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PPT > Wk 3 Cardioresp > Flashcards

Wk 3 Cardioresp Flashcards

1
Q

presenting symptoms of PE (5)

A 
dyspnea 
pleuritic pain 
cough 
DVT symptoms 
Haemoptysis
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2
Q

Wells score asks (7)

A
  • clinical signs and symptoms of DVT
  • Alternative diagnosis less likely
  • HR >100 bpm
  • immobilisation >3 days/ surgery in previous 4 weeks
  • previous DTV/PE
  • Haemoptysis
  • Malignancy
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3
Q

PE likely on Wells if score >

A

4

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4
Q

PE unlikely on Wells if score

A

less than 4

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5
Q

CTPA if

A

> 4 on well

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6
Q

investigation required before CTPA

A

U&Es

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7
Q

if poor kidney function what is used instead of CTPA

A

V/Q

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8
Q

1st line treatment of PE

A

low molecular weight heparin

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9
Q

e.g of low molecular weight Heparin

A

Dalteparin

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10
Q

e.g of 2 factor Xa inhibitors

A

apixaban

Rivaroxaban

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11
Q

what is fondaparinux

A

synthetic version of active heparin (similar to LMWH)

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12
Q

what blood tests are needed after PE confirmed and LMWH started

A

COAG

FBC

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13
Q

what is taken into account when prescribing dalteparin (LMWH)

A

body weight

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14
Q

when do you need to take care when prescribing LMWH

A

> 20% above ideal body weight
pregnancy
severe renal impairment

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15
Q

monitoring for LMWH

A

none needed

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16
Q

what is the procedure with LMWH when commencing warfarin

A

continue LMWH at least 5 days -can stop after 5 provided INR >2 for 48hrs

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17
Q

do you need to continue LMWH with DOAC

A

no

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18
Q

score that assess severity of PE

A

pessi score

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19
Q

if very severe PE what can be used

A

thrombolysis

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20
Q

aspirin + warfarin?

A

high risk of bleeding so avoid in most cases

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21
Q

SE of warfarin (7)

A
  • weakness in one side of body/ trouble speaking/ change in balance/ blurred eyesight
  • chest pain
  • dizziness
  • swelling, warmth, numbness, change in colour, pain in leg or arm
  • feeling tired or weak
  • swelling
  • change in skin color –> black/ purple
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22
Q

treatment of Warfarin

A

vitamin K

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23
Q

major bleeding on warfarin –>

A

-stop warfarin
-give phytomenadione (vit K) IV
-give dried prothrombin complex
or fresh frozen plasma

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24
Q

INR >8.0 minor bleeding

A
  • stop warfarin
  • give vit K IV
  • restart warfarin when INR <5
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25
INR >8.0 no bleeding
- stop warfarin - give Vit K by mouth - repeat vit K if INR still too high - restart warfarin INR <5
26
INR 5-8 minor bleeding
- stop warfarin - give Vit K IV - restart warfarin when INR <5
27
INR 5-8 no bleeding
withhold 1 of 2 doses of warfarin and reduce maintenance dose
28
DOAC advantages vs Warfarin (2)
- more predictable -no monitoring needed | - safer (reduced bleeding risk
29
DOAC reversal agent only avaliable to which drug
dabigatran
30
DOAC disadvantages vs Warfarin
- no reversal agent (except dabigatran) | - more expensive cost
31
How long do you anticoagulate after acute PE if temporary risk/ reversible RF
3 months of Warfarin therapy
32
pneumonia antibiotic treatment
co-trimoxazole IV
33
what is co-trimoxazole
trimethoprim and sulfamethoxazole
34
possible hyponatremia causes
- SIADH due to pneumonia - indapamide (thiazide like diuretic) - spironolactone
35
verapamil and beta blockers -->
serious bradycardia
36
alternatives to verapamil to lower Bp
dihydropyridine CCB (amlodipine)
37
why use co-trimoxazole vs con-amoxiclav in elderly
co-trimoxazole less likely to cause C.diff
38
risk of C.diff increases with use of
broad spectrum antibiotics
39
most common antibiotics causing C.diff (4)
- fluoroquinolones - clindamycin - broad spectrum penicillins - cephalosporins
40
increasingly widespread use of which antibiotic correlates to CDAD
fluoroquinolone
41
e.g of fluoroquinolones (3)
- ciprofloxacin - gemifloxacin - levofloxacin
42
3 healthcare acquired infections caused by broad spectrum antibiotics
C.diff MRSA ESBL
43
ESBL=
extended spectrum beta-lactamases
44
what are extended spectrum beta-lactamases
enzymes that confer resistance to most beta-lactam antibiotics
45
3 beta-lactam antibiotics
cephalosporins penicillins monobactam aztreonam
46
which bacteria are ESBL found exclusively in
gram negative bacteria
47
3 gram negative bacteria commonly with ESBL
Klebsiella pneumoniae Klebsiella oxytoca Escherichia coli
48
what are carbapenem antibiotics
retain activity against chromosomal cephalosporinases and ESBL found in many gram - species
49
which carbapenem resistant enterococci are most important and why
Klebsiella pneumonia carbapenemase | -as these enzymes confer resistance to all beta-lactams
50
compliance=
patient expected to stick to regimen prescribed by doctor without question
51
concordance=
mutually agreed contract between doctor and patient to take medicine in a way which suits both parties
52
adherence =
why a patient may not take medications in they way agreed between doctor and patient
53
unintentional non-adherence=
lack of understanding
54
intentional non-adherence=
doesn't agree on whats decided
55
assessment services to improve medication adherence and concordance
- fuller's self-medication screening risk assessment - self medication schemes - medication review service
56
aids to improve medication adherence and concordance
- reminder charts - nomad/ dosette boxes - medication record charts
57
aspirin MOA
antiplatelet inhibits thromboxane A2 production
58
Clopidogrel MOA
antiplatelet inhibits ADP binding to its platelet receptor
59
enoxaparin MOA
LMWH activates antithrombin III --> inhibition of factor Xa
60
fondaparinux MOA
activates antithrombin III --> inhibits factor Xa
61
Bivalirudin Dabigatran Lepirudin MOA
reversible direct thrombin inhibitor
62
abciximab eptifibatide Tirofiban MOA
gylcoprotein IIb/IIIa receptor antagonist
63
DOACs=
apixiban | rivaroxaban
64
DOACs MOA
direct factor Xa inhibitors

PPT (8 decks)

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