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275 Cards in this Set

  • Front
  • Back
What class of drugs are used with symptomatic patients with PVC's?
Class II
What is the treatment of choice for sustained v-tach?
Cardioversion or chest thump, Lidocaine for acute treament
What is the treatment of choice for v-fib?
What do you use in case of digitalis induced V-Tach
Digibind. Avoid cardioversion except for V-fib.
What is the treatment for torsades de pointes?
IV Magnesium bolus (1-2 grams over 5 minutes) also potassium if hypokalemic.
Name some adverse effects of Class I drugs.
Negative inotropic effect, Atrial Flutter ( IA = torsades de pointes, digitalis toxicity and hypotension, IC = CAST proarrhythmia - monomorphic sustained V-Tach)
What is the major cause of Quinidine discontinuation?
GI disturbances followed by Cinchonism and hypotension
What are the adverse effects of Class II drugs?
Sinus Bradycardia, AV Block, Depressed LV function
Give examples and action of Class IV drugs.
Verapamil and Diltiazem - Prolong PR interval, Reduce SA node automaticity, Decrease contractility
When is adenosine used and what is a side effect and what is it's half life?
Used for supraventricular tachycardias, has 10 sec. half life and metallic taste
What conditions respond well to RF catheter ablation?
WPW, AV nodal reentry, Atrial ectopic tachycardia
What is treatment of choice for A fib/flutter?
Defibrillation and/or Verapamil, (Digoxin as alternative)
Which subclass of Class I drugs show a high mortality rate?
Class IA
In addition to adenosine, what other drugs may be used for SVTs?
Class II or digoxin
What drugs are used for asymptomatic patients with PVCs?
No drug therapy
Give examples and action of Class IB drugs.
Lidocaine and Toacainide. Decrease QT interval
What is a common side effect of Lidocaine?
What is a side effect of procainamide?
Hypotension, Lupus and arthritis
Give examples and actions of Class IC drugs.
Flecainide and Ecainide. Prolong QRS interval
What are some side effects of flecainide?
Dizziness and Tremors
Give examples and actions of Class II drugs?
Propanolol. Slow sinus rhythm, prolong PR interval, no effect on QRS
Give examples and actions of Class III drugs?
Amiodarone (Codarone, Pacerone) and Bretylium (Prolong repolarization)
What are some side effects of Amiodarone?
Pulmonary toxicity and fibrosis, damage to eyes, liver, thyroid, and death
Why is heparin use ok during pregnancy and how is it administered?
Unable to cross placenta or enter breast milk. IV
In what conditions is heparin used?
PE, evolving stroke, DVT
What do you monitor for signs of bleeding with heparin use?
BP, Increased HR, bruises, petechiae, red or black stools, discolored urine, lumbar pain
How does the parasympathetic system effect the heart?
Slows impulses from SA node, slows AV node conduction, constricts coronary arteries, reduces contractility
How does the SNS effect the heart?
From T1-T5, speeds SA and AV nodal conduction, dilates coronary arteries
Give examples and action of Class IA drugs.
Quinidine, Procainamide, Disopyramide. Prolong QRS interval and prolong QT interval
Describe how Morphine works in ischemia?
Controls pain, venodilation and some arterial dilation reduce preload and afterload lower cardiac oxygen demand
What does aspirin inhibit to prevent thrombus formation?
Which anti-platelet drugs have less intracranial hemorrhage & GI bleeding than aspirin?
Adenosine diphosphate receptor antagonists (Clopidogrel and Ticlopidine)
Which adenosine disphosphate receptor antagonist is approved for prevention of ischemic stroke?
How are glyco-protein IIB/IIIA receptor antagonists used therapeutically?
Short term prevention of ischemic events in patients with acute coronary syndrome and patients undergoing PCI
What is the mechanism of fractionated heparin?
Binds to antithrombin to enhance ability to inactivate thrombin and factor Xa. Suppresses fibrin formation
How would you treat stable angina?
Aspirin, BB, ACEI, Lipid lowering drug if LDL >130, sublingual nitroglycerin. CCB's where BB contraindicated
How do you recognize variant angina on an EKG?
