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NAPLEX STUDY > Stable Ischemic HD, ACS, and HF > Flashcards

Stable Ischemic HD, ACS, and HF Flashcards

1
Q

cardiac stress test medications

A

adenosine, dipyridamole, dobutamine or regadenoson (Lexiscan)

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2
Q

Non-drug treatment for SIHD

A

BMI 18.5-24.9
waist circumference of < 35 in in females and < 40 in males

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3
Q

drug regimen for SIHD

A

aspirin 81 mg and beta blockers (clopidogrel if allergy to aspirin)

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4
Q

when do you suggest clopidogrel + aspirin

A

history of bare metal stent placement (DAPT 1 month), drug-eluting stent (DAPT 6 month) or CABG (DAPT 12 months)

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5
Q

alternatives when beta-blockers are contraindicated in patients

A

CCB (both DHP and non-DHP), long-acting nitrates, ranolazine (in addition or instead of)

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6
Q

SIHD preventative medications

A
  • SLNG for immediate relief
  • high intensity statin
    -antihypertensives with HTN, HF, and DM
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7
Q

how long should aspirin be used in patients with SIHD

A

indefinitely - use non-enteric coated chewable aspirin

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8
Q

Clopidogrel

A

avoid use with omeprazole and esomeprazole

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9
Q

ranolazine

A

not for acute treatment of chest pain
has little to no effect on HR and BP
QT prolongation

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10
Q

nitroglycerin

A

hypotension, headache, tachyphylaxis

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11
Q

ISDN + hydralazine

A

preferred combo for HFrEF

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12
Q

nitrates

A

do not use with PDE-5s and riociguat
-avanafil in the past 12 hours
-sildenafil or vardenafil in the past 24 hours
- tadalafil in the past 48 hours

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13
Q

NG TL Spray

A

do not shake
spray onto or under the tongue
do not inhale the spray or try to swallow
do not spit or rinse mouth for 5-10 min after

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14
Q

Unstable angina (UA)

A

chest pain
negative cardiac enzymes
none/transient ischemic changes in ECG
partial blockage

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15
Q

NSTEMI

A

chest pain
positive cardiac enzymes
none/transient ischemic changes in ECG
partial blockage

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16
Q

STEMI

A

chest pain
positive cardiac enzymes
ST-segment elevation on ECG
complete blockage

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17
Q

NSTEMI-ACS

A

can be treated with medications alone or with PCI

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18
Q

STEMI

A

PCI or fibrinolytic

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19
Q

Time to PCI

A

90 minutes (door to balloon time) or within 120 minutes of first medical contact

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20
Q

Time to fibrinolytic

A

30 minutes

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21
Q

MONA-GAP-BA

A

MONA: morphine, oxygen, nitrates, asa
GAP: GPIIb/IIIa antagonists, anticoagulants, P2Y12 inhibitors
BA: beta-blockers, ACEi

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22
Q

when not to use IV nitroglycerin in ACS

A

SBP < 90 mmHg

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23
Q

when should beta-blockers be given post ACS?

