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Assessment 2.5 > Test type questions for 2.5 > Flashcards

Test type questions for 2.5 Flashcards

1
Q

What are the Bile Acid Sequesterants?

When are the bile acid sequesterants CI’d?

What are the conversion doses for the statins(FLPSARP)?

A

Cholestyramine, Colestipol, Colsevelam

High Triglycerides >400 for sure, possibly >200.

Fluvastatin, Lovastatin, Pravastatin 40 mg. Simvastatin 20 mg. Atorvastatin 10 mg. Rosuvastatin 5 mg. Pitavastatin 2 mg.

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2
Q

What are the side effects associated with the statins?

Which Statin has the most drug interactions? The least?

What are the main drugs that interact with statins?

A

Myalgia, GI disturbances, Increase in LFT’s.

Lovastatin. Pitavastatin.

Amiodarone, Dilitiazem, Verapamil, Azole antifungals.

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3
Q

What are the two statins that interact with CYP2C9 inhibitors?

When taking simvastatin what should your max dose be when taking dilitiazem or verapamil?

When taking simvastatin what should your max dose be when taking amiodarone, amlodipine, or ranolazine?

A

Fluvastatin, Rosuvastatin.

10 mg

20 mg.

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4
Q

When are the statins CI’d?

What are the short acting statins and when are they administered?

What is the major side effect of bile acid sequesterants?

A

Active or Chronic liver disease( if LFT’s are greater than 3x the upper limit), Pregnancy, Drug interactions, Grapefruit juice.

Everything except Simvastatin, Atorvastatin, and Rosuvastatin.

GI!!!

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5
Q

What are the side effects of Niacin?

When is Niacin CI’d?

How can you lower Niacin flushing?

A

FLUSHING, Hepatoxicity(OTC SR version is worse), Gout, Hyperglycemia, GI disturbances.

Chronic liver disease, severe gout, possibly hyperuricemia, hyperglycemia, and peptic ulcer disease.

Aspirin or NSAID 30 minutes before dose, Take at night, Slowly titrate, Take ER version.

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6
Q

What are the Side Effects of the Fibric Acid derivatives?

When are the Fibric Acid Derivative’s CI’d?

What is preferred FAD when combined with a statin?

A

GI symptoms, Myopathy, Hepatitis, Gall Stones.

Renal impairment, Hepatic Disease, Use in caution with Gallbladder and billary cirhossis.

Fenofibrate

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7
Q

When are FAD’s extra effective?

What did the ACCORD trial state?

What did the AIM HIGH trial prove?

A

When the person has very high TG’s.

Simvastatin with Fenofibrate has no extra benefit vs just Simvastatin unless you have very high TG’s.

Adding Niacin to a statin didn’t help.

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8
Q

What did the PROVE IT trial show?

When is LDL high? What about triglycerides?

What are the high intensity statin therapy doses?

A

A high potency statin should be used for CHD

> 190, >150.

Atorvastatin 80 mg, Rosuvastatin 20 mg.

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9
Q

What are the moderate intensity statin therapy doses?

What are the low intensity statin therapy doses?

What is initial hypertensive treatment in non black populations including those with diabetes?

A

Atorvastatin 10 mg, Rosuvastatin 10 mg, Simvastatin 20-40 mg, Pravastatin 40 mg, Lovastatin 40 mg, Fluvastatin 40 mg BID

Pravastatin 10-20 mg, Lovastatin 20 mg.

Thiazide type diuretic, CCB, ACEI, or ARB.

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10
Q

What is initial hypertensive treatment in black populations including those with diabetes?

What treatment is initial treatment in those with CKD and HTN regardless of race?

What is your blood pressure goal at age 60 and up?

A

thiazide diuretic or CCB.

ACEI or ARB.

150/90

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11
Q

What did the ACCOMPLISH trial state?

When are thiazide diuretics not recommended?

What are the thiazide diuretics side effects?

A

ACEI and CCB is better combination than others.

Kidney dysfunction(<30 CrCl). Not good for HF patients.

Lower potassium and magnesium. Increase calcium, uric acid, blood glucose, lipids. Causes sexual dysfunction.

