Notes 465-cardio Flashcards
when to treat low risk framingham patients
ldl 5 or more or genetic dyslipidemia
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
which cholesterol lowering agent should not be used in diabetes
niacin- hyperglycemia and reduced insulin sensitivity
hypertensive urgency
should be reduced within hours (more than 180 over 130 and target organ changes)
hypertensive emergency
need immediate BP reduction
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
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
how much does one bp drug typically lower on own
10/5
how long for BP drug max effect
about three weeks
when is HCTZ not effective anymore
CrCl less than 30
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
3 classes that have shown benefit in isolated systolic HTN
thiazides, ARBs, DHP CCB
age over ___, lower BP target of less than 150/90 used
80 yo
beta blockers in pheochromocytoma
can result in unopposed vasconstriction- CI
first line HTN therapy without compelling indication
thiazide, ace/arb (non black), BB (under 60), long acting CCB
HTN with CAD first line? stable angina? recent MI?
CAD-ACE/ARB, stable angina-CCB or BB. recent MI_-BB and ACE
HTN with HF? second line?
ACE and BB. Isosorbide dinitrate and hydralazine second line if first option not tolerated
HTN recent after stroke?
ACE and thiazide
HTN CKD
ACE or ARB
HTN with diabetes- with and without kidney/CV disease
without- any first line in non compelling indications. With- ace or arb
why aren’t alpha antag recommended as first line in HTN
not shown to be as effective as others
drugs for supraventricular tachycardias
non DHP CCB, BB
drugs for ventricular arrhytmias
1A, 1B, 1C, 3
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)
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
20
what happens when you take amiodarone and digoxin together
elevated digoxin levels
