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Treatments Flashcards

0
Q

What is the treatment for rheumatic fever with carditis?

A

IM pen g every 4 weeks for 10 years or until 21

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1
Q

What is the treatment for rheumatic fever without carditis?

A

IM pen G every 4 weeks for 5 years or until 21 years old

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2
Q

What is the treatment for rheumatic fever with carditis and persistent valvular HD?

A

IM pen G q 4 weeks for 10 years or until 40

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3
Q

What is the diagnostic criteria for infective endocarditis?

A

Duke’s criteria

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4
Q

How do you diagnose an AV fistula?

A

Doppler ultrasound

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5
Q

What is the treatment of AVF?

A

Surgery

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6
Q

What is the treatment for stable chronic angina?

A 
Beta blocker 
CCB (if Bb alone is not working)
Nitroglycerin 
Aspirin
Statin
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7
Q

What is first line treatment for HTN?

A

Hydrochlorothiazide

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8
Q

What is used for angina if Bb are contraindicated?

A

CCB

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9
Q

When is ranolazine used?

A

When patients are on Bb, CCBs, and nitrates, but still have recurrent symptoms of angina

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10
Q

What is the treatment for a-fib in an unstable (hypotension, AMS) patient?

A

DC cardioversion

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11
Q

What is the rule for anti coagulation in A-fib?

A

Anticoagulate if over 48 h

Anticoagulate with CHADS2 score greater than 2

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12
Q

What is the CHADS2 score?

A 
CHF - 1
HTN - 1
Age over 75 -1
Diabetes -1
Previous stroke -2
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13
Q

What’s the rule for cardioversion in Afib?

A

Only if:
New onset (stable and less than 48 h or unstable)
TEE done
After 3-6 weeks of anti coagulation therapy

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14
Q

What is used for rate control in Afib?

A

Bb
CCB
Digoxin

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15
Q

When is digoxin used for rate control in A-fib?

A

When the patient also has CHF or if they can’t tolerate bb or CCB

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16
Q

What is the treatment for patients with A-fib over 48 h who are stable?

A

Rate control for 3-4 weeks and anticoagulation

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17
Q

What is the treatment for SVT?

A

Carotid sinus massage

Adenosine - slows AV nodal conduction and interrupts the reentry pathway

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18
Q

What is the treatment for AAA less than 5 cm?

A

Observe

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19
Q

How do you diagnose AAA?

A

Abdominal US

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20
Q

Who should be screened for AAA?

A

Men 65-75 who smoked

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21
Q

What is the treatment for AAA over 5.5 cm?

A

Surgical repair

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22
Q

What is the treatment of PAD?

A

Exercise to develop collateralz

Aspirin, Cilostazol, thromboxane inhibitors

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23
Q

What are the indications for surgical treatment of aortic stenosis?

A 
Syncope
Angina
Dypsnea 
Poor LV systolic function
LVH greater than 15 mm
Valve area less than .6 cm squared 
Abnormal response to exercise
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24
Q

What is the first step in treating symptomatic bradycardia?

A

IV atropine

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25
Q

What is the diagnostic test of choice for aortic dissection?

A

CT angiography

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26
Q

What can be done if CT Angio is contraindicated in aortic dissection?

A

MRA or TEE

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27
Q

What is the treatment for aortic dissection?

A

IV labetolol

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28
Q

What is the treatment for a Type A dissection?

A

Surgery! Plus IV labetolol

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29
Q

When should vasodilators be considered in the management of aortic dissections?

A

After beta blockers only if bp still needs to be lowered

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30
Q

What is the best nonpharm treatment of HTN in an obese patient?

A

Weight loss (5-25 points per 10 kg loss)

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31
Q

What is the best nonpharm treatment of HTN in an nonobese patient?

A

DASH diet (8-14)

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32
Q

What is the third best nonpharm treatment for lowering bp?

A

Exercise 30 minutes daily (4-9 points)

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33
Q

What is the treatment for Prinzmetal’s angina?

A

Nitrates or CCB

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34
Q

How do you diagnose vasovagal syncope?

A

Upright tilt table test

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35
Q

How do you diagnose cardiac syncope?

A

Holster monitor for arrythmias

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36
Q

What is diagnostic of carotid sinus hypersensitivity syndrome?

A

Carotid sinus massage that creates asystole greater than 3 seconds
Or bp drop of greater than 50

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37
Q

What is the treatment for dilated cardiomyopathy?