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12
Q

Do loop diuretics increase calcium?

What are the main ACEI side effects?

When are ACEI CI’d? PARK

A

NO

Dizziness, Orthostatic hypertension, Dry Cough, Angioedema, Hyperkalemia, Rash, Taste(captopril),

Pregnancy, Angioedema, Renal impairment

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13
Q

What are the ACEI drug interactions?

Which drugs decrease sympathetic tone, increase vagal tone, and can cause rebound hypertension?

What are the NON selective beta blockers?

A

Potassium sparing diuretics, potassium supplementation, lithium, salicylates, NSAIDS, Calcineurin inhibitors.

Methyldopa, Clonidine, Clonidine Patch

Propanolol, Nadolol, Timolol.

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14
Q

What are the mixed beta blockers?

What drugs can decrease HR and Coronary artery tone?

Which CCB’s are considered 1st line therapy?

A

Carvedilol, Labetolol

Nondihydropine

Dihydropine’s.

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15
Q

How does Ezetimibe work?

What is the dose for Ezetimibe?

When should you take Ezetimibe in regards to bile acid sequestrants?

A

Essentially keeps cholesterol in in the intestinal lumen for excretion by preventing it from being absorbed.

10 mg Daily

Take 2 hours before or 4 hours after.

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16
Q

What did the ENHANCE trial show?

What did the IMPROVE IT trial show?

What is Alirocumab’s Side effects?

A

Simvastatin with Ezetimibe significantly decreases LDL-C but did not change carotid artery thickness.

Ezetimibe and Statin’s lower LDL.

Nasopharyngitis, influenza, diarrhea, UTI’s, injection site reaction, myalgia.

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17
Q

What is Alirocumab’s dosing?

What did the ODYSSEY LONG TERM trial show?

What is Evolocumab’s side effects?

A

75-150 every 2 weeks or 300 per month

Alirocumab and Statin together did very well.

Nasopharyngitis, Upper respiratory tract infections, Injection site reaction, Myalgia, Gastroenteritis.

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18
Q

What is Evolocumab’s dosing?

Between Alircoumab and Evolocumab which is stable at room temperature for longer?

What is a common complication associated with morbidity/mortality in Atrial Fibrillation?

A

140 mg every 2 weeks or 420 every month

Evolocumab

Stroke

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19
Q

What are the 3 treatment goals for Atrial Fibrillation?

What needs to be excluded before cardioverting if the patient has AF >48 hours?

The AFFIRM trial determined that _____ control is better than ____ control?

A

Rate Control, Prevention of Thromboembolism, Rhythm Control

Thrombus

Rate control is better than Rhythm control

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20
Q

What antiarrhtymic treatment options are preferred for patients with atrial fibrillation and heart failure?

What treatment options are approved in stroke prevention in atrial fibrillation?

What are the class 3 antiarrythmics?

A

Amiodarone and Dofetilide

Aspirin, Warfarin, DOAC’s.

Sotelol, Amiodarone, Dofetilide, Drondarone, Ibutilide

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21
Q

What did the DIONYSIS find when comparing Amiodarone to Dronedarone?

What are the monitoring parameters for Amiodarone?

Can fluroquinoline antibiotics cause QT prolongation?

A

Amiodarone was more efficacious and had a non significant increase in side effects.

ECG, LFT’s, Thyroid, Chest X-ray, Eye exam, Skin coloration, PFT’s

Yes

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22
Q

What is the pharmacologic treament of choice for Torsaddes?

What are the classes of medications that can cause QT prolongation?

What is the primary treatment of AV block?

A

Magnesium

Antiarrythmic drugs, Psychotropics, Toxins, Antibiotics(Macrolides, Bactrim, Fluroqinolines,Voriconazole), Methadone

Atropine

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23
Q

What are the indications for a pacemaker?

What is the first line treatment for emergency PSVT after cardioversion?

What agents are used in hypertensive urgency?

A

Third degree AV block plus symptoms, Treatment with medication contributing to AV block, Documented Asystole, Catheter ablation of AV junction, Neuromuscular disease, Symptomatic second degree AV block

Adenosine

Clonidine, Captopril, Labetelol

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24
Q

Can you use Nifedipine in hypertensive urgency?

