Stuff to remember Flashcards
What are the drugs used in treating hypertension and stable ischemic heart disease?
ACE inhibitors, ARBS/ calcium channel blockers beta blockers,
What are the drugs used in treating hypertension and diabetes?
diuretics ace inhibitors arbs calcium channel blockers
What are the drugs used in treating hypertension and recurrent stroke?
diuretics ace and arbs
What are the drugs used in treating hypertension and heart failure?
diuretics b-blockers ace and arbs aldosterone-receptor antagonists
What are the drugs used in treating hypertension and previous MI?
b-blockers, ace, aldosterone-receptor antagonists
What are the drugs used in treating hypertension and chronic kidney disease?
ace inhibitors and arbs
What do you use to treat atrial flutter?
metoprolol, verapamil, or rarely (digoxin)
cardioversion w/ ibutilide or electrical synchronized cardioversion
prevention: ablation is preferred, amiodarone can be used until definitive treatment
What do you use in Atrial fibrillation treatment?
Unstable: IV BB (metoprolol-preferred if MI) or IV CCV (diltizem). may need cardioversion (flecanide, dofetalide, propafenone, and ibutilide) if shock, hypotension, pulmonary edema, MI
decrease heart rate and promote conversion to sinus rhymed
Stable: BB (metoprolol) or CCB (diltizem) slow down nodal contraction
Maintenance: BB, CCB, or digoxin (not for pre-excitation AF) combination only in younger patients.
Use BB for hypertensive, CAD, heart failure, and COPD or asthma.
not CCB for CAD, CHF.
critically ill w/out preexcitation can also use amiodarone
Apixaban best choice anticoagulant
What drugs treat av nodal reentry?
Narrow: vagal maneuvers IV adenosine, verapamil or BB IV
Wide: avoid BB and CCB to prevent vfib use IV procanamide and ibutilide
cardioversion: valvsava, carotid, massage, adenosine
acute SVT long term?
vagal maneuvers adenosine possibly verapamil/diltiazem prevent w/ BB or CCB.
brady arrhythmias- implantable pacemaker
sinus tachy: treat hypotension, use metoprolol to stabilize and maintain
PSVT in structural heart disease sotalol and amiodarone
What do you use to treat acute vtacha nd ventricular fibrillation?
vtach: cardioversion first, wide complex (amiodarone, lidocane). BB or CCB for maintenance
polymorphic VT unstable w/ normal QT: defibirillate amiodarone if defibrillation ineffective, pacemaker
torsades: defibrillate , magnesium
what is the first line agent for black patients and older and diabetics w/ hypertension? second line
CCB or diurhetic (later on) (thiazide) ACE or ARB or vasodilation
what is the first line agent for patients all other less than 55 w/ hypertension and renal disease? second line
ACE or ARB/CCE or diuretic (thiazide) vasodilation beta blocker
what are the alternatives for systemic hypertension? resistant hypertension?
alpha agonist or antagonist; aldosterone receptor blocker
What is step 3 of treating patients w/ hypertension?
all three ACE or ARB; CCB, when you add diuretic (thiazide-like)
what do you do for step 4 of resistant hypertension?
alpha-blocker, diuretic, or alpha beta blocker
What occurs in compensated heart failure?
decompensated meanis initial reduction of contractility w/ low CO like fatigue. compensated EDV increase to maintain adequate causing congestion and dyspnea
What medications would you use in renal disease? what are some indications that that particular drug may not be useful?
Chlorthalidone, HCTZ: ◦Okay to use until CrCl(until the creatinine clearance or glomerular filtration rate)
any of the lipid drugs but fenofibrate and ezemetmibe
when are calcium channel blockers useful?
afib, angina, COPD
when are beta blockers useful?
atrial fibrillation, stable heart failure, asymptomatic LV dysfunction
what is HFpEF or HFrEF?
preserved ejection fraction in diastolic failure reduced ejection fraction in systolic failure
what are the L type calcium channels
long acting let calcium into the cell triggering additional release from sarcoplasmic reticulum as well as binding allowing it to successfully contract
how do you treat acute decompensated heart failure? chronic, compensated heart failure?
agressive administrions of congestive features such as pulmonary edema w/ diuresis loss of cardiac output w/ short-term inotropic agents for contractility chronic,compensated- fluid and sodium restrictions, treat comorbidities, and diuresis to avoid triggers
what medications slow the SA and AV node?
beta-blockers AV node slowing- digoxin
what do you use in angina?
beta-blockers
what do you used in MI?
Beta blocker prevent remodeling
what are drugs involved in the P450 system?
carvedlil P-glycoprotein substrate beta blockers
Class IB- impacted by CYP 450 and P glycoprotein
Class IC- CYP issues for both. propanefone inhibit P-glycoprotein
Class III- amiodarone inhibitor to CYPs and P-glycoprotein impact
Class IV- inhibit CYP and P-glycoprotein
NOACs
how does inotropic drugs work?
describe the stepwise progression of CHF?
