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42 Cards in this Set
- Front
- Back
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Essential Hypertension
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Diuretics (Furosemide)
ACEi (Lisinopril, Ramipril) ARBs (Valsartan, Losartan) Ca channel Blockers (Verapamil, Diltiazem) Alpha-1 Sympatholytic (Prazosin, Terazosin, Doxazosin) |
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CHF (general)
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Diuretics
ACEi or ARBs Beta-Blockers (compensated CHF - Metoprolol, Atenolol - B1 selective) Digoxin (increases contractility) |
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Angina
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Nitroglycerin (NTG)
Nitrates Beta-Blockers (decrease afterload) |
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Atrial Flutter
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Class 1A (Quinidine, Procainamide, Disopyramide),
1C (Flecainide, Propafenone) or III Antiarrhythmics (Amiodarone, Sotalol, Dofetilide) |
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Atrial Fibrillation
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Digoxin (decreases conduction at AV node, depresses SA)
Beta-Blocker (slows ventricular rate) Anticoagulation Prevention: Class III Antiarrhythmic (Sotalol |
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Ventricular Tachycardia
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Beta-Blocker
Class 1A Anti-Arrhythmic (Quinidine, Procainamide, Disopyramide) |
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SupraVentricular Tachycardia (SVT)
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*Adenosine: short acting, hyperpolarizes cell
Beta-Blocker (aka Class 2 AntiArrhythmic) Ca channel Blockers (Prevent nodal arrhythmias - Verapamil, Diltiazem) Class 1A Anti-Arrhythmic (Quinidine, Procainamide, Disopyramide) |
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Intractable SVT
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Class 1C Antiarrhythmics (Flecainide, Propafenone)
*But: contraindicated post-MI AEs: proarrhythmic, especially post-MI. Prolongs refractory period in AV node |
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Torsades de Pointes
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Magnesium
*TdP can be caused by Class III Antiarrhythmics (so stop!) |
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Digoxin Toxicity
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Digibind
Potassium Lidocaine |
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Acute Ventricular Arrhythmias
Digitalis-Induced Arrhythmias |
Class 1B Antiarrhythmics (Lidocaine, Mexiletine, Tocainide)
*Preferentially affect ischemic or depolarized Purkinje/Ventricular tissue AEs: local anesthetic, CNS stimulation or depression, CV depression |
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Atrial Arrhythmias
Ventricular Arrhythmias |
Class 1A Anti-Arrhythmic (Quinidine, Procainamide, Disopyramide)
AEs: Thrombocytopenia, Torsades de Pointes from increasing QT interval. Procainamide can cause reversible SLE-like syndrome |
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Ventricular Fibrillation
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CPR
Defibrillation Class III Antiarrhythmic: Amiodarone! Can use 1B Antiarrhythmic Lidocaine |
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Lipid Lowering: Decrease LDL a LOT, Increase HDL, Decrease TGs
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HMG-CoA reductase Inhibitors (Lovastatin, Pravastatin, Simvastatin, Atorvastatin, Rosuvastatin)
*Most potent = Rosuvastatin AEs: hepatotoxicity, rhabdomyolysis |
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Lipid Lowering: Decrease LDL a lot, Increase HDL a lot, Decrease TGs
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Niacin (Vitamin B3) - inhibits lipolysis in adipose, reduces hepatic VLDL secretion
AEs: red flushed face, hyperglycemia, hyperuricemia (exacerbates gout) |
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Lipid Lowering: Decrease LDL a lot, slightly increase HDL, slightly increase TGs
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Bile Acid Resins (Cholestyramine, Colestipol, Colesevelam) - prevent intestinal reabsorption of bile acids
AEs: GI discomfort, decreased absorption of fat-soluble vitamins |
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Lipid Lowering: Decrease LDL a lot, no effect on HDL or TGs
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Cholesterol Absorption Blockers (Ezetimibe) - prevents cholesterol reabsorption at small intestine brush border
AEs: diarrhea, rarely an increase in LFTs |
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Lipid Lowering: Decrease LDL, Increase HDL, Decrease TGs a LOT
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Fibrates (Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate) - Upregulate LPL to increase TG clearance
AEs: Myositis, hepatotoxicity, cholesterol gallstones |
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Mitral Regurgitation
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Acute: Valve replacement
Chronic: afterload reduction (vasodilators, diuretics) |
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Mitral Stenosis
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HR Control with Digoxin, Beta-Blocker
Anticoagulation Therapy (especially if AFib present) Surgery (Balloon, Valve Replacement) |
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Aortic Regurgitation
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Afterload Reduction (Vasodilators)