What drugs are used in hypertensive crisis?

What drugs contribute to RATE control?

A

NO!!!

Nitroprusside, Labetelol, Esmolol, Fenoldopam, Nicardipine, Phentolamine

Beta blockers, Nondihydropine CCB’s, Digoxin.

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25
Q

What drugs contribute to RHYTHM control?

Who should receive rhythm control?

What is the rhythm control drug of choice for minimal heart disease?

A

Class 1a, 1c, 3

Symptomatic AF, Not permanent AF, Risk of antiarrythmics

Dronedarone, Flecainide, Propafenone, Sotalol

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26
Q

What is the rhythm control drug of choice for hypertension and substantial LVH?

What is the rhythm control drug of choice for hypertension and no LVH?

What is the rhythm control drug of choice for coronary artery disease?

A

Amiodarone

Dronedarone, Flecainide, Propafenone, Sotalol

Dofetilide, Dronedarone, Sotalol

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27
Q

What is the rhythm control drug of choice for hypertension and heart failure?

What do the CHADSVASC scores stand for?

What do you use to treat symptomatic PSVT?

A

Amiodarone, Dofetilide

Congestive Heart Failure, Hypertension, Age(>75 2 points), Diabetes, Previous Stroke(2), Vascular disease

Adenosine(if rate is regular), cardioversion.

28
Q

What do you use to treat non symptomatic wide interval PSVT?

How do you treat narrow complex PSVT without symptoms?

What is adeonsines major drug interaction to know?

A

Adenosine(1st line), antiarrythmic next.

Vagal manuevers, Adenosine, B-blocker or NDCCB

Verapamil

29
Q

How to treat acute emergency Vtach?

How to treat acute vtach with mild symptoms?

How to treat chronic vtach?

A

Direct cardioversion

Amiodarone preferred.(Can treat with procanamide and lidocaine as well).

Amiodarone

30
Q

How do you treat vfib?

What medications can cause AV block?

How do you treat 2nd or 3rd degree AV block?

A

Defibrillation–> if still no pulse resume CPR and after 2 minutes give epinephrine or vasopressin and reshock–> if still no pulse give amiodarone(pref), magnesium, lidocaine, and procainamide and reshock.

Digoxin, NDCCB, Beta blockers, Antiarrythmics may exacerbate symptoms

Symptoms of poor perfusion–> Atropine, Transcutaneous pacing or epinephrine/dopamine, chronic is pacemaker.

31
Q

What is primary prevention criteria for a ICD?

What are secondary prevention criteria for a ICD?

What are the indications for a pacemaker?

A

VT due to prior MI and inducible VT/VF at EPS

Survived VF and or sustained VT not due to a reversible cause, structural heart disease and a sustained VT, unexplained syncope with VT or VF induced by EPS

Symptomatic 2nd degree AV block or 3rd degree AV block with symptoms, medication contributing to AV block, documented asystole, catheter ablation of AV junction, neuromuscular disease

32
Q

What are the side effects of adenosine?

What are the big compelling indications for beta blockers?

What are the side effects of the vasodilators?

A

flushing, chest discomfort, ab pain, dizziness, headache

Post MI, Systolic HF(Bisoprolol, Carvedilol,Metoprolol Succinate).

Lupus like syndrome,Compensatory increase in HR, CO, and renin and sodium retention. Hair Growth with minoxidil.

33
Q

What are the hallmark symptoms of heart failure?

What is stroke volume?

What does the frank starling law represent?

A

Edema, Fatigue, Dyspnea

Preload, Afterload, and Contractility

Cardiac Output, Left ventricular end diastolic pressure(preload)

34
Q

What is the difference between FC 1 and FC 2 staging?

What is the difference between FC 3 and FC 4 staging?

What is the difference between Stage A and Stage B?

A

FC 1- no limitations or symptoms on PA. FC 2- Slight limitation of PA Comfortable at rest but ordinary activity results in HF symptoms.

FC 3- marked limitation of of PA. Comfortable at rest but less than ordinary activity results in HF symptoms. FC 4- Symptoms at rest.

