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Front 1

What does SIG E CAPS stand for?

Back 1

Suicidality
Interest (loss)
Guilt

Energy

Concentration
Appetite
Psychomotor Changes
Sleep Changes

Front 2

3 Goals of Tx of Depression

Back 2

1. Reduce Sx of Acute Depression
2. Facilitate Patient’s Return to a Level of Functioning (Before the Onset of Depression)
3. Prevent Further Episodes of Depression

Front 3

3 phases of Tx

Back 3

acute 6-10 weeks
maintenance 4-9 months
chronic 12-36 months

Front 4

nonresponse is defined as

Back 4

< 25% decrease in baseline sx

Front 5

partial response is defined as

Back 5

26-49% decrease in baseline sx

Front 6

partial remission is defined as

Back 6

> 50% decrease in sx.

Front 7

remission is defined as

Back 7

return to baseline

Front 8

1st line agent in depression:

Back 8

SSRI

Front 9

if SSRI fully remits, then Tx strategy is to

Back 9

continue during maintenance and continuation phases

Front 10

if SSRI partially remits, then Tx strategy is to

Back 10

augment with nonSSRI, Li, liothyronine, atypical antipsychotic

OR

switch to an alternative agent

Front 11

if SSRI fails

Back 11

switch to an alternative agent and start algorithm over

Front 12

if 1 episode of depression, Tx for ___ months after remission

Back 12

6 months

Front 13

if 2 episodes of depression, Tx for ___ months after remission

Back 13

1 year

Front 14

if 3 episodes of depression, Tx for ___ months after remission

Back 14

indefinitely

Front 15

3 parameters of efficacy monitoring in depression treatment

Back 15

1) TSH should be between 0.5-4.7 U/mL
2) HAMD or MADRS scale at baseline, after 6-8 weeks, then periodically
3) Interview family if pt permits

Front 16

6 parameters of safety monitoring in depression treatment

Back 16

1) vitals
2) chem 7 (hypoNa, hypo K can cause depression Sx)
3) adverse effects
4) suicidal ideation
5) venlafaxine: BP
6) TCA: EKG baseline and periodically

Front 17

labs to obtain for stroke patients on arrival

Back 17

1) vitals: BP HR T
2) electrolytes: SCr BUN Glucose
3) CBC to r/o infxn
4) coagulation
5) LFTs
6) toxicology

Front 18

Meaning of NIHSS <10

Back 18

60-70% have favorable outcome at 1 year

Front 19

Meaning of NIHSS >10

Back 19

4-16% have favorable outcome at 1 year + increased risk for ICH

Front 20

(pre) Treat BP in stroke patients if

Back 20

BP >220/121 (no TPA)
BP >180/105 (yes TPA)

Front 21

Treatment of BP in stroke patients

use

Back 21

labetalol
nicardipine
nitroprusside

Front 22

3 goals of Tx of stroke

Back 22

1) reduce ongoing neurologic injury to decrease mortality and disability

2) prevent complications 2' to immobility and neurologic dysfunction

3) prevent recurrence

Front 23

how to use labetolol in stroke

Back 23

if HR is TOO FAST

start with (10-20 mg)/ (1-2 mins) or 2-8 mg/min

up to 300 mg/1-2 mins (double dose every 10-20 mins)

Front 24

how to use nicardipine in stroke

Back 24

IF HEART RATE IS TOO SLOW

5 mg/hr titrate by 2.5 mg/hr PRN up to
15 mg/hr

Front 25

blood sugar goals during stroke

Back 25

acute: 80-140 mg/dL

chronic: 70-130 mg/dL

Front 26

how to use insulin during stroke

Back 26

1 U/hr - 120-150
2 U/hr - 151-200
4 U/hr - >201

D/C PO hypoglycemics

Front 27

when to use TPA during stroke

Back 27

within 3-4.5 hours

Front 28

can't use TPA between 3 and 4.5 hours if

Back 28

1. > 80 yo
2. NIHSS > 25
3. Oral Anticoagulants
4. Previous Stroke w/DM

Front 29

how to use TPA

Back 29

0.9 mg/kg up to 90 mg

Bolus: 10% of dose over 1 minute.