A

CHF treatment with ACEi/ARBS and beta blockers

Consider ICD if EF is less than 35%.

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38
Q

How is dilated cardiomyopathy diagnosed?

A

Echo showing diffuse enlargement of ventricles and hypokinesia

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39
Q

What is the treatment for PAD?

A

Aspirin
Statin
Supervised exercise program for 12 weeks for 30-45 minutes at least 3 times a week

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40
Q

What is the treatment for symptomatic premature atrial contractions?

A

Beta blockers

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41
Q

What is the drug of choice for patients with and essential tremor and HTN?

A

Propranolol

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42
Q

What is the treatment for acute MI?

A 
ASA
beta blockers
Morphine
Nitrate
Oxygen
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43
Q

If a patient with an acute MI is in heart failure or cardiogenic shock what medication should not be given?

What med should be given instead provided the patient is not hypotensive?

A

Beta blocker

An ACEi

44
Q

When should PCI be performed in acute MI?

A

Within 90 minutes

45
Q

What is indication for tPA if patient presents with acute MI?

A

Greater than 90 minutes but less than 3 hours of onset of chest pain
No CI to tPA (bleeding, hemorrhagic shock/stroke, in shock, HF)

46
Q

What are the long term treatments of MI?

A 
ASA
ACEi (reduce ventricular remodeling)
Bb
High dose statin 
Clopidogrel (if PCI was performed)
47
Q

What is the best predictor of survival after MI.

A

LV Ejection fraction

48
Q

What is the most common complication following an MI and most frequent cause of death?

A

Arrythmias

49
Q

What is the TIMI score?

A 
Risk score for Unstable angina or NSTEMI
Age over 65 - 1
ASA use in past 7 days - 1
Known CAD (stenosis over 50%) - 1
Greater than 3 CAD risk factors - 1
Severe angina (more than 2 episodes in the last 24 h)
ST deviation greater than .5 mm
Positive cardiac markers
50
Q

What is the treatment for stable angina, unstable angina

A

Clopidogrel

heparin or enoxaparin

51
Q

What is the indication for IV heparing, angiography and possible PCI?

A

St changes greater than 1 mm
TIMI score greater than 3
Troponin elevation

52
Q

What is the treatment for second degree AV block type I?

A

Stop the offending agent

Atropine

53
Q

What is the treatment of second degree AV block type II?

54
Q

What is the treatment of third degree block?

55
Q

What is th treatment of sick sinus syndrome?

A

Pacemaker!

56
Q

What is the treatment for hypertensive urgency?

A

Oral anti hypertensives with the goal of lowering BP over 24-48h

57
Q

What is the treatment of hypertensive emergency?

A

IV labetolol, hydralazine, or nicardipine without lowering BP mor than 25% over first 2 hours

58
Q

What is the treatment of supra ventricular tachy with unstable vitals?

A

DC cardioversion

59
Q

What is the treatment for long QT?

A

Propranolol
And pacemaker if symptomatic
Also, no vigorous exercise

60
Q

What is the management of asx first degree heart block?

A

Observation

61
Q

What is the management of symptomatic first degree heart block?

A

24 h holder monitor

62
Q

When is the use of spironolactone most useful?

A 
In class III and IV HF
In patients with ascites from cirrhosis
63
Q

What is the treatment for stable wide complex VT?

A

IV Amiodarone

64
Q

What is the treatment of unstable arrythmia?

A

Synchronized cardioversion

65
Q

What is the treatment for stable SVT?

A

Carotid sinus massage

Rate control

66
Q

What do you do if you suspect a myocardial contusion?

A

EKG to look for dysrhythmia or LBBB

67
Q

What is the first line treatment for HOCM?

A

Beta blockers because decrease heart rate and allow for more filling time as well as decree angina

68
Q

What test would you order to detect a recurrent occlusion of the coronary vessels?

A

Ck-MB because it rises and falls rapidly so it may have risen again if recurrent occlusion has occurred

69
Q

What is the first line treatment for dyslipidemia?

A

A trial of 12 week diet and exercise program

70
Q

At what level LDL is drug therapy considered if the patient has CAD?

A

LDL over 130

71
Q

At what level LDL should lifestyle modification be considered if the patient has CAD?

72
Q

At what level of LDL should lifestyle modifications be considered in a patient with 2 or more risk factors?

