E3 WOOD HINTS - FROM C/O 2025 QUIZLET

what antianginals is a patient given unless contraindicated?

ASA
BB if prior MI
ACEi if DM or LV dysfunction
statin
SL NTG for quick relief

what antianginals are given for daily symptoms/prevention?

BB
CCB
long acting nitrates

what is the first line treatment for angina?

BB

what is the second line treatment for angina?

CCB

what is the first line treatment for vasospastic angina?

CCB (DHP)

BB work best for antianginal in what population?

HF
post MI

sudden discontinuation of BB can cause?

rebound HTN

propranolol can have an adverse effect of?

nightmares

can you combine NDHP and BBs?

NO!!!!! → causes heart block and bradycardia

what antianginal must you be cautious using in case of CYP3A4 interactions?

CCB

when are NDHP CCBs contraindicated for angina?

HR < 60
sBP < 100
acute HF
EF < 40%

what is a big adverse reaction of CCB?

constipation
DHP → HA, flushing, peripheral edema

what is a risk for short acting nitrates (NTG)?

orthostatic HTN → esp if pt is already on BB/CCB/ACE

why are long acting nitrates dosed 12 hrs on/12 hrs off?

to avoid tachyphylaxis

can you use long acting nitrates as monotherapy for prevention of angina?

NO!

what is an ABSOLUTE contraindication for nitrates?

PDE5 inhibitors → leads to severe hypotension, MI, and stroke

what meds are avoided in vasospastic angina?

BB → worsens symptoms

what med is given at first sign of chest pain from ACS?

ASA
use clopidogrel if recent GI bleed or intracranial hemorrhage

when do you give morphine in ACS?

when the pt is unresponsive to nitrates

what is an adverse reaction of morphine use for ACS?

hypotension → d/t histamine release

who do fibrinolytics work best on?

< 75 y/o w/in 12 hrs of onset & only in STEMIs

what is the major adverse reaction of fibrinolytics?

bleeding

what are the contraindications for fibrinolytics?

- surgery < 10 days
- GI bleed < 3 months
- hx of HTN (diastolic > 110)
- active bleed/hemorrhagic disorder
- previous CVA/intracranial tumor
- aortic dissection
- acute pericarditis
- STK prior exposure/allergic rxn
- pregnancy

co-morbidity: HTN

1st line tx:

alt:

AVOID:

1st line tx: BB
alt: NDHP CCB
AVOID: n/a

co-morbidity: prior MI

1st line tx:

alt:

AVOID:

1st line tx: BB
alt: n/a
AVOID: CCB monotherapy (okay to use in combo w BB)

co-morbidity: ↓ LV function

1st line tx:

alt:

AVOID:

1st line tx: BB
alt: amlodipine
AVOID: NDHP CCB (further depresses function)

co-morbidity: bradycardia/AV block

1st line tx:

alt:

AVOID:

1st line tx: DHP CCB
alt: LA nitrate
AVOID: NDHP & BB

co-morbidity: DM

1st line tx:

alt:

AVOID:

1st line tx: NDHP CCB
alt: LA nitrate or CS BB
AVOID: NCS BB

co-morbidity: asthma

1st line tx:

alt:

AVOID:

1st line tx: NDHP or CS BB
alt: n/a
AVOID: NCS BB

what diuretics are mainstay therapy for CHF?

loops

are diuretics mandatory for treatment of CHF?

NO

are ACEs and BB mandatory for treatment of CHF?

YES

what class of drugs for CHF have a risk of impairing renal function?

ACE (and ARBs)

what is a benefit of using a BB for CHF?

↑ EF & slows disease progression

what is the first line treatment for CHF + afib?

digoxin

what are adverse effects of digoxin?

xanthopsia → yellow-green halos

↑ PR int, ↓ QT int, depressed ST & sinus bradycardia

what is a contraindication for digoxin?

hyperkalemia → risk for arrhythmias is very high
monitor electrolytes!

what is the antidote for digoxin?

Digoxin immune Fab (Digibind)

what does DIgibind do?

binds to the antigen-binding site of Ig and reverts everything back to normal
- so if pt was in afib before taking digoxin, they will go back into afib

what makes a pt "not eligible" for spironolactone in treatment of CHF?

K > 5 or serum Cr > 2.5

when is Spiro used for CHF?

later stages (3 or 4)

what population is milrinone and inamrinone best for?

hypertensive patients

what population is dopamine (for CHF) best for?

hypotensive patients

what is the MOA of dobutamine?

β1 agonist → ↑ force of contraction
- only used short term to stabilize pts!

what is a drug interaction for quinidine?

CYP2D6 inhibitors (codeine, morphine) → causes exaggerated effects of drug

what are adverse reactions for quinidine?

cinchonism → tinnitus, dizziness, blurred vision
sudden death
torsades

what is procainamide metabolized through?

the acetylation pathway

what are adverse reactions of procainamide?

lupus like syndrome → slow acetylators
torsades

what are adverse reactions of disopyramide?

CHF (↓ contractility)
torsades

what antiarrhythmics are rate vs rhythm control?

rate control → class 2 & 4
rhythm control → 1 & 3

lidocaine is most effective on Na channels in what kind of tissue?

ischemic

what is an early sign of lidocaine toxicity?

nystagmus

what is a contraindication for lidocaine?

seizure history

what are adverse reactions of propranolol?

worsened HF
heart block
hypotension
bronchospasm

what is the MOA of amiodarone?

block Na, K, & CA channels

blocks a & b receptors

prolongs refractory periods

what are adverse effects of amiodarone?

pulmonary fibrosis
blue-grey skin color
thyroid abnormalities

what are drug interactions with amiodarone?

digoxin, warfarin, flecainide, phenytoin, procainamide
- CYP3A4 inhibitor!
increases levels of these drugs

what are adverse reactions of dofetilide?