ST-sement elevation that has sharper less rounded transition into T-wave. Returns quickly to baseline with nitroglycerin
How do you treat variant angina?
CCB's and Nitro (both relax coronary artery spasm)
What sequence of steps would you take in treating unstable angina?
Aspirin, Oxygen, Nitro, get and EKG
When is Nitro contraindicated?
Rt heart MI, Aortic stenosis, Hypertrophic cardiomyopathy
What is a normal dose of chewable aspirin initially used in unstable angina?
What is a common substitute for aspirin sensitivity?
What meds are used at discharge to control ischemia?
Sublingual nitro, aspirin or clopidogrel, Lipid lowering drugs if LDL >130
What problem may exist with using Thiazide in diabetes?
Promotes hyperglycemia
What type of drug should not be used together with ACEI?
Angiotensin II receptor blocker
What drug type is commonly used in heart failure?
What drug type should be avoided in asthmatics?
What drug is used in a hypertensive emergency?
Sodium Nitroprusside (IV)
Why don't you use a BB with variant angina?
Doesn't do anything for vessel spasm
Which CCB does not work on the heart?
What EKG signs exist for stable angina?
ST-segment depression or T-wave inversion. ST-segment returns to baseline after attack
What values indicate pre-hypertension?
120-139 or 80-89
What BP is considered normal?
<120 and <80
What values indicate stage 1 hypertension?
140-159 or 90-99
What values indicate stage 2 hypertension?
>160 or >100
At what classification of HTN are 2 drugs recommended?
Stage 2
What type of HTN drug is recommended with renal disease?
What type of HTN drug increases MI risk in diabetics?
What negative effect do BB have in diabetics?
Blunt hypoglycemia symptoms
What is the drug of choice for acute angina attacks?
Nitroglycerin is highly water soluble. True or False?
What are some adverse effects of Nitro?
Headaches, Orthostatic hypotension, Reflex tachycardia
How can you prevent reflex tachycardia of Nitro?
Pretreat with BB or verapamil
Why should Nitro be avoided with Sildenafil (Viagra)?
Intensifies vasodilation
What dosage levels are normally used for Nitro when taken sublingual?
Why are sublingual tablets more effective at lower doses than oral Nitro?
Don't go thru first pass metabolism
Name some side effects of Nifedipine.
Reflex tachycardia, flushing, increased mortality in patients with MI and unstable angina
What effect do Verapail & Diltiazem have on the heart?
Name 2 ACEIs.
Captopril and Enalapril
How do ACEIs work?
Prevent formation of angiotensin II and stops angiotensin II mediated vasconstriction and aldosterone mediated volume expansion
What side effects exist with ACEI?
Persistent cough, Hyperkalemia, Fetal damage, First dose hypotension
Name 2 aldosterone receptor blockers.
Eplerenone and Spirolactone
How do aldosterone receptor blockers work?
Promotes renal excretion of water and sodium
What is one adverse effect of aldosterone receptor blockers?
Name 2 direct acting vasodilators.
Hydralazine and Minoxidil
How do direct acting vasodilators work?
Dilation of arterioles
Name some adverse effects of direct acting vasodilators.
Reflex tachycardia, renin release, fluid retention (adverse effects decreased when diuretic used in combination)
Name 2 groups of CCB.
Dihydropyridine (Nifedipine) and Nondihydropyridines (Verapamil and Diltiazem)
How do CCB work?
Dilation of arterioles, decreases oxygen demand
Name some adverse effects of BB and when are they contraindicated.
Bradycardia, decreased AV conduction, depression, bizarre dreams. Don't use with sick sinus syndrome, 2nd or 3rd heart block, Asthmatics and caution with diabetics
Name 1 or 2 alpha1 blockers.
Doxazosin and Terazosin
What is the mechanism of alpha1 blockers and what is a big side effect?
Block vasoconstriction. Cause sever orthostatic hypotension with initial dose. NOT recommended as first line therapy
Name 2 alpha/beta blockers.
Carvedilol and Labetalol
Name 2 centrally acting alpha2 agonists.
Clonidine and Methyldopa
How do centrally acting alpha2 agonists work?
Acts within brainstem to suppress sympathetic outflow to heart and blood vessels
Name 2 adverse actions of centrally acting alpha2 agonists.
