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74 Cards in this Set
- Front
- Back
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Anginal pain for how long indicates an infarct?
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>30 min
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Which chemicals can be used to induce a stress test if a physical one cant be done?
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persantine
dobutamine adenosine |
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What chemical stress test drugs cant be used in asthmatics?
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adenosine
persantine |
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What are the 7 Class 1 recomendations for angina prevention?
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ASA
HTN management Smoking cessation DM management Exercise Lipid lowering Weight reduction |
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What are the 4 Class II recomendations for angina prevention?
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Clopidogrel (pts that cant take ASA)
Folate therapy Tx for depression Stress reduction |
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What are Class III harmful to patients with angina?
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hormone replacement therapy
chelation therapy vitamin E vitamin C garlic acupuncture |
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What B blocker has both beta1 and alpha 1 properties (useful in CHF pts)?
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Carvedilol
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What B blockers are long acting and used outpatient?
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Metoprolol succinate
Atelolol |
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What interaction do B blockers have in diabetic pts?
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masks insulin induced hypoglycemia
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What CYP2D6 inhibitors create adverse drug interactions with B blockers?
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cimetidine
fluoxetine diphenhydramine |
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What drug given with B blockers exacerbates rebound HTN when abruptly stopped?
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Clonidine
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What B blocker crosses the BBB and leads to symptoms of depression?
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propranolol
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What B blockers should be avoided with renal disease?
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atenolol
propanolol |
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How do nitrates decrease intramyocardial wall tension?
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dilate veins more than arteries which decreases BP flowing into the heart
dilate coronary arteries well also |
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What long acting nitrate can be used if a patient cant take a B blocker?
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Imdur (doesnt affect BP or HR)
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Which CCB decreases BP and intramyocardial wall tension by vasodilation?
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amlodipine
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ACEIs inhibit breakdown of what substance, leading to a cough?
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bradykinin
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How do ACEIs decrease morbidity and mortality in high risk patients?
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improves endothelial function
decreases remodeling post-MI |
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All patients with what medical problems should be on an ACEIs?
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CAD
DM Heart failure HTN |
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What electrolyte is often elevated as an adverse reaction to ACEIs?
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potassium
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ACEIs cause what side effect from sensitivity to bradykinin?
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angioedema
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ACEIs are contraindicated in what 2 conditions?
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pregnancy
bilateral renal artery stenosis |
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What is the most important pleotropic effect that statins have on the body?
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reversal of endothelial dysfunction
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What are the 5 pleotropic effects of statins?
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anti-inflammatory properties
plaque stabilization reversal of endothelial dysfunction inhibition of monocyte recruitment decreased thrombogenicity |
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What statin produces the greatest % reduction in LDL?
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rosuvastatin
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Which statin can be used in high risk patients of CAD and is independent of starting LDL levels?
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simvastatin
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Which statin is the safest?
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pravastatin
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What should a goal LDL be in pts with CHD plus multiple major risk factors, multiple risks of metabolic syndrome, or acute coronary syndromes?
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<70
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What nicotinic acid derivative increases HDL by up to 35%?
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niaspan
(also decreases LDL and VLDL synthesis) |
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What medications could replace a B blocker if there was a contraindication?
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CCB or long acting NTG
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What medication is an adjunct for use in pts with refractory angina?
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ranolazine
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What are contraindications to ranolazine?
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prolonged QT interval
CYP3A4 inhibitors liver impairment |
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What causes the cascade of symptoms in acute coronary syndromes?
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rupture of a plaque
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Unstable angina and NSTEMI are caused by what type of thrombus?
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Mural thrombus (platelet rich)
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STEMI are caused by what type of thrombus?
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occlusive thrombus (fibrin rich)
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How does the pain of angina differ from the pain of an MI?
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non reversible pain in an MI
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What is the normal value of Tropi I?
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<0.05 ng/ml
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What is the normal value of CPK?
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5-200 U/L
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Heart injury is assumed if CKMB is what percentage of the total CK?
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>4-5%
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Which cardiac enzyme is the most specific for myocardial damage?
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troponin
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How soon does myoglobin elevate in the blood after myocardial damage?
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2 hrs
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How soon does CPK-MB reach its peak after heart injury?
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10-24 hrs
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How soon does troponin reach its peak in the blood after heart injury?
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12 hrs
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What is the goal BP and HR in a patient with acute coronary syndrome?
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BP <130/80
HR 55-65 |
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What is the invasive treatment for a pt with a STEMI or NSTEMI?