Infusion: 90% of dose given over 1 hr

Front 30

use of antiplatelets as 2' prevent in stroke

Back 30

ASA 50-325 mg QD
ASA/dipyramidole
clopidogrel

warfarin in AF

Front 31

TPA monitoring after stroke

Back 31

BP

o Every 15 minutes for 1 hour
o Every 30 minutes for 6 hours
o Every hour for 17 hours
o Every shift thereafter

Front 32

ASA monitoring after stroke

Back 32

bleeding risk

Front 33

warfarin bleeding monitoring after stroke

Back 33

INR, Hb/Hct
o INR Every 3 days weekly until stable
o Monthly thereafter

Front 34

warfarin vitals monitoring after stroke

Back 34

Every 2 hours in ICU

Front 35

guidelines associated with stroke

Back 35

NINDS
National Institute of Neurological Disorders and Stroke Study

Front 36

Asthma Guidelines

Back 36

NAEPP (National Asthma Education Prevention Program)

Front 37

5 goals of asthma therapy

Back 37

1. Prevent chronic and troublesome sx
a. Coughing
b. Breathlessness at daytime, night, or after exertion
2. Require infrequent use (≤ 2 days a week) of inhaled short acting B2 agonist for quick relief os sx (not including prevention of EIB)
3. Maintain near normal pulmonary function
4. Maintain normal activity levels (including exercise and other activity and attendance at work or school)
5. Meet patients’ and families’ expectations of satisfaction with care

Front 38

3 goals for reducing risk with asthma therapy

Back 38

Prevent recurrent exacerbations of asthma and minimize the need for visits or hospitilizations
2. Prevent loss of function (children prevent reduced lung growth)
3. Minimal or no adverse effects of therapy

Front 39

classification of intermittent asthma symptoms

Back 39

-Sx/SABA use 0-2x per week
-night time awakenings <2x per month

Front 40

treatment of intermittent asthma symptoms

Back 40

-environmental control
-----prevent allergens/triggers

-PRN SABA

Warning if: using MDI >3 times/week or >1 time/month for 3 months

Front 41

classification of mild persistent asthma symptoms

Back 41

-Sx/SABA use 2+ times per week, but not daily

-night time awakenings 3-4 times per month

Front 42

treatment of mild persistent asthma symptoms

Back 42

-continue environmental control
-continue SABA

ADD inhaled LOW DOSE steroid

Front 43

classification of moderate persistent asthma symptoms

Back 43

-Sx/SABA use daily

-night time awakenings >1/week

Front 44

treatment of moderate persistent (1) asthma symptoms

Back 44

-continue LOW DOSE steroid
-ADD LABA

OR

-step up to MEDIUM DOSE steroid

Front 45

treatment of moderate persistent (2) asthma symptoms

Back 45

-MEDIUM DOSE steroid
-LABA

Front 46

classification of severe persistent asthma symptoms

Back 46

-Sx throughout the day
-nighttime awakenings >4 days/week

Front 47

treatment of severe persistent asthma symptoms

Back 47

-HIGH DOSE steroid
-LABA

Front 48

Tx of acute exacerbations of asthma

Back 48

-frequent high dose inhaled beta agonists

-systemic corticosteroids

Front 49

COPD guidlines

Back 49

GOLD
Global Initiative for Chronic Obstructive Lung Disease

Front 50

7 goals of COPD therpay

Back 50

-slow disease progression
-minimize symptoms
-maximize pulmonary function
-maximize functional ability
-prevent acute exacerbations
-prolong survival
-educate patients with realistic expectations