Rebound hypertension with clonidine if therapy abruptly stopped. Methyldopa can cause hemolytic anemia
What type of diuretic is considered 1st line therapy in HTN?
What are some negative effects of Hydrochlorothiazide?
Hypokalemia, Hyperglycemia, Hyperuricemia
Name a common loop diuretic and a common side effect.
Furosemide, Same side effects as Thiazides plus hearing loss
Name a K+ sparing diuretic.
How does a BB work in treating HTN.
Decreases HR and Renin release
How does a BB with intrinsic sympathomimatic activity differ from a regular BB?
Produce mild stimulation of beta receptors while blocking receptor stimulation of strong agonists
Name some common BBs.
Propranolol and metoprolol
Nam some common BBs with ISA.
Carteolol, Acebutolol, Pentutolol, Pindolol
What are the minor criteria for ARF?
Fever, Leukocytosis, Arthralgias, Previous Rheumatic fever, Pronlong PR Interval, and Elevated acute phase reactants
What is evidence of prior group A Beta-hemolytic strept?
Positive throat culture, elevated strep antibody test - anti-streptolysin O, Anti-DNAse, Streptozyme
How do you treat ARF?
Single dose IM benzathine penicillin and aspirin for arthritis and carditis
How do you treat chorea?
How do you treat ARF long term?
IM benzathine benzylpenicillin 1.2 million units every 28 days
Name some causes of secondary hypertension.
Chronic renal failure, oral contraceptives, coarctation of aorta, primary aldosteronism, pheochromocytoma
List some lifestyle modifications to control HTN?
Wt. loss, sodium restriction, DASH, alcohol restriction, aerobic exercise, smoking cessation, maintain K+ and Ca++
What are the criteria of diagnosis for Kawasaki?
Fever (5 days or more), Red palms and soles of feet, rash, bilateral conjunctival congestion, changes of lips and oral cavity, unilateral nonpurulent cervical lymphadenopathy
Within how many days is treatment needed for Kawasaki?
10 days
What is the treatment for Kawasaki?
Intravenous gamma globulin (IVGG), high dose aspirin (80-100mg/kg/day in 4 divided doses up to 14 days
What is the pathophysiology for ARF?
Antigenic similarities between cellular components of strep and the host tissue. Connective tissues effected
What areas are affected by ARF?
Connective tissues - heart, brain, joints, cutaneous and subcutaneous tissues
What normally precedes ARF 2-6 weeks?
According to Jones, criteria diagnosis of ARF requires what?
Evidence of prior strep infection and one major and two minor or two major manifestations
What are the major criteria for ARF?
Polyarthritis, Erythema maginatum (pink macules on trunk), Carditis, Chorea, Subcutaneous nodules (nontender nodes on ankles, knees, elbows, scalp
Describe the pathophysiology of SBE.
Blood borne pathogen adheres to damaged endocardium, proliferation of microorganisms, vegetations develop on heart valves
Who are at high risk for SBE and moderate risk?
Prosthetic cardiac valves and complex cyanotic congenital heart disease. Moderate - mitral valve prolapse with regurg.and/or thickened leaflets
When is SBE prophylaxis NOT recommended?
Surgical repair without residual beyond 6 months in septal defects, patent ductus arteriosus, mitral valve prolapse without regurg.
When is SBE prophylaxis recommended?
Dental procedures known to cause bleeding, urethral catheterization in urinary tract infections, tonsillectomy/adenoidectomy
What meds are used for SBE prophylaxis?
Amoxicillin:2gm 1 hour prior. Or Ampicillin, Clindamycin, Cephalexin or Azithromycin or Clarithromycin
What other name is Kawasaki Disease known as?
Mucocutaneous lymph node syndrome
What causes, who is affected, and what time of the year is associated with Kawasaki?
Suspect viral. Spring time. Asian children most susceptible
What is the pathophysiology of Kawasaki?
Cell mediated immune response attack on medium sized vessels leading to aneurysms and increased clots
What drug is used to prevent the reoccurence of V-Fib
What are some alternative therapies for V-Fib
Amiodarone, Procainamide or Bretylium to prevent recurrence, RF Ablation or ICD
What electrolyte may serve as an alternative treatment in digitalis induced V-Tach
Potassium if hypokalemic
What are the adverse effects of Class III drugs?