Aortic Valve Replacement |
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Aortic Stenosis
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Diuretics (But, be careful because preload still necessary to pump enough blood)
Valvuloplasty |
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CHF: Stage A
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ACEi (Enalapril, Zofenopril - But cause dry cough)
OR ARB (Losartan, Valsartan, Candesartan if patient can't tolerate ACEi) |
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CHF: Stage B
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ACEi/ARB... plus
Beta Blocker (Carvedilol, Bisoprolol, Metoprolol if COPD) If weight gain, treat with Diuretics *Furosemide first choice, loop diuretic *HCTZ or Metolazone are Thiazide options *Spironolactone is aldosterone antagonist |
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CHF: Stage C
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ACEi + Beta Blocker + Diuretics... plus
Aldosterone Antagonist (Aldactone, Eplerenone) Digoxin Hydralazine and Nitrates (produce NO) ARB (if persistently symptomatic, NOT routine with an ACEi) |
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CHF: Stage D
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HF Program - LV Assist Device, Transplantation
Can add... Sympathomimetic Amines (bind Beta-1 receptors to increase contractility - Dopamine, Dobutamine) Phosphodiesterase Inhibitors (decrease cAMP degradation = more cytosolic Ca - Amrinone, Milrinone) |
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Stable Angina
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Aspirin (decrease platelet aggregation)
Decrease Oxygen Demand (2 or more agents) *Nitrates *Beta-Blocker *Ca-channel Blocker *ACEi Statin Or surgery (stent, angioplasty, CABG) |
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Unstable Angina
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Antiplatelets (Aspirin, possibly add Thienopyridine derivatives - Clopidogrel, Ticlopidine, Prasugrel)
Heparin Decrease Oxygen Demand (Nitrates, Beta blocker, Ca-channel blocker, ACEi) Later Option: G2b3a Inhibitor (Abciximab, Tirofiban/Aggrastat, Eptifibitide/Integrilin) |
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Acute MI
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Aspirin
Thienopyridine/Heparin Analgesia Oxygen Reperfusion Decreased Oxygen Demand *If Increased PCWP: diuretics *If decreased CO: vasopressors (Epi, Norepi) |
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Anti-Thrombotic/ Anti-Platelet Options
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Antithrombins - Heparins
*Unfractionated Heparin (UFH): binds AT-3, risk of HIT2 *Lovenox: anti-Xa, less reversible than UFH Antithrombins - Direct Thrombin Inhibitors *Bivalirudin (Angiomax), Refludin, Argatroban) Fibrinolytics *t-Pa, Reteplase, Tenecteplase Antiplatelet *Aspirin *P2Y12 Inhibitors = Thienopyridine, metabolized by Cyp450 (Clopidogrel, Ticlopidine, Prasugrel) *Ticagrelor G2b3a Antagonists - often if angioplasty *Abciximab, Tirofiban/Aggrastat, Eptifibitide |
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Acute Coronary Syndrome (ACS)
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Aspirin
At least one antithrombin Plavix or Prasugrel (unless CABG necessary) G2b3a Antagonist if high risk/angioplasty |
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STEMI
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Fibrinolytics (t-Pa, Reteplase r-Pa, Tenecteplase TNC-ase)
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Hypovolemic Shock
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Volume resuscitation (colloid or crystalloids = saline)
Hemoglobin "resuscitation" second with packed RBCs |
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Cardiogenic Shock
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Dopamine
Intra-Aortic Balloon Pump |
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Vasogenic Shock
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Volume Resuscitation
Vasopressor Therapy (Alpha-receptor agonist) Corticosteroids |
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Dilated Cardiomyopathy
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Decrease Preload
*Diuretics *Venodilators Vasodilate *ACEi |
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Hypertrophic Cardiomyopathy
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Beta-Blockers
Ca-channel Blockers Amiodarone to prevent Afib Surgical Myomectomy (remove upper IV septum) Dual Chamber Pacemaker AICD (to prevent sudden death) |
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Restrictive Cardiomyopathy
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Must treat underlying cause!
Diuretics for symptoms (but can decrease CO) Digoxin Amiodarone |
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Organophosphate Poisoning
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Atropine (for muscarinic SE)
Pralidoxime (to reactivate acetylcholinesterase) |
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Pericarditis
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Pain Relief (NSAIDs)
Steroids if recurrent If the Pericarditis is... *Uremic: dialysis *Purulent: antibiotics, drainage *Neoplastic: radiation, chemotherapy |
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Constrictive Pericarditis
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only treatment is surgical
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Cardiac Tamponade
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Pericardiocentesis
Balloon Pericardiotomy Pericardial Window |
