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78 Cards in this Set

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mech for fibrinolytics
converts plasminogen to plasmin...which degrades fibrin
fibrinolytics indicated for?
when prefered?
goal time?
STEMI only
onset <3H and PCI not imm available
door to needle-30 mins
fibrinolytic meds?
which is highes risk of bleeding
which ones require heparin coadmin?
streptokinase
alteplase
retaplase
Tenectaplase

highest bleeding-STPK

alteplase
retaplase
tenecteplase
fibrinolytic abs contrindications
any previous intracranial hemm
recent ischemic stroke
head/facial trauma
fibrinolytic relative contraindic
uncontrolled HTN >180/ 110
past history of ischemic stroke
surgery, pregnancy, peptic ulcer
fibrinolytic bleeding complications
acute nuerological changes--> intracranial hemmorage
when are PCI preferred over fibrinolytics?
sytmptoms >3H
<3 H and no delay expected
contraindication to fibrinolytic
TIMI risk score components
> or = 65
> or = 3 CAD risk factors(Hyperlipids, DM, HTN, smoke, premature CHD fam history)
Know CAD (>50% stenosis)
Aspirin in last 7 days
ST depression
>2 episodes of chest discomf
Positive cardiac enzymes
UF anticoag
recc for UA/STEMI/ NSTEMI receiving fibrinolytic or PCI
UFH doses
without fibrinolytic-
LD: 60-70 u/kg Bolus
MD: 12-15 u/kg/H infusion

with fibrinolytic-
LD: 60 u/kg Bolus
MD: 12 u/kg/H infusion

continue for 48h or end of PCI
Dalteparin dose
for UA/NSTEMI
120 inter. units/kg Subq q 12 H
Enoxaprin normal dose
for UA/NSTEMI/STEMI
1 mg/kg Subq q 12 H
enoxaprin renal dose
<30 ml/min
1mg/kg subq q 24H
Enoxaprin dose for >75 y.o
.75 mg Subq q 12 H
Enoxaprin Bolus
PCI- .3mg/kg

Fibrinolytic- 30mg bolus
Fondaprinux
not used in PCI alone (requires UFH)

2.5 mg Subq daily
Not for renal insuff
Plavix dose
LD 300-600 mg PO
MD- 75 mg PO daily

Withhold for at least 5 days prior to CABG
Prasugrel dose
only if pt is getting PCI
LD- 60 mg PO
MD- 10 mg PO daily
<60 kg- 5mg PO daily
abciximab info
GP 2b/3a inhb

started WITH PCI
NOT for med. management
Eptifibatide info
may be started PRIOR to PCI or med managment

requires renal dose adjust.
Tirofiban
NEEDs to be PRIOR to PCI

requires renal dose adjust.
Aspirin doses
given indef

75-81 mg PO daily
stent- 162-325 mg PO for 1-6 months depending upon stent--->then 75-162 mg PO daily
secondary prevention doses
plavix

prasugrel
plavix- 75mg po daily for 12 MONTHS
STEMI pts with high bleeding-2-3 weeks

Prasugrel- 10mg po daily for 12 months
BB secondary prevention benefits
prevents cardiac remodeling
reduces mortality
continue indefintely

CCB may be used if allergic toBB
ACEI benefits
same benefits as BB
should be used within first 24 H for post MI
when are ARB's reccom? and which ones?
when ACEI not tolerated and LVEF <40%

use Candesartan and valsartan
Aldosterone Antag
prevent cardiac remodeling

use when LVEF <40% or pt has diabetes and CHF

use sprionolactone or eplerenone
discharge meds?
ABCDE
asprin, ACEI, anti-platelet, anti-anginal
BB
Cholesterol
Diet
Exercise
what class is disopyramine
1a
what class is BB
2
what class is procainamide
1a
what class is quinidine
1a
what class is lidocaine
1b
what class is mexiteline
1b
what class is amiodarone, sotalol, dronedarone?
3
what is name of most commonly use classification system for anti-arrythmic
vaughn williams drug class.
Main action of class 1a
prolongs repolarization/conduction
substantially afects phase 0
main action of class 1b
shortens repol and no effect on conduction

weakly phase 0
main action of class 1c
Not for AFibb

prolongs conduction/ little effect on repol.