Sinus Bradycardia and Torsades de Pointes
What are the adverse effects of Class IV drugs
Sinus Bradycardia, AV Block, and Heart Failure
Give some characteristics of torsades de pointes
Can rapidly develop into V-Fib, often seen with hypokalemia and hypomagnesmia and drug induced long QT syndrome (DILQTS)
Which antiarrhythmic drug has the lowest toxicity incidence
What may you risk with the sudden withdrawal of a BB in a patient with angina
Precipitate angina, MI, Cardiac Arrhythmia
What are some side effects of Verapamil
Hypotension, Increases serum concentration of digoxin
What type of side effects does Digitalis have
Headaches, GI Distress, Confusion, Anorexia
What is a common side effect of Adenosine
How does a BB work as an antiarrhythmic
Decreases SA nodal automaticity, Decreases AV nodal conduction velocity, Negative inotropic effect
What is the drug of choice for PSVT
Adenosine IV bolus
How would you treat someone with triglycerides greater than 500mg/dL
Use fibrate or nicotinic acid
How would you manage CHD patients or CHD - at risk patients who have low HDL levels
Utilize nicotinic acid or fibrates
What type of drugs decrease HR and Contractile force
BB and CCB
What type of drugs decrease blood volume
What type of drugs decrease venous return
Name a side effect of Spironolactone
Hyperkalemia (Do not use with other drugs that promote hyperkalemia like ACEI and angiotensin II receptor blockers)
What are the side effects of Nifedipine
Reflex tachycardia and increase mortality in patients with MI and unstable angina
Name three Angiotensin II Receptor Blockers
Candesartan, Losartan, and Valsartan
When are angiotensin II receptor blockers contraindicated
During pregnancy
How does nitro work in stable angina
Decreases venous return (decrease preload), decreases cardiac oxygen demand
How does nitro work in variant angina
Relaxes or prevents coronary artery spasm, Increase oxygen supply
What is the mechanism of nitro tolerance development
Depletion of sulfhydryl groups in vascular smooth muscle
True or False. Long acting nitro should be discontinued slowly to avoid vasospasm
Why is aspirin used
Reduce risk of coronary thrombosis (primary and secondary MI prevention)
What are the major side effects with aspirin
GI bleeding and Hemorrhagic stroke
What is the prevention dosage of aspirin
What group of antiplatelet drugs are referred to as super aspirins
Glycoprotein IIB/IIIa receptor antagonists
When should Furosemide be used
In patients needing more diuresis and who have low GFR
What enzymes rapidly inactivate Nitro
Name 3 mechanisms of action BB play in ischemic heart disease treatment
Decrease oxygen demand, Increase oxygen supply, Blunts reflex tachycardia
Why should Verapamil and Diltiazem be cautioned in patients taking BB
Because they suppress the heart and contractility adding to the effect of the BB
What are the incations for the use of Clopidogrel (Plavix)
Secondary prevention of MI, ischemic stroke and other vascular events.