A- Patients with risk factors for HF without structural heart disease or symptoms of HF. B- Structural heart disease but no symptoms

35
Q

What is the difference between Stage C and Stage D?

How to treat Stage A?

How to treat Stage B FC-1?

A

Stage C- Structural heart disease plus current/previous symptoms, HFpEF or HFrEF. Stage D- Refractory HF requiring specialized interventions.

ACEI or ARB, Statins, Aspirin, Glucose lowering

Same as A but add Beta Blocker

36
Q

How to treat Stage C and FC 1-4, HFrEF?

How to treat Stage C and FC 1-4, HFpEF?

How to treat Stage D and FC 1-4?

A

ARNI, Select beta blockers, Aldosterone antagonists, Loop diuretics. Can also use CRT, ICD, etc.

Loop diuretics, manage co morbidities.

Establish end of life goals, severe options like transplant.

37
Q

How to dose ARNI? What is it’s brand name?

What are ARNI ADR’s?

What stage do you give an ARNI? What trial showed good stuff?

A

Increase to target dose until patient is no longer able to around 97/103. Entresto.

Renal function impairment, hypotension, hyperkalemia, Edema

Stage C. PARADIGM.(20% reduction in CV death and HF hospitilizations).

38
Q

What are the 2 main ACEI to use in HF?

What are the 2 main ARBS to use in HF?

What 4 beta blockers can you use in HF?

A

Enalapril(20 mg BID), Lisinopril(40 mg daily)

Losartan(150 mg daily), Valsartan(160 mg BID)

Metoprolol Succinate(200 mg daily), Carvedilol(50 mg BID), Carvedilol XR(80 mg daily), Bisoprolol(10 mg daily)

39
Q

What are beta blockers place in therapy in HF?

What are aldosterone antagonists place in therapy in HF?

What is Hydralazine/ ISDN’s place in therapy in HF?

A

1st line therapy in HFrEF

Recommended in HFrEF(<35%) with NYHA FC 2-4 unless CI’d

African Americans FC 3-4 on target doses of ACEi and BB.

40
Q

Which blood pressure medicine has the highest incidence of sexual dysfunction?

What are the two most common ways to have structural heart disease?

What is acute decompensated heart failure?

A

Central Alpha 2 agonists. Diuretics and beta blockers also associated unless you use a cardioselective beta blocker.

Lower muscle mass(MI), Ventricular Hypertrophy

Worsening sign and symptoms, worsening NYHA-FC. Basically everything gets out of balance.

41
Q

What are some precipitating medications for ADHF(8)?

What happens when you are chronically exposed to Angiotensin 2?

What happens when you are chronically exposed to AVP?

A

NSAIDS, TZD’s, Glucocorticoid Steroids, TNF-alpha inhibitors, Doxorubicin and Digoxin, Calcium channel blockers except Amlodipine. Too high or too rapid titration of beta blockers.

Hypertrophy, Remodeling

Hypertrophy, remodeling, collagen deposits

42
Q

What happens when you are chronically exposed to aldosterone?

What is systolic dysfunction?

What is diastolic dysfunction?

A

Cardiac Fibrosis, hypertrophy, endothelial dysfunction

Impaired contractility which leads to decreased cardiac output. HFrEF. Loss of heart muscle, muscle mass. Reduced Ejection Fraction. EF<40%.

Impaired relaxation. Left ventricular hypertrophy, loss of functional muscle. HFpEF. >50% EF.

43
Q

If NT-proBNP is less than 100 is that good?

What are the signs of right sided heart failure?

What are the signs of left sided heart failure?

A

YES.

Peripheral edema, jugular vein distention, hepatojugular reflux.

Dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, tachypnea, cough, bibasilar crackles.

44
Q

What is the difference(cutoff) between a person being “dry” or “wet”?

When is someone “cold” or “warm”?

How do you treat HFrEF?

A

<18 is dry, >18 is wet.

<2.2 is cold, >2.2 is warm.

Treat with GDMT.

45
Q

How do you treat HFpEF?

Do diuretics have mortality and morbidity benefits?

