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Cardio Tx


HTN Tx w/ meds, cough or angioedema ACEI is cause
Tx: DM & HTN ACEI is best choice
Tx: Heart failure, LVH ACEI (improves survival, prevents development of heart failure Sx)
Tx: Post MI Beta-blockers
Tx of HTN w/ alpha-blocker: SE is: postural Hypotension
CHF pharma tx ACE/ARB, BB, AA: nitrate + hydralazine; ald antag (III/IV); poss digoxin, statin, anticoag; poss CCB in diastolic (NOT IN SYSTOLIC)
Prinzmetal tx RX: Nitrates, Ca+ Blockers, +/- Beta
Pharm mgmt of CHF Diuretics; digoxin; statins; proven mortality benefit: ACEI; ARBs; Beta Blockers; Nitrates + hydralazine; AAs
Resynchronization therapy (Biventricular pacing): indications Low EF, Wide QRS > 130 ms and Class III or IV
Anticoagulation for CHF Consider Coumadin (chronically) for Low EF; Hosp pt: prophylactic anticoag; aspirin if CAD (but no evidence for non-ischemic)
Acute Decompensated CHF: Tx Diuretics (Natriuretics); O2 (CPAP or BiPAP); morphine? ; Nitrates (Vasodilators); Inotropes (Dobutamine, Milrinone); Hold Beta; ACE/ ARB or other afterload reduction; Balloon pump; ID & tx underlying cause
Acute Pulmonary Edema: Rx IV Diuretics, nitrates, inotropes (or BNP nesiritide), pressors (BP support), ACE/ARB or hydralazine + nitrate; HOLD beta in acute phase; O2, Morphine, Anti-arrhythmics if indicated
CHF Device Tx AICD; IABP; Ultrafiltration/hemofiltration to remove fluid; LVAD
AICD criteria EF < 35% for most CHF etiologies
AICD Purpose: Prevention of sudden death; also for some HCM
IABP = Intra-aortic balloon pump, temporary measure for acute CHF in hospital
AICD = Automatic Implantable Cardioverter Defibrillators
LVAD is considered a ____ tx bridge therapy prior to heart transplantation
Placement of LVAD May be internal or external
AICD indicated if: Previous V-Tach, SCD
Effect of antiarrhythmics for VT/VF (Amiodarone, Dofetilide) do not improve survival
OHT for CHF: median survival = 10 years
OHT for CHF: one-year mortality predicted by: need for post-op dialysis or ventilation
V tach firstline tx lidocaine
Hypertensive Emergency: tx Controlled, gradual lowering of BP; 10% decrease in first hour, then 15% over next 3–12 hrs to BP of no less than 160/110; rapid correction of BP to norm levels puts pt at high risk for worsening cerebral, renal or cardiac ischemia
Beta blocker : MOA Blockade of parts of the symp NS (reduce PVR); Lowers HR; Initially lowers cardiac output; Reduces circulating renin
Fn of Angiotensin II Normally stims release of Na+-retaining hormone aldosterone (adrenal corticol cells); normally amplifies vasoconstriction (systemic and renal)
ARBs: MOA Act to block Angiotensin II from binding points; same effect as ACEI, without some of the AEs
Diuretics: MOA Act to block Na+ (and K+) from being absorbed, thus increasing urine Na+. Water follows Na+ out of the body. Blood volume is less (lowering BP)
CCBs: MOA Blocks vascular smooth mx contractility (resulting in vasodilatation & afterload reduction). Also result in coronary vasodilatation & are used in coronary artery spasm
CCBs: Dihydropyridines (DHPs) vs nonDHPs DHPs (eg, amlodipine) more vascular selective; nonDHPs (dilt, verapamil) are more cardio-selective with more inhibitory effects on the SA/AV node
Most single HTN meds lower BP: at most 20/10 mm Hg (so most pts on more than 1 drug)
Compelling Indications: CHF Diuretic; Beta-blocker; ACEI; ARB; AA
Compelling Indications: High Coronary Dz Risk Beta; ACEI; CCB; Diuretic
Compelling Indications: Post-MI Beta; ACEI; AA
Compelling Indications: DM Beta; ACEI; Diuretic; ARB
Compelling Indications: Chronic Kidney Dz ACEI; ARB
Compelling Indications: Recurrent Stroke Prevention ACEI; Diuretic
First Line Tx for HTN *Thiazide*; beta; ACEI; ARB; other diuretics; CCB
ACEI MOA Block formation of angiotensin II; blocking Angiotensin II results in vasodilatation and Na+ loss
Excessive Na+-K+ exchange which results in hypokalemia; associated with HTN Hyperaldosteronism
HTN med tx: optimal for AA & older pts CCB
PVC: tx beta, amiodarone, poss ablation
AAA mgmt: Risk factor mod (stop SMK, aggressive HTN & Lipid Rx), med mgmt to slow progression
Acute Arterial Occlusion Tx Revascularization; IV heparin; Intra-arterial thrombolytic therapy; Surgical thromboembolectomy; Surgical bypass
Varicose V. Tx: Graduated compression stockings (TED); Elevate legs; endovenous ablation (radiofrequency vs laser); sclerotherapy; greater saphenous vein stripping (older)
DVT Tx Hep (vs LMWH) & concomitant warfarin loading; warfarin; Thrombolytic tx; embolectomy; IVC filter
Giant Cell Arteritis Tx prevention of blindness, Prednisone 60 mg ASAP & cont for 1-2 mos before taper dosage
Atrial fibrillation or prosthetic valve Warfarin (2 – 3 for Afib; 2.5 – 3.5 for valve); Tx Warfarin OD is vitamin K
Dz w/ Compelling Indications for tight HTN ctrl CHF; High Coronary Dz Risk; Chronic Kidney Dz; DM; Post-MI; Recurrent Stroke Prevention
for a patient with DVT treat with ____ for about 5 days UFH or LMWH
for a patient with DVT treat with ____ for at least 3 months warfarin
advantages of LMWH over UFH Increased bioavailability, x1 or twice daily subQ, Monitoring not required, O/P therapy, Lower rate of HIT
HTN tx: stroke prevention thiazide, ACEI
hypertensive urgency tx urgency (no/stable TOD): observe 3-6 hr, PO tx (captopril, clonidine, or labetalol)
Which med is contraindicated in a patient with CAD? PDE-5 inhibitors (eg, sildenafil)
Bile acid sequestrant MOA in GI tract: decreases triglycerides
Firstline / secondline tx for elevated TGs Fibrates (2nd line: niacin)
Statin MOA HMG-CoA reductase inhibitor: decreases cholesterol and TG
Created by: Abarnard



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