A

Greater than 130

73
Q

At what level of LDL should medical therapy be considered in a patient with 2 or more risk factors?

A

LDL over 160

74
Q

At what level of LDL should lifestyle modifications be considered in a patient with 0-1 risk factors?

A

LDL greater than 160

75
Q

At what level of LDL should medical therapy be considered in a patient with 0-1 risk factors?

A

Greater than 190

76
Q

What is the LDL goal for someone with CAD?

A

Under 100 or under 70

77
Q

What is the LDL in someone with 2 or more risk factors for CAD?

78
Q

What is the goal LDL in someone with 0-1 risk factors?

79
Q

What are the CAD risk equivalents?

A

AAA
PAD
DM
symptomatic CAD

80
Q

What is the treatment of pre hypertension?

A

120-139/80-89

Lifestyle modifications: weight loss, dash diet, exercise, low sodium, low EtOH

81
Q

What is the treatment for stage I HTN.

A

140-159/90-99

Thiazide diuretics

82
Q

What is the treatment for stage 2 HTN?

A

Greater than 160/100

Two drug combo

83
Q

What are the meds of choice for isolated systolic HTN?

A

Diuretics
ACEi
Dihydropyridine calcium channel blockers

84
Q

What is the treatment of secondary HTN due to primary renal disease?

85
Q

What is the treatment of secondary HTN due to renal artery stenosis?

A

ACEi in unilateral disease

Angioplasty or stenting

86
Q

What is the treatment of secondary HTN due to pheochromocytoma?

A

Surgical removal of tumor with alpha and beta blocker

87
Q

What is the treatment for aortic stenosis?

A 
Aortic valve replacement if:
LVH greater than 15 mm
Valve area less than .6 cm squared 
Abnormal response to exercise 
Undergoing cabg
88
Q

What is the treatment for aortic regurgitation?

A

Vasodilator therapy (ACEi or dihydropyridines)

89
Q

How do you treat mitral stenosis?

A

Antiarrythmics (Bb or digoxin) for symptomatic relief

Mitral balloon valvotomy and valve replacement

90
Q

What is the treatment for mitral regurgitation ?

A

Antiarrythmics
Nitrates and diuretics if have left atrial enlargement
Valve replacement

91
Q

What assesses the severity of mitral regurgitation?

A

Angiography

92
Q

What is the treatment for Dressler’s syndrome?

A

NSAIDs

Glucocorticoids

93
Q

Which antiarrythmics are best post-MI.

A

Class iB = sodium channel blockers

Lidocaine, mexilitine, tocainamide

94
Q

What is the treatment for Afib in a person with WPW.

A

Procainamide

95
Q

What is the treatment of infective endocarditis?

A

If pen allergic: give IV vanc

If penicillin sensitive strains: give IV pen g or IV ceftriaxone for 4 weeks

96
Q

What is the recommended initial tx for stable ventricular arrythmia?

A

Loading dose of IV amiodarone

97
Q

What is the treatment for rate control in A-fib?

A

Metoprolol or esmolol

Verapamil or diltiazem

98
Q

How do you initially stabilize an acute MI?

A 
Oxygen 
ASA (325)
Clopidogrel 
Beta blocker (unless hypotension, Brady, CHF, heart block)
Nitrates
Statin
Anti coag 
percutaneous coronary angioplasty within 90 minutes or thrombolysis within 120 minutes
99
Q

What do you do if the patient with an acute MI continues to have pain, HTN or heart failure after initial tx?

A

IV nitroglycerin

100
Q

What do you do if the patient with an acute MI continues to have severe pain?

A

IV morphine

101
Q

What do you do if the patient with an acute MI continues to have unstable bradycardia ?

A

IV atropine

102
Q

What do you do if the patient with an acute MI continues to have pulmonary edema?

A

IV furosemide

103
Q

What should be done to asses for CAD in someone with intermediate risk?

A

Exercise ECG with or without myocardial perfusion imaging

104
Q

How do you assess for CAD in someone unable to exercise?

A

Pharmacological stress test

105
Q

What is the first step in assessing CAD risk in someone who has intermediate risk?

106
Q

Who should be on clopidogrel?

A

Post PCI

Patients with unstable angina or NSTEMI

107
Q

How do you confirm an aortic dissection?

A

Contrast CT

TEE

Cardiovascular (8 decks)

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