Front 51

Stage 0 COPD

Back 51

At risk
normal PFTs

Front 52

Treatment of Stage 0 COPD

Back 52

avoid risk factors
smoking cessation
flu vaccine

Front 53

Stage 1 COPD - Mild

Back 53

FEV >80 FEV/FVC <70

Front 54

Treatment of Stage 1 COPD - Mild

Back 54

PRN SABA

Front 55

Stage 2 COPD - Moderate

Back 55

FEV 50-80 FEV/FVC <70

Front 56

Treatment of Stage 2 COPD - Moderate

Back 56

Add scheduled LABA

formoterol
tiotropium
theophylline

Front 57

Stage 3 COPD - Severe

Back 57

FEV 30-50, FEV/FVC <70

Front 58

Treatment of Stage 3 COPD - Severe

Back 58

Add inhaled steroid

Front 59

Stage 4 COPD - Very Severe

Back 59

FEV <30, FEV/FVC <70

Front 60

Treatment of Stage 4 COPD - Very Severe

Back 60

add oxygen
surgery

Front 61

Sx of hypothyroidism

Back 61

-cold intolerance
-constipation
-depression
-changes in menses
-voice changes/hoarseness
-elevated T-cholesterol and LDL
-increased LFTs
-delayed reflexes
-cool dry skin
-goiter
-periorbital edema
-hair loss

Front 62

Tx of hypothyroidism

Back 62

thyroid hormone replacement

Front 63

monitoring thyroid hormone replacement

Back 63

measure TSH in 6-8 weeks at steady state
Target is 0.2 - 3.0

if not at ss, measure T4

Front 64

iatrogenic causes of hypothyroidism

Back 64

dopamine
glucocorticoids
estrogen
anticonvulsants
ASA
amiodarone
heparin
fenclofenac
anabolic steroids

Front 65

Dx of DM

Back 65

FPG >/ 126
casual glucose >200

Front 66

prediabetes impaired fasting glucose

Back 66

100-125

Front 67

prediabetes impaired glucose tolerance

Back 67

140-199

Front 68

DM fasting glucose target

Back 68

70-130

Front 69

DM postprandial target

Back 69

ADA <180

Front 70

DM total cholesterol goal

Back 70

<200

Front 71

DM HDL goal

Back 71

>40 M
>50 F

Front 72

DM TG goal

Back 72

<150

Front 73

goals of DM therapy

Back 73

reduction of micro/macrovascular complications

fasting: 70-130
post prandial <180

Front 74

metformin CIs

Back 74

risk of lactic acidosis

SCr >1.4
abnormal renal fxn
Hx of lactic acidosis
cardiac insufficiency/hypoxia
HF - using drugs
impaired LFTs
alcohol abuse/binge drinking
age > 80 + CrCl <60

Front 75

metformin adverse effects

Back 75

GI - diarrhea
metallic taste

Front 76

3 CHD risk equivalents

Back 76

ACS (MI, unstable angina)
CSA
Coronary by-pass, PTCA, stents

Front 77

4 CHD risk equivalents

Back 77

PAD
stroke, TIA
DM
multiple risk factors (use Framingham)

Front 78

6 risk factors for CHD

Back 78

age (M >45, W >55)
smoking
HTN
HDL <40
FH of premature CAD (M<55, F<65)

HDL>60 (negative risk factor)

Front 79

use the Framingham equation when

Back 79

multiple risk factors are present

Front 80

If < 1 RF,
10 year risk is ____
LDL goal is ____

Back 80

<10%
<160

Front 81

If 2+ RF,
10 year risk is ____
LDL goal is ____

Back 81

0-20%
<130

Front 82

If CHD/equivalent,
10 year risk is ____
LDL goal is ____

Back 82

>20%
<70-100

Front 83

If TG >200, evaluate for metabolic syndrome...

Back 83

3+ of

waist circumference (M 40, F 35)
BP >130/85 (or taking drugs)
Fasting glucose >100 (or drugs)
low HDL (M<40, F <50)
TG > 150 (or drugs)

Front 84

4 classes of drugs for hypercholesterolemia

Back 84

statins
BAS
ezetimibe
niacin

Front 85

2 classes of drugs for mixed dyslipidemia

Back 85

statins
niacin

Front 86

4 classes of drugs for hypertriglyceridemia

Back 86

niacin
fibrates
fish oils
(statin)

Front 87

2 classes of drugs for low HDL

Back 87

niacin
fibrates