What is the loop diuretic used in HF? Does it have a target dose?

A

Identify and treat comorbidities

No. Only morbidity.

Furosemide. No target dose, based on signs and symptoms.

46
Q

How does digitalis work? Does it have mortality and morbidity benefits?

What is digitalis place in therapy?

What is Ivabradine’s place in therapy?

A

Promotes Ca2+ influx. NO, only morbidity.

Patients on target GDMT doses but who still have persistent symptoms

Recurrent HF hospitalizations in patients with GDMT(lowers hospitalization).

47
Q

What is your Urine output goal for ADHF?

What is subset 1 of Forrester indexing?

What is subset 2 of Forrester indexing?

A

0.5 mL/kg/hr

Warm and Dry (>2.2,<18)(well perfused and no congestion)

Warm and Wet(most patients fall here)

48
Q

What is subset 3 of Forrester indexing?

What is subset 4 of Forrester indexing?

How do you treat subset 2?

A

Cold and Dry

Cold and Wet

IV loop diuretic–> IV loop diuretic + vasodilator–> strategies to overcome diuretic resistance.

49
Q

How do you treat subset 3?

How do you treat subset 4?

What is the mainstay of treatment for most hospital management?

A

Most uncommon. If PCWP <15 give IV fluids. If PCWP and SBP >90 give IV vasodilator then IV inotrope+/- vasopressor. if SBP< 90 –> inotrope +/- vasopressor.
If SBP>90 give IV diuretic +/- vasodilator–> IV inotrope–> MCS

If SBP<90–> IV diuretic plus IV inotrope +/- vasopressor. No improvement –> MCS.

Loop diuretics.

50
Q

What is the mainstay of ADHF? How much do you give them?

What is the goal pull off for loop diuretics?

What do the venodilators do?

A

Loop diuretics. 2x the home regiment.

500 mL of fluid loss within first 2 hours. 250 mL fluid loss in patients with SrCr>2.5

Decrease preload, pulmonary pressure/edema.

51
Q

What do the arterial dilators do?

What are the vasodilators place in therapy?

Is Nitroglycerin a vasodilator?

A

Lower SVR, afterload, and increase cardiac output.

Persistent congestive symptoms despite aggressive diuresis, rapid resolution of congestive symptoms.

Yes.

52
Q

Does Nitroprusside effect veins or arteries more?

Does nesirtide effect both veins and arteries?

What is Nesirtides adverse effects?

A

It effects both equally. Second line treatment to NTG.

Yes. Second line to NTP and NTG.

Hypotension, Headache, Worsening Renal Function

53
Q

Will most patients require inotropes? What subset of patients do require them?

When are inotropes indicated? What should we monitor?

What does dobutamine do to the heart?

A

NO. COLD patients.

Hypotensive, Cold, or inadequate response to vasodilators. Short term therapy. Monitor for Arrythmias.

Increases HR, force of contraction, lowers SVR and PCWP.

54
Q

What are the ADR’s of dobutamine?

What is the preferred inotrope in hypotension?

When is milrinone preferred?

A

MI, Tachycardia, Premature ventricular contractions.

Dobutamine

Preferred in patients receiving beta blockers. Watch for Hypotension.

55
Q

What are some ways to overcome loop diuretic resistance?

What hypertensives should you avoid in gout?

Should you combine Alsikiren with an ACEi or an ARB?

A

increase dose, continuous infusion, addition of thiazide type diuretic or vasodilator, ultrafiltration

Thiazide diuretics, Alskiren.

Hell naw.

56
Q

When do Alsikiren doses get bad?

What are the ADE’s of beta blockers?

Which CCB causes the most peripheral vasodilation? Which one’s affect contractility and AV node conduction?

A

> 300 mg.

Bradycardia, transient increase in serum lipids and glucose, can mask symptoms of hypoglycemia, fatigue/weakness, exercise intolerance, dizziness/hypotension.

Dihydropine. Non dihydropine.

57
Q

Which drug class is associated with first dose phenomenon, reflex tachycardia, CNS effects, and fluid and sodium accumulation?

What two drug classes should you avoid abrupt withdrawal?

