Heart Meds
(Jeff)
(Jeff)
This heart med pulls quadruple duty, holding indications for HFrEF, HFpEF, Chronic Kidney Disease, and Type 2 Diabetes.
What are SGLT2 Inhibitors? (Acceptable: Dapagliflozin / Empagliflozin)
This is the largest insurance company in America by patient population covered.
What is Medicare? 66 million total
These are the two most important factors which increase survival in treatment of cardiac arrest.
Answer: What are high quality CPR and early defibrillation?
This is the first-line DMARD initiated in patients with newly diagnosed rheumatoid arthritis, and as FM doctors we should monitor liver function while patients are on it.
What is Methotrexate?
A 24-hour urine protein of ≥300 mg, a protein/creatinine ratio ≥0.3, or a dipstick reading of 2+ are the diagnostic criteria for this condition in pregnancy.
What is proteinuria?
This heart med is used to reduce mortality in HFrEF, but it is also frequently prescribed off-label to treat hormonal acne and hirsutism.
What is Spironolactone?
A patient says a local med spa will give him "semaglutide" for 50$ a month. The drug is likely coming from a _____ pharmacy instead of directly from the drug producers NovoNordisk. What is the type of pharmacy and are compounded drugs subject to FDA approval?
"compounding pharmacy", not FDA approved, legal oversight is identical to OTC vitamins.
This dose of medication is used every 3-5 minutes in nonshockable rhythms.
Answer: What is Epinephrine 1mg?
In a patient with an ESR > 50 complaining of a new headache, this is the most important first step to prevent what further complications?
What are high dose glucocorticoids given to prevent risk of permanent blindness?
These are the three first-line agents used for acute severe hypertension in preeclampsia.
What are IV labetalol, IV hydralazine, and oral immediate release nifedipine?
This heart med carries FDA-approved indications for hypertension, arrhythmias, and angina, but is also the only drug FDA-approved specifically for essential tremor and migraine prophylaxis in addition to being used off-label for performance/situational anxiety.
What is Propranolol?
A resident begins hyperventilating because their meal card is empty but its taco tuesday.
Their symbicort inhaler for SMART therapy costs them 260$ cash at the pharmacy. What is the closest alternative you could prescribe them instead and how much would it cost?
Breyna (symbicort BRANDED generic) $90, make sure to type in "BREYNA" on cerner
These two rhythms found during cardiac arrest are treated with defibrillation.
Answer: What are vfib and pulseless vtach?
This medication is one of the only maintenance therapies for SLE that is safe to continue during pregnancy and will decrease risk of neonatal lupus.
What is Hydroxychloroquine?
According to ACOG, this term describes more than five uterine contractions in 10 minutes averaged over a 30-minute period. Also, these medications carry the highest risk.
What is uterine tachysystole? What are misoprostol (Cytotec) and mifepristone?
The ACC/AHA uses a Class I / IIa / IIb / III classification system to grade the strength of its guideline recommendations. Per the 2022 AHA/ACC/HFSA Heart Failure Guidelines, this is the number of drug classes that carry a Class I recommendation for HFrEF, and separately, the number that carry a Class I recommendation for HFpEF. (You need to give me two different numbers)
Hint: "The _"number"_ pillars of treating HFrEF". I have no hint for the HFpEF number (lol).
What are four and zero?
Double Point Bonus: Following the EMPEROR-Preserved and DELIVER trials, the 2023 ACC Expert Consensus Decision Pathway upgraded this drug class from Class IIa to Class I for HFpEF — making it the first and only drug class to achieve this distinction of being Class I for HFrEF AND HFpEF.
Answer: What is/are ____?
50% of the U.S population with the lowest healthcare costs per year counts for ___% of total health expenditure. The top 10% population with the highest healthcare costs per year accounts for ___% of total U.S health expenditures.
3% and 50%. Overall expenses will increase with the "silver tsunami" and aging population.
These are the two second line medications used in shockable rhythms.
Answer: What are amiodarone and lidocaine?
This medication is the preferred anticoagulant for patients with thrombotic antiphospholipid syndrome.
What is Warfarin?
These are the two prostaglandins commonly used for cervical ripening and labor induction
What are misoprostol (Cytotec) and dinoprostone?
DAILY DOUBLE QUESTION (double the points, double the questions)
This heart med class is part of GDMT (Guideline-Directed Medical Therapy) with mortality-reducing benefit for treatment of HFrEF, but the 2022 AHA/ACC/HFSA guidelines DO NOT include a Class I/IIa/IIb classification for this heart med class for treatment of HFpEF.
Double Point Bonus: Name another class of heart med that is GDMT for HFrEF but does not have a Class I/IIa/IIb classification for HFpEF (like unto the "above med class"), BUT is indicated for first-line treatment of HTN (be specific).
What are Beta-blockers? (Acceptable: Bisoprolol, Carvedilol, Metoprolol Succinate)
What are ACE Inhibitors? (Acceptable: -pril)
Triple Point Bonus: Although ACE inhibitors do not have a class recommendation for HFpEF, ARB's do have a class IIb recommendation, but only 1 specific ARB was shown to be beneficial in HFpEF (CHARM-Preserved trial), which ARB is it? It also happens to be my favorite one.
Answer: What is ____?
One of our doctors with afib can't use his phone stipend to pay cash for eliquis anymore. Eliquis is $400 a month without insurance. Name an alternative medication to treat his condition and its per month cash price that a patient could get it for without insurance (or phone stipend).
Dabigatran (generic pradaxa) $60 a month (GOODRX.COM)
DAILY DOUBLE (Each team gets 30 secs, or less, to write down as many as possible; whichever team wrote the most gets DOUBLE POINTS)
Commonly referred to as the H's and T's, these are the reversible causes of cardiac arrest (there are ten).
What are hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, cardiac tamponade, toxins, thrombosis pulmonary, thrombosis coronary?
The behavior/levels of these proteins are one of the distinguishing factors between drug induced lupus and SLE.
Half Points: What are C3 and C4?
Full Points: Which proteins fall in correlation to flare ups and disease activity in SLE but remain normal in drug induced lupus.
DAILY DOUBLE
These are indications for intrapartum antibiotic prophylaxis against GBS. (name at least 3)
What is ....?
A) GBS+ status in current pregnancy as indicated by 1 of the following
-Positive Prenatal rectal or vaginal culture
-Bacteriuria (asymptomatic or associated with UTI)
-Positive intrapartum NAAT
B) Unknown GBS status in current pregnancy and any of the following
- Intrapartum maternal fever > 100.4
- ROM > or equal 18 h earlier
- Preterm onset of labor(<37wks)
- PROM (<37wks)
- Hx of positive GBS in previous pregnancy
C) GBS disease in previous pregnancy