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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
Q

INR >8.0 no bleeding

A
  • stop warfarin
  • give Vit K by mouth
  • repeat vit K if INR still too high
  • restart warfarin INR <5
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26
Q

INR 5-8 minor bleeding

A
  • stop warfarin
  • give Vit K IV
  • restart warfarin when INR <5
27
Q

INR 5-8 no bleeding

A

withhold 1 of 2 doses of warfarin and reduce maintenance dose

28
Q

DOAC advantages vs Warfarin (2)

A
  • more predictable -no monitoring needed

- safer (reduced bleeding risk

29
Q

DOAC reversal agent only avaliable to which drug

A

dabigatran

30
Q

DOAC disadvantages vs Warfarin

A
  • no reversal agent (except dabigatran)

- more expensive cost

31
Q

How long do you anticoagulate after acute PE if temporary risk/ reversible RF

A

3 months of Warfarin therapy

32
Q

pneumonia antibiotic treatment

A

co-trimoxazole IV

33
Q

what is co-trimoxazole

A

trimethoprim and sulfamethoxazole

34
Q

possible hyponatremia causes

A
  • SIADH due to pneumonia
  • indapamide (thiazide like diuretic)
  • spironolactone
35
Q

verapamil and beta blockers –>

A

serious bradycardia

36
Q

alternatives to verapamil to lower Bp

A

dihydropyridine CCB (amlodipine)

37
Q

why use co-trimoxazole vs con-amoxiclav in elderly

A

co-trimoxazole less likely to cause C.diff

38
Q

risk of C.diff increases with use of

A

broad spectrum antibiotics

39
Q

most common antibiotics causing C.diff (4)

A
  • fluoroquinolones
  • clindamycin
  • broad spectrum penicillins
  • cephalosporins
40
Q

increasingly widespread use of which antibiotic correlates to CDAD

A

fluoroquinolone

41
Q

e.g of fluoroquinolones (3)

A
  • ciprofloxacin
  • gemifloxacin
  • levofloxacin
42
Q

3 healthcare acquired infections caused by broad spectrum antibiotics

A

C.diff
MRSA
ESBL

43
Q

ESBL=

A

extended spectrum beta-lactamases

44
Q

what are extended spectrum beta-lactamases

A

enzymes that confer resistance to most beta-lactam antibiotics

45
Q

3 beta-lactam antibiotics

A

cephalosporins
penicillins
monobactam aztreonam

46
Q

which bacteria are ESBL found exclusively in

A

gram negative bacteria

47
Q

3 gram negative bacteria commonly with ESBL

A

Klebsiella pneumoniae
Klebsiella oxytoca
Escherichia coli

48
Q

what are carbapenem antibiotics

A

retain activity against chromosomal cephalosporinases and ESBL found in many gram - species

49
Q

which carbapenem resistant enterococci are most important and why

A

Klebsiella pneumonia carbapenemase

-as these enzymes confer resistance to all beta-lactams

50
Q

compliance=

A

patient expected to stick to regimen prescribed by doctor without question

51
Q

concordance=

A

mutually agreed contract between doctor and patient to take medicine in a way which suits both parties

52
Q

adherence =

A

why a patient may not take medications in they way agreed between doctor and patient

53
Q

unintentional non-adherence=

A

lack of understanding

54
Q

intentional non-adherence=

A

doesn’t agree on whats decided

55
Q

assessment services to improve medication adherence and concordance

A
  • fuller’s self-medication screening risk assessment
  • self medication schemes
  • medication review service
56
Q

aids to improve medication adherence and concordance

A
  • reminder charts
  • nomad/ dosette boxes
  • medication record charts
57
Q

aspirin MOA

A

antiplatelet inhibits thromboxane A2 production

58
Q

Clopidogrel MOA

A

antiplatelet inhibits ADP binding to its platelet receptor

59
Q

enoxaparin MOA

A

LMWH activates antithrombin III –> inhibition of factor Xa

60
Q

fondaparinux MOA

A

activates antithrombin III –> inhibits factor Xa

61
Q

Bivalirudin
Dabigatran
Lepirudin
MOA

A

reversible direct thrombin inhibitor

62
Q

abciximab
eptifibatide
Tirofiban
MOA

A

gylcoprotein IIb/IIIa receptor antagonist

63
Q

DOACs=

A

apixiban

rivaroxaban

64
Q

DOACs MOA

A

direct factor Xa inhibitors

PPT (8 decks)

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