profoundly dec. phase 0
class 2 BB main actions
slows av conduct.

supp. ventric. ectopic beats
Class 3 main action
slows repol.
class 4 main action
slows AV node conduct.
Dronaderone inhibits....
NA, K, Ca, alpha, and beta

lacks iodine moiety
Dronaderon contrindic.
sick sinus syndrome
2 or 3rd HB
HR <50 bpm
preg.
Andromeda study
dronaderon vs placebo
not for use with HFailure

2x likely to die on it
Eurdonis/Adonis study
Dronaderone vs placebo
reduced incidence of 1st recurrence
*Not compared to amiodarone

Adonis took longer
Athena study
Dronedarone vs placebo

sig. reduct. in rate of hosp

**NOT reduce mortaility
dronaderone indications
dose/ form
paroxysmal or persistent atrial fibb/ flutter

400 mg bid po (NO IV)
ICD-prev. of SCD
>40days post MI and LV Syst. dysfunc
Paroxsymal vs persistent
par- <7days usualy self
terminating

persist->7 days not self term.
AFFIRM study
no sig diff between rate vs rthythm

rhythm- higher hosp and higher adv effects

strict control provides no benefit
AFibb management
if persist and non perm use Rate Control and AC ---> consider antiarrthymic-----> cardioversion

if perm ratecontrol + AC
Afibb rhythm unstable for <48H
DCC +IV UFH
Afibb Unstable for >48H
DCC +IV UFH + Echocardio
Afibb Stable for > 48H
Rate control + AC for 3-4weeks prior and 4 weeks after DCC
AFibb Rhythm control
DCC

of pharm cardioversion
AF <7days Flec, tilide's, amiodarone and propafenone

>7days tilide's and amiodarone
what 2 drugs not for cardioversion?
sotalol and digoxin
Mainten. of Sinus Rhytm and HTN
Hypertrophy-
Yes-Amiodarone

No-Dronedarone, Flec, Propafenone, Sotalol
Catheter Ablation
radiofreq to destroy heart tissure responsible for errant electrical impulses
Anticoag for Afibb is not bassed on _____, but based on ________
Not rhytm

based on stroke risk
Dabigatrin
direct thrombin inhib
non valvular AFibb
150mg po BID
renally dosed 75mg bid
*No Antidote
how do u discontinue warfarin and go to dabagatrin
stop warfarin and wait till INR is <2
Atrial flutter
240-320bpm
predictable ventricular rate
sawtooth
PVC tx
stable-BB, amiodarone
unstable-lidocain, amiodarone
Octane
C8H18
CH3 - CH2 - CH2 - CH2 - CH2 - CH2 - CH2 - CH3
Ventricular arrhythmia stable vs unstable
stable- rapid HR, dyspnea/chest pain

unstable-hypotension, poor perfusion
Cardiac arrest
Sinus arresst, VFibb, AV block
Ventricular arrhythmia management + not ICD
1ST line-BB
then, amiodarone, Sotalol

with repeated ICD firings
-Sotalol
-BB +Amiodarone
Ventricular Tachyarryh
Non sustained VT
< or = 30 sec.
self termin.
sustained VT
> or = 30 sec. need therapuetic interv.
incessant VT
VT is dominate rhytm over sinus rhytm
recurrent VT tx
amiodarone
when to use catheter ablation
persistent AF
paroxysmal AF (failed anti-arrhytmic drugs)

*NOT in severe pulm. disease
HF is...
HF, not CHF
clinical syndrome
#1 hosp for >60 yo
Heart Failure
Etiology of HF
Ischemic Heart Disease (post MI)
HTN
systolic dysfunction overview
low ejection fraction
ischemia(muscle loss)
diastolic dysfunction overview
preserved ejection
LVEF>45%
stiff myocardium