Statins
What is the definition of dyslipidemia (in lab values of HDL, trigs, LDL)
1. LDL > 130mg/dL
2. TG > 200mg/dL
3. HDL < 40mg/dL
Name three (3) rate control agents used in the treatment of Afib
1. Esmolol
2. Verapamil
3. Diltiazem
4. Metoprolol
What are the treatment goals for stage C heart failure?
Relieve HF symptoms within 2-7 days
Provide patient education to increase self-care activities within 1-2 months
Improve functional capability and quality of life within 2-3 months and lifelong
Reduce hospitalizations lifelong
Improve survival lifelong
Name three (3) symptoms of HYPOthyroidism and HYPERthyroidism
1. Constipation (hypo), diarrhea (hyper)
2. Weight gain (hypo), weight loss (hyper)
3. Periorbital edema (hypo)
4. Cold intolerance (hypo), heat intolerance (hyper)
5. Fatigue/decreased energy (hypo), excess energy (hyper)
What are the goals of treatment for acute ischemic stroke?
1. Limit ischemic injury
2. Reduce mortality and long term disability
What are the goals of treatment for hypertriglyceridemia
1. TG < 150mg/dL
2. Prevent acute pancreatitis
**BONUS 100 PTS**
What are s/sx of acute pancreatitis?
True or False
The use of Beta Blockers should be avoided in patients with asthma, but may be used in patients with COPD
TRUE - and why is that?
Why is it important for CHF patients to check daily weights and at what point should they contact their doctor?
Can imply fluid overload, if they gain 3 lbs in one day or 5 lbs in one week
Give three (3) counseling points for Levothyroxine
1. Best if taken 60 min prior to breakfast
2. Avoid antacids/iron containing products while taking levothyroxine
3. Take dose as soon as you remember
4. May take up to a month to see effects
What is the blood pressure goal if tPA is indicated?What is the goal if it is not?
Less than 185/110 mmHg
Less than 220/120 mmHg
Give three (3) high intensity statins and their doses
1. Simvastatin 80mg
2. Atorvastatin 40-80mg
3. Rosuvastatin 20-40mg
What does the acronym CHADS2 mean, and what do the scores mean regarding risk level
C - congestive heart failure
H - HTN 0 = Low risk
A - age > 75 1 = Moderate risk
D - DMII ≥2 = High risk
S - stroke
Name 3 contraindications and 3 adverse reactions associated with ACE inhibitors
Contraindications
Bilateral renal artery stenosis
H/O intolerance or ADR
Serum K >5.5 mEq/L and cannot be reduced
Pregnancy
Symptomatic hypotension
Mild renal insufficiency is not a
contraindication
Caution and close follow-up if Scr > 3 mg/dL
ADRs
Hyperkalemia (Caution K supplements and K-sparing diuretics
Hypotension
Cough
Angioedema
What labs do you want to get with HYPOthyroidism and explain the monitoring/follow-up
TSH and Free T4
TSH and Free T4 every 4-6 weeks until TSH goal reached; once reached, every 4-6 months
s/sx at each visit
62 year old WM presents with s/sx of stroke and physician decides patient is candidate for tPA. Pt weighs 115kg. What will the dose/admin schedule look like?
Total dose: 90 mg
9 mg bolus over 1 minute followed by 81 mg infusion over 1 hour
What is the most severe adverse event associated with statins, and what labs do should we draw to verify our diagnosis
Rhabdomyolysis, and
Creatinine kinase + SrCr + urinalysis
What is an appropriate treatment for a patient with a CHADS2 score of 1
Aspirin 81-325mg + Clopidogrel 75mg OR
Warfarin OR
Xarelto/Eliquis OR
Dabigatran (Pradaxa)
In patients with chronic HFrEF class 2-4 who tolerate an ACE-I, the following therapy adjustment should be made:
Entresto
What is the average starting dose of Levothyroxine in patients who are young/healthy with overt hypothyroidism for a few months
1.6mcg/kg/day
**BONUS 100 PTS**
What are the lab values asso. with HYPOthyroidism and the labs asso. with HYPERthyroidism?
This is the most important modifiable risk factor in secondary stroke prevention, and the goal we treat to.
Blood pressure, goal less than 130/80 mmHg
What are three (3) contraindications to starting a statin in a patient
1. Pregnant (X)
2. Nursing mothers
3. Active liver disease
4. Unexplained ALT elevation ≥3x ULN
In the early pharmacologic treatment for ACS, what are the four (4) main considerations? **hint: think of artwork**
MONA:
1. Morphin
2. Oxygen
3. Nitroglycerin
4. Aspirin
What are 6 drugs to avoid in patients with HFrEF?
Non-dihydropyridine Calcium Channel Blockers
Metformin
NSAIDS
Class I antiarrhythmics (quinidine, procainamide, flecainide, lidocaine, phenytoin, propafenone)
Glitizones
Cilostazol
What are ALL the available doses of Levothyroxine
25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300
Name 5 exclusion criteria for tPA use.
Minor or rapidly improving S/Sx
ICH (current or history of)
Other active internal bleeding
Intracranial surgery, head trauma, stroke
within 3 months
Major surgery or serious trauma w/in 2 weeks
GI or urinary hemorrhage within 3 weeks
BP > 185/110 that cannot be lowered
Glucose < 50 or > 400
Arterial puncture at a non-compressible site
or lumbar puncture within 1 week
Seizure at stroke onset
Intracranial neoplasm, arteriovenous
malformation, aneurysm
Active treatment with warfarin AND INR > 1.7
Active treatment with heparin with elevated
aPTT
Platelet count < 100,000