QT prolongation → torsades
renal eliminated → monitor electrolytes

class 4 antiarrhythmics only work on?

SUPRAventricular arrhythmias

what are adverse effects of verapamil & diltiazem?

hypotension
bradycardia
- CYP3A4 inhibitors!

when do you use adenosine?

PSVT

what is the treatment of torsades?

Magnesium

what are adverse effects of magnesium?

hypotension
- watch renal function & mag levels

you have a patient who you suspect a MDR nosocomial PNA, they are in the hospital for 1 week and develop a ventilator associated PNA and you need to start ABX ASAP, what is the treatment?

2 drugs that cover pseudomonas (double-cover bc of resistance)

PLUS

vanco/linezolid (for gram + coverage)

nosocomial PNA treatment for MDR pathogens

anti-pseudo ceph (cefepime) or carbapenem (merepenem) or Zosyn

PLUS

anti-pseudo FQ or aminoglycoside

PLUS

vanco or linezoid

what is important to know for all of the ABX that treat MDR nosocomial PNA?

except for linezolid, they are ALL really eliminated!

must watch renal function!!!!

TB meds and their side effects

Rifampin → induces CYP450 enzymes; orange body secretions

Ethambutol → ↓ red-green discrimination; ↑ uric acid levels

Pyrazinamide → inhibs uric acid secretion; avoid in prenancy

Isoniazid → peripheral neuritis = give B6; lupus-like syndrome

dosages of volume expansion!

IV crystalloids (0.9% NaCl)
20mL/kg bolus (1-2 L at a time)
4:2:1

what are IV crystalloids used for?

profound vasodilation/hypotension

preferred reliever asthma med

SABA PRN or low-dose ICS-fomoterol

step 1 asthma treatment controller med

PRN low-dose ICS-fomoterol
OR
low-dose ICS

step 2 asthma treatment controller med

DAILY low-dose ICS
OR
PRN low-dose ICS-fomoterol

alt: LTRA

step 3 asthma treatment controller med

DAILY low-dose ICS-LABA
OR
med-dose ICS
OR
low-dose ICS + LRTA

step 4 asthma treatment controller med

med-dose ICS-LABA
OR
high-dose ICS
OR
add-on tiotropium or LTRA

step 5 asthma treatment controller med

high-dose ICS-LABA +/- biologic or tiotropium
OR
low-dose OCS (consider SE)

can LABA be used for monotherapy?

NO!!

status asthmaticus treatment

continuous albuterol
IV steroids
magnesium bolus (followed by continuous infusion)
ketamine (if intubated)

COPD treatment classes

A = short-acting bronchodilator (SABA/SAMA/SABA+SAMA) PRN

B = long-acting bronchodilator (LAMA/LABA) daily + SABA PRN

C = LAMA daily + SABA PRN

D = LAMA or LAMA+LABA daily + SABA PRN

what should you educate your patient on while using nicotine replacement?

if they relapse (start smoking again), they MUST STOP the nicotine replacement or else there is a high risk for nicotine OD!

black box warning for Chantix

neuropsychiatric events (depression, suicidal ideations, vivid dreams)

What statins are metabolized by CYP3A4?

atorvastatin
lovastatin
simvastatin

adverse rxns of statins

↑ liver enzymes
myalgia
myopathy
rhabdomyolysis

what test is used to monitor muscle toxicity?

CPK

which antihyperlipidemic is safe for pregnancy, kids and adolescence?

bile acid sequestrants → they aren't absorbed in GI tract

if someone is taking CYP450 drug, what should they not drink?

grapefruit/grapefruit juice
- he really harped on this and it's probably not important but oh well

what is the first line treatment/gold standard for HDL?

statins

ezetimibe + statin relationship?

they are synergistic in ↓ LDL

which antihyperlipidemic can ↑ effects of warfarin?

fibrates

how to avoid cardio drug interactions with bile acid sequestrants?

take interacting med 1 hour before or 4 hours after bile acid sequestrant

bile acid sequestrant (resins) effect on TG?

increases!!!

what drug causes cutaneous flushing and what can help prevent it?

seen with niacin
prevent by taking ASA

what meds are the best at ↑ HDL?

niacin & fibrates

which meds are the best at ↓ TG?

niacin & fibrates

four major groups that benefit from statins

1. clinical ASCVD
2. LDL > 190
3. 40-75 y/o DM w/ LDL 70-189 and w/o clinical ASCVD
4. w/o clinical ASCVD or DM but w/ LDL 70-189 + estimated 10-yr ASCVD risk > 7.5%

which diuretics cause hypokalemia?

loop and thiazide

"a pt has a potassium of 5.5, which one of these diuretics are contraindicated?"
a. loop diuretic
b. thiazide diuretic
c. potassium sparing diuretic
d. carbonic anhydrase inhibitor

potassium sparing diuretic (triamterene)

if a patient is having a lot of side effects from spironolactone, what can they be switched to?

eplerenone (it has less effect on androgen receptors)

what is the result of ↓ aldosterone secretion?

potassium levels ↑

what meds cause hyperkalemia?

potassium sparing diuretics
ACE-I
ARBs

it a patient has HTN along with other comobidities (like T2DM), what medication is the best for treating HTN?

ARBs