A

within 24 hours to increase long term survival

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24
Q

P2Y12 inhibitors

A

prodrugs that irreversibly bind to the P2Y12 receptor
*not ticagrelor

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25
Clopidogrel
LD: 300-600 mg (600 mg PCI) MD: 75 mg -bleeding risk (stop 5 days prior to surgery) di not use with omeprazole or esomeprazole
26
Prasugrel
LD: 60 mg (no later than 1 hour after PCI) MD: 10 mg (5 mg < 60 kg) -dispense in original container -do not initiate if CABG is likely - stop at least 7 days prior to elective surgery
27
Ticagrelor
LD: 180 mg MD: 90 mg BID x 1 year then 60 mg BID - do not exceed 100 mg of ASA -avoid use when CABG likely, stop 5 days before any surgery
28
SSRIs and SNRIs
increase the risk of bleeding when used with P2Y12
29
GIIb/IIIa receptor antagonists
Abciximab (ReoPro), Eptifibatide (Integrillin) -bleeding, thrombocytopenia
30
PAR-1 antagonist
Vorapaxar (Zontivity)
31
Fibrinolytics
cause fibrinolysis by binding to fibrin and converting plasminogen to plasmin -used only for STEMI
32
Alteplase (Activase) | Tenecteplase (TNKase)
contraindications: active internal bleeding, hx of a recent stroke, ICH, severe controlled HTN
33
Secondary prevention: ASA
indefinitely (81 mg/day) unless contraindicated
34
Secondary prevention: P2Y12 inhibitor
-medical therapy: ticagrelor or clopidogrel with asa 81 mg for at least 12 months -PCI-treated patients: clopidogrel, prasugrel, or ticagrelor with asa for 12 months
35
Secondary prevention: BB
3 years - continue indefinitely in patients with HF or if needed for management of HTN
36
Secondary prevention: ACEi
indefinitely in patients with EF < 40%, HTN, CKD, or diabetes; consider for all I patients with no CI
37
Secondary prevention: aldosterone antagonist
indefinitely in patients with EF < 40% and symptomatic HF or DM receiving target doses of an ACEi and BB -CI: significant renal impairment or hyperkalemia
38
Secondary prevention: statin
indefinitely high statin for most people (those > 75 can consider moderate or high intensity)
39
HFrEF
EF < 40% (systolic dysfunction) impaired ability to eject blood during systole
40
HFmrEF
EF 41-49%
41
HFpEF
EF > 50%
42
HFimpEF
< 40% at baseline then > 10% increase and second F > 40%
43
Lab/biomarkers of HF
increased BNP (normal < 100) increased NT-proBNP (normal is < 300) BNP and proBNP are used to distinguish between cardiac and non-cardiac causes of dyspnea
44
Left-sided S/Sx
orthopnea: SOB when laying down Paroxysmal nocturnal dyspnea: nocturnal cough and SOB Bibasilar rales: crackling lung sounds heard on lung exams S3 gallop hypoperfusion (renal impairment, cool extremities)
45
General S/Sx of HF
dyspnea (SOB at rest or upon exertion) cough fatigue, weakness reduced exercise capacity
46
Right-sided S/Sx
peripheral edema ascites: abdominal fluid accumulation JVD HJR hepatomegaly
47
cardiac output
CO = HR x SV
48
cardiac index
CI - CO/ BSA
49
Drug Information NATION (drugs that cause or worsen HF)
DPP4-inhibitors Immunosuppressants/TNF inhibitors Non-DHP CCB/diltiazem and verpamil Antiarrhythmics (class 1 agents) Thiazolidinediones Itraconazole Onc drugs NSAIDs
50
Initial medications for HF (w/o CI)
ARNI, ACEi, or ARBs BB Loop diuretics
51
Which HF medications decrease mortality
ARNI/ACEi/ARBs BB ARAs, SGLT-2 (NYHA II-IV)
52
Secondary medications for HF in select patients
ARA SGLT-2 BiDill Ivabradine
53
Which HF medications decrease morbidity
ARAs, SGLT-2, Bidill
54
Additional medications for HF
Dig, vericiguat
55
BB in HF
bisoprolol, carvedilol (IR and ER), metoprolol succinate (ER) -only discontinue during acute decompensated HF
56
carvedilol CR and IR dose conversion
Coreg 3.125 mg BID = Coreg CR 10 mg daily
57
Loop diuretics
- do not use in those with sulfa allergies - decrease K, Mg, Na, Cl, Ca - increase HCO3, UA, BG, TG, TC - ototoxicity - orthostatic hypotension, photosensitivity - keep at room temperature
58
oral loop diuretic coversion
furosemide 40 mg = torsemide 20 mg = bumetanide 1 mg - ethacrynic acid 50 mg
59
furosemide IV:PO
1:2 (20 mg IV = 40 mg PO)
60
ARA in HF
do not initiate for HF if K > 5
61
Ivabradine
bradycardia, increased risk of QT prolongation and ventricular arrhythmias -side effects: bradycardia, HTN, AFib Target: resting HR between 50-60 BPM
62
digoxin level target
< 1 ng/mL in HF (0.5-0.9 ng/mL)
63
magnesium and potassium levels in those on digoxin
>2 and 4-5
64
digoxin
-0.125-0.25 mg PO QD -LD not used in HF -CrCl < 50 mL/min decrease dose or freq -decrease dose 20-25% when switching from PO to IV
65
digoxin toxicity
blurred/double vision, greenish-yellow halos
66
digoxin and amiodarone/dronedarone
reduce digoxin dose by 50%
67
KCl ER capsules
capsule contents can be sprinkled on a small amount of applesauce or pudding
68
KCl ER Tab
K-Tab, Klor-Con: swallow whole; do not chew, crush, cut or suck on tablet Klor-Con M: can be cut in half or dissolved in water; do not chew, crush, or suck on the tablet
69
KCl oral packet
dissolve contents in water and drink immediately

NAPLEX STUDY (25 decks)

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