Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
78 Cards in this Set
- Front
- Back
- 3rd side (hint)
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 |
|