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Cardio Tx
Cardiology
| Question | Answer |
|---|---|
| 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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