What is the approved indication for Ticlopidine (Ticlid) use
Prevention of ischemic stroke and thrombus formation in coronary artery stents
What are the most effective antiplatelet drugs available
Glycoprotein IIB/IIIa receptor antagonists (Abciximab, Tirofiban, Eptibatide)
When is the use of Dipyrimadole (Persantine) indicated
Prevention of recurrent stroke
In addition to protamine sulfate what other drug can treat heparin induced thrombocytopenia
Lepirudin (Refludan)
What drug would you never send a heart failure patient home on
Dopamine (Intropin). It is administered by continuous infusion and requires constant monitoring of BP, ECG and urine output
What is the reason for giving potassium with digoxin
Potassium ions compete with digoxin for binding to sodium so potassium levels may run low due to excretion
How does Hydralazine (Apresoline) in combination with isosorbide dinitrate work in heart failure
It causes selective dilation of veins to reduce preload
Name some symptoms of heart failure
Dyspnea, fatigue, peripheral edema, JVD
List some agents that cause cardiotoxicity
Alcohol, Chemotherapy
What is the treatment for lyme carditis
doxycycline and prednisone
What drugs are used to treat hypertrophic cardiomyopathy
BB, Verapamil, Diuretics if evidence of heart failure
What syndrome is associated with pericardial disease after a MI
Dressler's Syndrome
How do you treat pericarditis
Nonsteroidal anti-inflammatory drugs (Indomethacin, Aspirin, Prednisone)
Describe a holosystolic murmur
Begins abruptly with S1 and continues at same intensity to S2
Name two conditions that cause holosystolic murmurs
AV valve regurgitation and ventricular septal defects
Describe the sound of an ejection murmur
What causes an ejection murmur
Narrowing of the seminlunar valves
Describe an early systolic murmur
Starts abruptly with S1 but tapers and disappears before S2
What causes an an early systolic murmur
A small muscular ventricular septal defect
What conditions are associated with mid to late systolic murmurs
Midsystolic clicks, mitral valve prolapse and/or sufficiency
What causes a diastolic murmur
Semilunar valve regurgitation, AV valve stenosis, Increased flow across AV valve. These all are pathologic
Where can pulmonary valve stenosis be heard and what does it sound like
Loud click or sharp sound at upper left sternal border that is louder with expiration
What is the most common innocent murmur in children
Vibratory Still's Murmur
At what ages is a Vibratory Still's murmur typically audible
2 to 6 years of age
Name some characteristics of a Vibratory Still's murmur
It is confined to early systole. Loudest in supine position and diminishes but doesn't disappear in a seated position. Musical twanging quality
What are the characteristics of a pulmonary flow murmur
Rough sound. Heard best in the supine position and diminished with upright positioning and breath holding
Where is a venous hum most audible
Lateral to sternocleidomastoid above clavicle (louder on rt. side and with patient sitting). Lying down may resolve or diminish.
What does a machinery murmur represent
Patent ductus arteriosus. Murmur is continuous at upper left sternal border
What causes a Carey Coombs murmur
Increased diastolic blood flow across the mitral valve in presence of mitral insufficiency. Heard at apex.
What causes a third heart sound (gallop)
Filling of the left ventricle in heart failure
Describe an Austin Flint murmur
Low frequency diastolic murmur with presystolic accentuation. Heard at apex in presence of aortic valve insufficiency
Describe the atherosclerotic process
How often should a fasting lipid profile be obtained in adults over 20 years
Once every 5 years
What is the optimal LDL level and when is it considered high
Less than 100 optimal; 160-189 high
What values are considered low and high for HDL
<40; >60
What is a desirable total cholesterol level and when is it considered high
<200 desirable; >240 high
What triglyceride level is considered normal and what is considered high
<150 normal; 200-499 High
Name some causes of secondary dyslipidemia
Diabetes, Hypothyroidism, Obstructive liver disease, Chronic renal failure, Drugs (progestins, anabolic steroids, corticosteriods)
What are the general features of Metabolic Syndrome
Abominal obesity, HTN, Insulin resistance, Elevated triglycerides, low HDL and small LDL, Prothrombotic and Proinflammatory state
Name 3 causes of Metabolic Syndrome
Overweight and obesity, Physical Inactivity and High Carb Diet
List the major risk factors that modify LDL goals
Cigarette smoking, HTN (>140/90 or on meds), Low HDL (<40mg/dL), Family History of CHD, Age, Diabetes
List some common side effects of HMG CoA Reductase Inhibitors (Statins)
Headache, GI distress, Myalgia, Liver Enzymes
Name one condition that is an absolute contraindication for statin use
Liver disease
How do bile acid sequestrants work
Bind bile acids forming insoluable complex excreted in stool. Cholesterol oxidized to make more bile.
