel (ONLY**) for 2 weeks to one year

adjunct antiplatelet therapy for PCI in ACS

asa 81mg indef, and p2y12 inh for one year (chose any)

advantage of prasugrel over clopidogrel

only one step bioactivation, less DI, quicker onset, but higher rates of major bleeds

advantage of ticagrelor over clopid

no bioactivation, quicker onset, lower all cause mortality, no increased major bleed, increased fatal intracranial bleed and non CABG, increased dyspnea

antiplatelet therapy for CABG or no medical management in ACS

ASA 81 indef, ticagrelor or clopidogrel for one year

anticoag in ACS

should be given at least 48 hours post ACS, may be continued for up to 8 days in HOSPITAL ONLY (enox, fonda, UFH)

which BB have alpha one activity

carvediolol, labetalol

when can you expect to develop tolerance to decreased exercise toelrance with BB

6-8 weeks. never stop taking them abruptly

classic signs of digoxin tox

PVCs, bradycardia, GI, drowsy, confused, blurred vision or YELLOW GREEN HALOS

effect of thyroid on digoxin

hyper enhances clearance, hypo reduces it

how many vials of digibind are usually needed for digoxin OD

what happens when you take amiodarone and digoxin together

elevated digoxin levels