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Cath lab
+ ASA, plavix, LMWH, heparin, or GP2B3A inhibitor maybe direct thrombin inhibitor |
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What is the thrombolytic tx for a pt with STEMI?
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Lytic
+ ASA, LMWH or heparin maybe GP2B3A inhibitor |
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What is the ED tx of a pt with chest pain?
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oxygen
ASA NTG morphine BB LMWH or heparin plavix high dose statin replace electrolytes check labs EKG |
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What antiplatelet therapy should be given to pts with a NSTEMI?
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ASA + clopidogrel for 1 year
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What clopidogrel therapy has shown to reduce post stent thrombosis or MIs?
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600mg PO loading dose
then 150 mg PO daily X 7 days then 75 mg PO daily |
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What drug is approved for ACS treated with immediate/delayed PCI and is useful for poor responders to clopidogrel?
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prasugrel
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What dosing of NTG is used in pts with chest pain?
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start with 5 mcg/min
increase by 5 mcg/min every 5 min up to 20 mcg/min then increase by 10 mcg/min up to a max of 200 mcg/min |
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Why is morphine the drug of choice for pts with chest pain?
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blocks sympathetic efferent discharge at the CNS = peripheral venous/arterial dilation
(decreased myocardial demand) |
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What dose of morphine is given to pts with chest pain?
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2-4 mg IV every 5-10 min
until pain is gone or adverse rxn |
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What analgesic meds are contraindicated in pts with chest pain because they compete with ASA for binding sites on platelets?
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NSAIDS
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Why are Beta blockers beneficial in a pt with an MI?
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prevents post/peri MI arrhythmias
may limit infact size decreases progression from unstable angina to MI prevents 2nd MI in longterm tx |
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What are absolute contraindications of Beta blockers tx?
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HR <55
SBP <90 uncontrolled asthma or COPD (relative contraindication) |
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What is the reversal agent for heparin?
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protamine
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What is the dose of heparin tx given to pts with ACS?
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60 units/kg bolus
then 12 units/kg/hr |
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What is the goal PTT in a pt with ACS?
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50-70 sec
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What LMWH is considered superior to heparin for tx of NSTEMI and STEMI?
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enoxaparin
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What dose of enoxaprin tx is given to pts with ACS?
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1 mg/kg SC BID for 3-5 days
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LMWH is contraindicated in what patients?
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obese
anuric hemodialysis |
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How do GP2B3A inhibitors work?
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prevent platelet aggregation
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Which drug can be given at the cath lab so that the patient doesnt need anticoagulation therapy after the stent is placed?
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bivalirudin (direct thrombin inhibitor)
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What is the dosing for tPA?
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100 mg/90 min =
15 mg IV bolus then 0.75 mg/kg for 30 min (dont exceed 50 mg) then 0.5 mg/kg over next 60 min (dont exceed 35 mg) |
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What adjuncts can be used with thrombolysis?
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IV heparin or enoxaparin for 48 hrs
ASA 160-325 mg/day |
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What is ASA and clopidogrel dosing after a bare metal stent is placed?
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ASA:
162-325 mg for 1 month then 75-162 mg for life Clopidogrel: 600 mg PO load 75 mg PO daily X 1 month-1 year |
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What is ASA and Clopidogrel dosing after a drug eluding stent is placed?
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ASA:
162-325 mg for 3-6 months then 75-162 mg for life Clopidogrel: 600 mg PO load 75 mg PO daily for at least 1 year |
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What are 4 methods of preventing contrast induced nephropathy from cardiac catheterization?
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DC metformin (48 hrs prior and post)
Fluid resuscitation (1-2 L prior & post) N-acetylcystine (prior and post) Sodium Bicarb (prior and post) |
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What is the tx of amiodarone in a post MI patient who now has sustained Vtach?
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150 mg bolus over 10 min
1 mg/min for 6 hrs 0.5 mg/min for maintenance 150 mg bolus for breakthrough |
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Clopidogrel should not be given with what PPI?
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omeprazole
(increases the risk of reinfarction) |
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Administering what type of drug within 4-6 wks post MI improves mortality and decreases the development of CHF?
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ACEI
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What CCB is contraindicated in pts with CAD?
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short acting nifedipine
(large fluctuations in BP) |
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All ACS patients should go home with what drug regimen?
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ASA
Beta blocker ACEI Statin NTG SL Clopidogrel (if PCI performed) Maybe long acting NTG,CCB, eplerenone, or niaspan |