Name four side effects with bile acid sequestrants
GI distress/constipation, Malabsorption of fat soluable vitamins (ADEK), decreased absorption of warfarin and statins, increase Triglycerides
What are some side effects of Nicotinic Acid
Flushing, Hyperglycemia, Hyperuricemia, Hepatotoxicity
When is Nicotinic Acid contraindicated
Liver disease, severe gout, and caution with diabetics
What are the drug intervention steps for dyslipidemia
Step 1 (after 3 months of TLC) = statins, bile acid sequestrant or nicotinic acid, follow-up in 6 weeks. Step 2 = higher dose statin or combine statin + bile acid sequestrant or statin + nicotinic acid. Step 3 = Refer to lipid specialist
What is the most common birth defect
Congenital heart disease
What heart conditions are associated with Marfan syndrome
Aortic or mitral regurgitation
What heart conditions are associated with Turner's syndrome
What heart conditions are associated with Holt-Oram
Atrial septal defect. The child also is born without a radius
What heart conditions are associated with Trisomy 18
VSD and Patent ductus arteriosus
A patent ductus arteriosus may cause what
Pulmonary congestion/HTN and Left ventricular failure
What murmur sound is associated with a patent ductus arteriosus
Machinery murmur
What is the treatment for patent ductus arteriosus
Fluid restriction, Indomethacin (blocks synthesis of prostaglandins which keep ducutus open), Surgery
How can a patent ductus arteriosus be prevented
Rubella immunization in women and good pre-natal care to prevent pre-maturity
What defect is the most common of all congenital heart defects
Ventricular septal defect
How can a small ventricular septal defect be recognized
Loud, harsh pansystolic murmur along left sternal border (3rd and 4th space), accompanied by thrill
How are small ventricular septal defects treated
Spontaneous closure in 30% of cases, SBE prophylaxis
How does a large ventricular septal defect effect the pulmonary system.
Pulmonary HTN develops eventually leading to reversal of left-to-rt. shunt to rt.-to-lt. shunt = cyanosis
How can a large ventricular septal defect be recognized on exam.
Low pitched diastolic murmur at apex from increased blood flow across mitral valve. An ECHO may show thickening of rt. ventricle wall (due to elevated pulmonary arterial pressure) and enlargement of left atrium and ventricle due to volume of pulmonary blood flow
What is the primary treatment for large ventricular septal defects
Surgery - suture closure or patch
What happens to the lower body BP, pulse and color with an aorta coarctation
BP is lower, pulse absent of weak and have cyanosis. Upper body has elevated BP and bounding pulses.
What are the 4 classic findings of Tetralogy of Fallot
Pulmonary stenosis (causes oxygen poor blood to be pumped out aorta = cyanosis), VSD, Overriding aorta, and Right Ventricle Hypertrophy
What is the most common cardiac malformation causing cyanosis in patients >2yrs. old.
Tetralogy of Fallot
How can Tetralogy of Fallot be recognized on a CXR
Boot shaped cardiac contour, Prominent aorta, Diminished pulmonary vascular markings
What are some signs/symptoms of Tetralogy of Fallot
Cyanosis (child squats to rest on exertion), Dyspnea, Clubbing
How do you treat Tetralogy of Fallot
Corrective surgery by 18 months, adequate diet and fluids
What do you give in case of Heparin overdose
Protamine sulfate (low dose)
How is Heparin monitored
Activated partial thromboplastin time (aPTT). The goal is 60-80 seconds
Name one of the most serious adverse effects of Heparin
What are the advantages of LMWH over Heparin
No aPTT monitoring, home therapy, less risk of thrombocytopenia and bleeding, fixed dose schedule
What is the mechanism of action for LMWH
Inactivates Factor Xa, less able to activate thrombin like unfractionated Heparin
When would you use LMWH
Ischemic stroke, DVT (prevention and treatment), PE, Non-Q-wave MI
What is Warfarin (Coumadin)'s mechanism of action
Blocks synthesis of Vit. K dependent clotting factors (VII, IX, X and prothrombin)
How does low albumin affect coumadin
Low albumin increases the amount of unbound coumadin in blood
Why shouldn't coumadin be used during pregancy or breast feeding
It crosses the membranes very easily causing fetal hemorrhage and teratogenesis
What are Class IA drugs used for
Atrial fibrillation and Ventricular Arrhythmias
What are Class IB drugs used for