What are the stages and class in combination of heart disease?
HFrEF-any cause ACE or ARB avoid CCB and BB
stage B:
- acute MI- reduced ejection fraction beta blockers.
- MI- statins
- HFpEF- bp controlled, diuretics-used for relief of symptoms due to volume, coronary revascularization (angioplasty or bypass) for patients w/ CAD in whom angina or myocardial ischemia is present.
- ACE or ARBS (decrease hospitilization), beta blocking for hypertension.
stage C
- present w/ SOB and edema symptoms to get echo.
- ACE or ARB plus BB
- Loop diurhetics if volume overload of fluid retention
- for persistent symptomatic black patients: hydralazine and isosorbide dinitrate
- if normal renal function can add aldosterone agonist
- digoxin benficial in patients w/ HFrEF
what do the nys guidelines fr hf state?
remaining options:
procedures to drain excess fluid-dialysis, pericentesis; continuous inotrop infusion, cardiac transplant, experimental therapies
what is the strategy for patients w/ angina?
sublingual nitroglycerin> B-blocker (propanolol w/out bronchospastic) >CCB (dihydropyridine: amlodipine-short term; nifedipine- coronary spasm/diltiazem) or isosorbide dinitrate> ranolazine
use long-acting nitrate for every possible disease not CCb for recent MI, not BB for patients feeling hypoglycemic or asthma COPD
what would you do if your patient had these things?
what are the good things about statins describe its beneficial timeline?
goal is a 50% reduction in LDL count if LDL responds and HDL doesnt you can add it
if patient <40 y/o or >75 y/o or LDL-C <70 risk-benefit profile done
clinical ASCVD <75 y/o high intensity if not tolerated moderate plus an additionl
LDL below 130
HDL >30 <80
What is the rank of strength of the lipid medications?
platelet cascade
factor 7 released from von vildebrand factor
What are some adverse effects of the platelet inhibitors?
What drugs interact w/ warfarin?
increase?
decrease
What are the side effects of the reversal agents?
What are the properties of the NOACs?
dont have to monitor short half life (requiring diligence to maintain antithrombotic event, not all have reversal agents
what should warfarin only be used for over NOAC? what is it contraindicated in?
How do you dose warfarin properly?
mechanical heart valves or hemodynamically signifciant mitral stenosis;
contraindicated in renal disease
2-3 times as long to clot for: history of DVT, VTE prevention following surgery, mechanical aortic valve; rheumatic disease; stent placement; afib/flutter; cardioversion; mitral stenosis; cancer and PE
2.5-3.5 mechanical mitral valve
you want to dose it w/ a bridge a week before surgery to take someone off it
you can miss a dose
What are the CHADS scores?
score of 2 or more high risk
score of 1 =moderate risk eval needed
what do you do in the event of a venous thromboembolism?
•Initiate anticoagulation immediately upon diagnosis to prevent complications
▫Injectable (fondaparinux) or oral (apixaban, rivaroxaban) Factor Xainhibitors –OR –
▫Low molecular weight heparin (enoxaparin) – OR –
▫Unfractionated heparin
- Long-term anticoagulation usually carried out with oral Factor Xaor direct thrombin inhibitors or with warfarin
- Anticoagulation should last for 3-6 months unless this is a recurrent problem or permanent physiology in which case it would last longer (potentially lifelong)
what are the normal selection of pharmacological agents postoperatively?
- LMWH and injectiblefactor Xainhibitor for high-risk surgical patients (such as TKA, THA)
- Low-Dose heparin: used with contraindication to LMWH (i.e. renal disease)
- Warfarin used in a delayed setting unless bridging with enoxaparin carried out for immediate anticoagulation
- ASA for orthopatients (THA, TKA) ineligible for other anticoagulation
- Direct thrombin inhibitor, factor Xainhibitors not well studied, but rivaroxaban(following after knee and hip replacement) indicated following THA/TKA
when do you use alteplase?
when do you treat DVT and PE?
▫PE:
Persistent hypotension or shock break it
Severe or worsening right ventricular dysfunction (“submassivePE”)
Cardiopulmonary arrest due to PE
Extensive clot burden (eg, large perfusion defects on ventilation/perfusion [V:Q] scan or extensive embolic burden on computed tomography)
Free-floating right atrial or ventricular thrombus
DVT:
▫Very rarely treated
Systemic thrombolyticsare associated with decreased risk of post-thrombotic syndrome, increased risk of bleeding complications, and increased rate of complete clot lysis
Only widely-accepted indication is for extensive ilio-femoral thrombosis with associated severely symptomatic limb swelling or limb-threatening ischemia
