Thyroid, ACS, dyslipidemia, HF, HTN Flashcards
definition of fever
consistently over 38’c
drugs that may help with weight loss
bupropion, glp1 agonists, orlistat
elevated TSH means
hypothyroidism
sx of hypothyroid
fatigue, impaired memory, constipation, cold intolerance, changes in skin or hair (dry), HTN, bradycardia
how many weeks after hypo thyroid tx does it take to reach a new steady state? how often are dose adjustments made?
6 weeks, q4-6weeks
what should women who are being treated for hypothyroidism do when they have a confirmed positive pregnancy test
increase dose by 2 tablets per week, and further adjust based on TSH levels. Requirement may increase by up to 30% in preg.
is thyroid hormone safe in preg
yes- and important to ensure healthy preg and normal fetal development
subclinical thyroid means
either elevated or low TSH but normal thyroid hormones- they are sometimes treated
graves disease, toxic nodule, goitre, iodine excess, and thyroid cancer are all examples of
hyperthyroidism
hashimotos, iodine deficiency are examples of
hypothyroidism
sx of hyperthyroid
weight loss, palpitations, diarrhea, heat intolerance, anxiety, opthalmopathy, tachycardia, warm/moist skin, goitre, etc
tx for hyperthroid
radioactive iodine, methimazole, propylthiouracil, BB for sx- propran and nadolol can decrease conversion of T4 to T3 too
SE of methimazole and propylthiouracil
both decrease production of thyrid hormones- SE rash, agranulocytosis, allergy, rarely hepato/renal tox (methimazole better for hepatotox)
use of antithyroid meds during pregnancy
propylthouracil for first (if can’t, methimazole okay but has increased risk congenital malformations), methimazole better 2nd/3rd due to increased risk hepatotox with propyl is you can switch without disrupting thyroid control
breastfeeding and hyperthryoid
methimazole preferred- propyl can be used if CI or not tolerated (but serious risk of hepatotox)
risks of not treating hyperthyroid
cardiomyopathy, cardiac arrhythmias, osteoporosis
what rare SE can methimazole and propylthiouracil cause? How should you caution patients/
rare neutropenia can develop gradually. May occur suddenly- tell patients to contact doc immediately if sx of infection occur (if rash/fever/sore throat occur d/c med)
what to council on with thyroid and treatment
that if over treated, can end up looking like the other spectrum and what those sx may be
with levothyroxine, how should it be taken
separated from calcium and iron by 6 hours
_____ is the preferred LMWH until renal fx is less than
____
enoxaparin, 30, then use heparin
what is contraindicated in patients with STEMI
CCB- increase morbidity and mortality- can be used cautiously to relieve ischemia or achieve rate control in a fib is BB CI. Monitor heart rate closely if used
in stroke, how soon do you need to present to get alteplase
4.5 hours-but should be ASAP. HC recommends within 3
T/F- ASA is ust as effective as warfarin in 2’ stroke prevention in patients with normal sinus rhythm
T
At what clearances are rivarox, dabig, and apix CI at?
riva and dabig less than 30, apix less than 15
when do you start anticoag therapy in stroke?
only after determined not hemorrhagic
when should ASA be started in stroke?
right away if alteplase isn’t used, or 24 hours after alteplase is used *not ever for intracranial hemorrhage
when do you double the framingham risk score? what is FRS?
family history of premature CV disease.. gives 10 year risk of cardiovascular disease
benefit of binding resins for cholesterol, and one major downside
reduce LDL and can slightly increase HDL, strong safety record, good for preg/breastfeeding and children, major down is can increase TG
what agent is best for HDL - what limits its use?
niacin- SE: hepatotoxic (slow release even worse), flushing
hyperlipidemia in pregnancy
advisable to discontinue all lipid lowering agents except binding resins, even though statin appear likley safe. Reassure patients stopping for pregnancy won’t significantly affect their risk
common SE of ezitimibe (and how does it work)? When is it not recommended?
inhibits cholesterol absorption, low potential for DI. Not in mod-severe liver dysfx. Common SE= pain in joints (arthralgia), diarrhea, fatigue dizzy, H/A
common SE with fibrates, when can’t they be used, when is a good time to use?
upper GI disturbances, myalgia. Good for diabetic dyslipid. Not for renal or hepatic dysfx.
what is different about gemfibrozil
can’t be used with statins whereas others just caution use and increased risk rhabdo, may increase repaglinide and rosiglitazone
which statins are metabolized by what enzyme?
ALS= 3a4. fluva/rosuv=2c9, prava- not 450 at all so low pot for DI
common SE with resins, how to take
GI (constipation, bloating, flatulence, increase TG). Take 1 hour before or 4-6hours after concurrent meds (might reduce their abso)
what does doubling a statin dose do in general
lower LDL further 6%
define systolic HF
LVEF less than or equal to 40%
starting therapy for all patients with HF reduced EF, and what do you add on if no improvement or inadequate sx management
ace and BB, add aldosterone antag, then digoxin or [hydralazine+isosorbide dinitrate if can’t tolerate ace/arb
when should you measure SCr, K and BP when starting arb/ace
baseline, 7-14days after therapy started, and 7-14 days after any increase (this is how long should be between titrations as well)
what increase in SCr can you expect on starting ACE therapy
30%
how quickly should beta blockers be titrated
q2-4w
what diuretics are required in most HF patients
loop
at what renal fx do thiazides have limited benefit
CrCl less than 50
when should the last dose of diuretic be taken in the day
ideally take in AM, but if BID take before 4pm to reduce diuresis HS
different between eplerenone and spironolactone
epler doesn’t produce gynecomastia, but has similar risk of hyperkal and renal dysfx
omega 3 for heart health
modest reduction of CV events with low dose omega 3 PUFA (polyunsaturated fatty acid) ie 1g/day can be used. Caution as 3g or more daily is associated with increased bleed risk. Choose ration of EPA and DHA of 1:1.2 as this is what has been studied
Which CCB should be avoided in HF
diltiazem and verapamil due to negative inotropic effects
what is the only antiarrhythmic drug that should be used in HF
amiodarone. Recall digoxin is a rate control agent but can be used in HF as well. All other antiarrhymthics avoid
how to treat HF preserved EF
focus on risk factors
