Vascular Medicine Flashcards
Name the factor Xa inhibitors
apixaban (Eliquis)
fondaparinux (Arixtra) - indirect via AT III, renal clearance
rivaroxaban (Xarelto)
Test for Ehler-Danlos
COL1A2 gene mutation in type III procollagen; autosomal dominant
Target HDL, LDL goal in pts w/ PAD
> 40mg/dL
Name the low molecular weight heparins
enoxaparin (Lovenox)
dalteparin (Fragmin)
Pathophys of Loeys Dietz syndrome
Mutations of TGFB, SMAD3
Pathophys, Rx of Marfans
Misfolding of fibrillin, increase in TGFB in heart valves, lung, aorta; beta blockers, ARBs
Rec for ASA s/p PCI
Indefinite
Rec for clopidogrel s/p BMS? DES?
> 1 mo.
> 12 mo.
Most effective monotherapy for hypertriglyceridemia
Fibrates
Test to detect Factor V Leiden
Assay for activated protein C resistance
Serum markers of atheroembolic injury to the kidney
Transient eosinophilia, hypocomplimentemia
Holding instructions for rivaroxaban (Xarelto)
3d before, 2d after
t1/2 = 5-9 hrs
No bridging required
Name the first line treatments for smoking cessation (3)
Nicotine replacement therapy
varenicline (Chantix)
bupropion (Wellbutrin, Zyban)
Method of excretion of direct thrombin inhibitors
Argatroban - hepatobiliary
Lepirudin, bivalirudin - renal, bivalirudin also 80% serum elimination
Half lives of direct thrombin inhibitors
Argatroban 1 hr
Lepirudin 90 min
Bivalirudin 30 min
Name the direct thrombin inhibitors
Hirudin
Bivalirudin
Lepirudin
Argatroban
Dabigatran (pradaxa)
Dx criteria for GCA
3 of 5 Age > 50 New headache Temp artery abnormality ESR >50 Biopsy w/ vasculitis, mononuclear cells, granulomatous inflamm
Goal INR for pt on warfarin and argatroban
4-5, correlates w/ true INR of 2-3; DC argatroban 5 d after starting Coumadin
Contraindications to thrombocytes therapy
Active internal bleeding
Recent (
High risk criteria for bridging off warfarin pre-op
Age >75 Prior vte DM Mech valve Stop warfarin 5d pre-op, therapeutic LMWH for 10d, resume warfarin
Medical mgmt of HIT
Start direct thrombin inhibitor (argatroban), await Plt level of 150k before starting low dose warfarin, dc argatroban after INR >2 (at least 5 days)
Antigenic target of HIT Ab
Heparin-bound PF4
Composition, mechanism of heparin
Mixture of glucosaminoglycans, bind to AT III, factor Xa, resulting in 1000x increase in AT III activity
One year mortality rate for pts w/ CLI
20%
Major amputation rate in pts w/ CLI, s/p revascularization
10%; increased further in pts w/ DM
Typical location of aneurysm in PAN
Renal, mesenteric, celiac arteries
Treatment of moderate-severe PAN (renal insufficiency, mesenteric ischemia, mononeuropathy)
Oral cyclophosphamide
Prednisone
Name the thienopyridine class of meds
Clopidogrel Plavix 7d hold
Prasugrel Effient 7d hold
Ticagrelor Brilinta 2d hold - reversible, nucleoside analog
Irreversible inhibition of Plt ADP receptor P2Y12
Contraindications to treadmill testing
Uncontrolled HTN
Severe AS
Advanced CHF
Advanced COPD
Dx criteria for PAD in treadmill testing
15-20% drop in ABI
Goal BP, HR in aortic dissection
100-120mmHg
55-65 bpm
Contraindications to esmolol in dissection
Sick sinus syndrome
Heart block greater than first degree
Severe sinus bradycardia
Contraindications to nitroprusside use in aortic dissection
Liver, renal impairment
First line treatment of diabetic peripheral neuropathy
duloxetine (Cymbalta)
venlafaxine (Effexor)
Dual trip take inhibitors serotonin, norepinephrine
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Ca2+ channel blockers
Percent of CABG pts w/ significant carotid dz
10%
Percent of CEA pts with surgically correctable coronary dz
30%
Medications used for urgent warfarin reversal
Weight-based prothrombin complex concentrate (25IU/kg) plus 5-10mg IV Vitamin K
Contraindication to cilostazol
CHF
Mechanism of metformin (Glucophage); peri-procedural mgmt
Buguanide anti glycemic, blocks intestinal absorption of glucose and hepatic conversion of lactate to glucose, resulting in lactic acidosis; hold immediately before contrast study and 48 hours after
Dose of radiation to produce skin reddening? Burn w/ blister? Very serious burn?
300 rad (3Gy) 1500 rad (15Gy) 3000 rad (30Gy)
Conversion between rad and Gy
100 rad = 1 Gy
Maneuvers to improve CO2 angiography quality
Trendelenburg
Selective catheterization
Rapid frame rate (4-8/sec)
Magnified views
Indication for systemic thrombosis in PE
Elevated troponin
Evidence of hemodynamics compromise (hypotension, R heart strain on EKG, echo)
Possible side effect of tetracycline like medications in cellulitis
Slate-colored skin discoloration, may be confused for venous insufficiency hyperpigmentation
Triad of Klippel Trenaunay Syndrome
Tissue hypertrophy
Varicose veins
Port wine stain
T or F: removal of clot below inguinal ligament in acute DVT reduces incidence of PTS compared to anticoagulation alone
False
Indication for open venous thrombectomy of LE
Phlegmasia cerulean dolens
