Bcacp - Cardiology Questions And Answers

MRA recommendation for CHF 1. symptomatic HFrEF /= 35% 2. Post-MI with /=40% and either HF symptoms or DM MRA CI 1. eGFR 30 2. SCr /=2.5 in male, /=2.0 in female 3. K 5.0 4. pt already on combination therapy with ACEI + ARB (d/t increase risk of hyperkalemia with MRA) Hydralazine/isosorbide recommended for which CHF patients? 1. AA patients with NYHA class III/IV taking ACEI/ARB , BB +/- MRA 2. any symptomatic HFrEF patients who are intolerant to ACEI/ARB Distal tubule diuretics - drugs and directions -place in therapy -Metolazone, Chlorthalidone -Given 30 min prior to loop diuretics to augment the effect CHF: digoxin toxicity 1. GI disturbances 2. Arrhythmia 3. CNS disturbances 4. Visual changes digoxin level goal CHF Afib both 0.5-0.9 ng/mL for CHF 1-2 ng/mL for Afib if both, use CHF goal (0.5-0.9) digoxin DDI 1. Amiodarone/Dronedarone 2. Verapamil 3. Quinidine 4. Erythromycin/Clarithromycin 5. Telaprevir, Saquinavir CHF: Ivabradine should be avoided in which patients? 1. AFib, 3rd degree heart block, pacemaker dependent 2. BP 90/50 or resting HR 60 bpm 3. acute CHF 4. severe hepatic impairment 5. strong CYP 3A4 inhibitors: dilt/vera, grpfrt juice 6. CYP 3A4 inducers: St John's wort, rifampin, barbiturates, phenytoin Afib rhythm control - choices for structural abnormalities CHF CAD CHF - amiodarone or dofetilide (then ablation) CAD - dofetilide or sotalol (then amiodarone or ablation) *must start dofetilide inpatient Pill-in-the-pocket, definition, CI, who qualifies -One single dose of flecainide or propafenone (class Ic) -must be on BB or CCB -Avoid in: sinus or AV node dysfxn, bundle-branch block, QT prolongation, Brugada syndrome, or structural heart disease Afib rhythm control - NO structural abnormality (no CHF/CAD) Class Ic: -flecainide 50-200mg bid, propafenone 150-300mg tid -should be combined with AV nodal blocking agent (rate control) Class III: -sotalol, dofetilide (amio last line but works best) -cautious in pts with risk of torsade LWMH: VTE treatment dose Dalt Enox Tinz Dalteparin: -200 units/kg subQ daily or 100 units/kg subQ BID Enoxaparin: -1.5 mg/kg subQ daily or 1 mg/kg subQ BID -if CrCl 30, use 1 mg/kg daily Tinzaparin: -175 units/kg subQ daily Fondaparinux - CI, PK -CI in severe renal impairment Crcl 30, cautious in 30-50 -AC effect persists for 2-4 days after the drug d/c -will not alter aPTT and PT -Not associated with HIT (unlike UFH and LWMH) Fondaparinux VTE treatment dose ppx dose --50kg, 5 mg subQ daily --50-100 kg, 7.5 mg subQ daily --100 kg, 10 mg subQ daily --CI in CrCl 30 ppx: 2.5mg SQ daily Dabigatran Dose, vte, afib, renal adjustment VTE 150 mg BID, initiated after initial treatment w/ LMWH Afib 150 mg BID crcl 15-30: 75 mg BID crcl 15: not recommended Dabigatran CI, DDI -avoid taking it in pt taking p-gp inhibitor with crcl 15-30 -crcl 15 -amio -dronedarone/ketoconazole (dec to 75 mg BID if crcl 30-50) -quinidine -verapamil Rivaroxaban dose, afib, vte AFib -20 mg daily WM -crcl 15-50: 15 mg daily -crcl 15: avoid VTE 15 mg BID WM x21 d, then 20 mg daily WM VTE ppx -10 mg daily -crcl 30: avoid antiplatelet/OAC/ periprocedural asa - continue clopid/ticag - stop 5 days prior prasugrel - stop 7 days prior dabigatran - stop 2 days prior (4 if crcl 30) apixaban - stop 24 hrs prior (48 for high bleed risk) rivaroxaban - stop 24 hrs prior edoxaban - stop 24 hrs prior warfarin - 5 days + bridge high risk Rivaroxaban DDI Increase serum conc -avoid p-gp and strong 3A4 inhibitors -keto-/itra-conazole -conivaptan -lopinavir/ritonavir, indinavir/ritonavir Decrease serum conc -avoid p-gp and strong 3A4 inducers -phenytoin -CBZ -rifampi