Which drug class do you avoid in stimulant abuse?

A

Alpha one blockers.

Central alpha 2 agonists and Beta blockers.

Beta blockers.

58
Q

Which Lipid lowering agents do you avoid in severe Renal disease? How do you dose for moderate?

What two disease states do we avoid when giving Niacin?

What are your 4 first line treatments for Hypertension according to JNC 8?

A

Fibric Acid Derivatives. Gemfibrozi(10-50)l–> half normal dose. Fenofibrate(<50)–> start with low dose

Gout and Liver disease.

ACE/ARB/Thiazide/CCB

59
Q

How do you find non-HDL levels?

What is the most potent thyroid hormone? How are T3 and T4 made?

What are some hypothyroidism causes?

A

Total cholesterol-HDL.

T3. T4 excreted solely from thyroid gland, Most T3 made from cleaved T4.

Hasimoto’s disease, Iatrogenic(radiation).

60
Q

What are some medication hypothyroidism causes?

What are the signs and symptoms of hypothyroidism?

What is the evaluation of hypothyroidism?

A

Amiodarone, Lithium, Interferon-alfa, Interleukin-2, Tyrosine kinase inhibitors, Quetiapine.

Dry skin, cold intolerance, hair loss, weight gain, lethargy, bradycardia, periorbital puffiness, infertility/menorrhagia in women.

Elevated TSH, low T4, T3 may be normal at beginning but then becomes low.

61
Q

What is subclinical hypothyroidism?

What is the treatment of choice for hypothyroidism?

What is the half life of Levothyroxine? How do you convert from oral to IV?

A

Elevated TSH, T3 and T4 within normal range, treatment is controversial.

Levothyroxine!

7 days. 75% of oral dose.

62
Q

What are some ADE’s for levothyroxine?

What are the drugs that decrease absorption with levothyroxine?

What are drugs that increase T4 clearance? How does it affect warfarin and antidiabetic medications?

A

Too low dose you can have erisk for myxedema coma, too high you can have cardiac ADR’s. Bone, allergic reaction, cardiac A/E’s. thyrotoxicosis.

Cholestyramine, Calcium Carbonate, Sucralfate, Aluminum hydroxide, Ferrous sulfate, dietary fiber, Acid suppresants(PPI, H2 blocker)

Anti seizure stuff and rifampin. You need to decrease warfarin dose and increase diabetic medications.

63
Q

What are the drugs that affect T4 to T3 conversion?

Should you take levothyroxine on an empty stomach? How should you give with tube feeds?

What is the initial dose for a healthy adult patient < 50? What about for severe, long-standing hypothyroidism, elderly, cardiac disease?

A

Selenium, Amiodarone, Steroids.

YES! Don’t take with coffee. Hold feeds for 1 hour before and after or use higher dose.

Initial dose 1.6 mcg/kg/day. 12.5-25 mcg/day(no more than 50).

64
Q

When do we follow up with levothyroxine?

How do you treat myxedema coma?

What is the thyroid drug of choice in pregnancy?

A

4-6 weeks after initiation or dose change, monitor every 6 weeks until euthyroid.

IV levothyroxine and you can use IV T3. Also glucocorticoids, supportive therapy.

Levothyroxine.

65
Q

What are the medication causes of hyperthyroidism?

What are the signs and symptoms of hyperthyroidism?

What are clinical signs of hyperthyroidism? What about subclinical hyperthyroidism?

A

Amiodarone and lithium.

Emotional lability, nervousness, heat intolerance, fine hair, tachycardia, etc.

low TSH and high t3 and t4. Low TSH and normal t3 and t4.

66
Q

How does PTU and methimazole work? What is more potent?

What are the A/E’s of PTU and methimazole?

When is methimazole 1st line? What about PTU?

A

Inhibit biosynthesis of thyroid hormone. Methimazole.

Rash with itching, arthralgia, fever, Transient leukopenia. Hepatic failure(more common with PTU).

most patients. First trimester of pregnancy.

67
Q

Can you uses beta blockers in hyperthyroidism?

A

Yes, symptom control, Propanolol traditionally used.

Assessment 2.5 (5 decks)

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