Ventricular Arrhythmias
What are Class IC drugs used for
AV Nodal Rentry, WPW, Ventricular Arrhythmias (can increase mortality despite suppressing PVC's)
What are Class II drugs used for
Atrial Fibrillation/Flutter and Ventricular Arrhythmias
What are Class III drugs used for
Atrial Fibrillation/Flutter and Ventricular Arrhythmias
What are Class IV drugs used for
Atrial Fibrillation; Atrial Automaticities and AV Nodal Rentry
What is Adenosine used for
AV Nodal Rentry and Orthodromic tachycardia
What is Digitalis used for
Atrial Fibrillation/Flutter and AV Nodal Rentry
What is the treatment for Torsades de Pointes
Radiofrequency catheter ablation is used to treat what conditions
Atrial Fibrillation and Monomorphic Ventricular Tachycardia
What drug alternatives exist for A-Fib/Flutter
Digoxin, Class IA and IC (long term suppression), and low dose Amiodarone for prevention
What is the treatment of choice for SVT
What is the treatment of choice for sustained ventricular tachycardia
Lidocaine for acute treatment
Name some drug to drug interactions with Statins that cause myopathy
Erythromycin, Fribates, Nicotinic Acids, Verapamil, Amiodarone
List three major actions of Fibrinic Acids
Lowers LDL and Triglycerides and Increases HDL
What lipid lowering drug may eleveate INR's when taken with warfarin
Fibrinic Acids
Is warfarin (coumadin) a fast acting anticoagulant
No. Initial response 8-12 hours after initial dose
How is warfarin levels monitored
Monitor prothrombin time (PT). Or International Normalized Ratio (INR)
What drug has more drug interactions than any other drug
Warfarin (Coumadin)
What drugs increase the anticoagulant effect of Warfarin
Aspirin, Chloral hydrate, Sulfonamides
What drugs decrease the effects of Warfarin
Phenobarbital, Rifampin, Oral Contraceptives, Vit. K, Cholestyramine and Colestipol (bile acid sequestrants)
How would you treat a warfarin overdose
Give Vitamin K1 and/or Fresh-frozen plasma.
How does the mechanism of action between heparin and warfarin differ
Heparin inhibits thrombin and factor Xa while warfarin inhibits synthesis of Vit. K dependent clotting factors
How do the routes of administration differ between heparin and warfarin
Heparin = IV or SC, Warfarin = oral
Between heparin and warfarin which has the fastest onset
Heparin (within minutes)
Between heparin and warfarin which one has the longest duration of action
Warfarin (prolonged for days)
Describe the mechanism of action for thrombolytic drugs
Bind to plasminogen forming a complex that is enzymatically converted to plasmin which digests the clot meshwork
List three major indications for the use of thrombolytic drugs
Acute MI, DVT, PE
What drug is used to control severe bleeding
IV Aminocaproic acid (Amicar). Inhibits plasmin
Under what circumstances would you never use a thrombolytic drug
Previous hemorrhagic stroke, known intracranial neoplasm, active internal bleeding, suspected aortic dissection
What is the pharmacologic therapy for atherosclerotic Peripheral Vascular Disease
Normalization of lipids, ACEI, Antiplatelet therapy, Propionyl-L-Carnitine
What street drug induced MI should BB not be used with and why
Cocaine. May exacerbate coronary artery spasm
How would you manage Acute MI with ST Elevation
BB (unless contraindicated), and combination therapy with half doses of antiplatelet meds and thrombolytic in the absence of contraindications
What are the normal values for CK-MB
<4% of total CK
What are the normal values for Lactic Dehydrogenase (LDH)
105-330 u/L
What are the normal values for Troponin
How do you treat Strep. viridans and S. bovis
What drugs do you use with S. viridans and S. bovis that have prosthetic valve involvement
PCN (IV) plus gentamicin
In case of PCN allergy when treating S. viridans and S. bovis what drug do you use
When treating Enterococci and PCN-resistant Strep what two drugs are used
PCN plus gentamicin (Replace PCN with Vancomycin if PCN allergy exists)
How is Staph aureus treated in bacterial endocarditis
Nafcillin plus gentamicin (If PCN allergy - replace Nafcillin with Vancomycin)
When treating MRSA what drug is used
What drug combination is used to treat MRSA prosthetic valve infections
Vancomycin plus gentamicin plus rifampin
How do you treat HACEK strains in prosthetic valve infections
What drugs are used to treat HAECK strains that produce B-lactamase
Ampicillin plus gentamicin