Cardiac + Antociag Must Know- Naplex

Drug interaction: Statins should not be used with ___ due to increased risk of rhabdomyolysis

Gemfibrozil

Who gets a high intensity statin?

Clinical ASCVD (ACS, Stable Agina, Coronary/Artery Revascularization, Stroke/TIA, PAD with atherosclerotic origin)

LDL≥190

DM + 40-75 + MULTIPLE ASCVD risks

LDL 70-189 + 40-75 + ASCVD >20%

High intensity statins

Rosuva 20-40

Atorva 40-80

Moderate Intensity Statins

Rosuva 5-10

Atorva 10-20

Simva 20-40

Prava 40-80

Lova 40-80

Fluvastatin 40BID/80XL

Pitavastatin 1-2

Low intensity statins

Simva 10

Prava 10-20

Lova 20

Fluva 20-40

Which statins must be taken at night

Statins with short half-lives

• Simvastatin (Zocor)

• Lovastatin (Mevacor, Altoprev)

• Fluvastatin (Lescol, Lescol XL)

• Pravastatin (Pravachol) [1, 2, 3, 4, 5]

Preferred HTN Drugs

Thiazide, DHP CCB, ACE, or ARB (CKD),

HTN agents in Pregnancy

Labetolol, Nifedipine ER, Methyldopa

Hypertensive Urgency (Asymptomatic) ≥180.0/120

• No evidence of acute target organ damage

• Decrease BP gradually 24-48 hours

Hypertensive Emergency

Evidence of acute target organ damage

Treat with IV meds (Clevidipine, Enalaprilat, Esmolol, Hydralazine, Labetolol, Nicardipine, nitroglycerin, Nitroprusside)

Decrease BP by no more than 25% within the first hour, then decrease ro 160/100 mmHg over the next 2-6 hours

Metoprolol IV:PO →

1:2.5

Rare sife effect with olmesartan

Sprue-like enteropathy (severe, chronic diarrhea with weight loss) can occur months to years after drug initiation

What drug patch must be removed before an MRI

Clonidine

Treatment Approach to Stable Angina

A- Antiplatelet* and antianginal** drugs  B- Blood pressure (ACE or ARB) C- Cholesterol (high intensity statin) and cigarette cessation D- Diet and diabetes E- Exercise and education *No DAPT, just ASA or clopidogrel if can't tolerate ASA **Beta blockers, CCBs, long-acting nitrates- can use multiple THEN Ranolize

Rare side effect with P2Y12s

Thrombotic Thrombocytopenic Purpura (TTP)- small blood clots forming in small vessels, causing low platelets, RBC destruction, and organ damage, headache

DO not use short acting nitrates if

• Avanafil apst 12 hours

• Sildenafil or Vardenafil past 24 hours

• Tadalafil past 48 hours

DO not use long acting nitrates with

•  any PDE5 inhibitor

• Long-acting requires a 10-12 nitrate-free period

• The patch goes on the chest

ACS Algorithm

MONA- GAP- BA

For ACS

Morphine	GPllb/llla antag	Beta Blockers- Start within first 24 hours
Oxygen (if <90%)	Anticoagulants	PO ACE inhibitors- Start within first 24 hours IF one; LVEF<40% HTN DM CKS
Nitrates	P2Y12 inhibitors
ASA

What P2Y12 contraindicated with omeprazole and esomeprazole

Clopidogrel- its a prodrug metabolized by CYP2C19

What P2Y12 contraindicated in stroke or TIA and 75 years and up

Prasugrel

What P2Y12 cintraindicated in hx of intracranial hemorrhage 

Ticagrelor

When to use fibrinolytics for ACS?

Used only in STEMI when PCI is not available, use within 30 minutes of hospital arrival

Anti-Arrhythmic Classifications

CLASS I: Na channel blockers 1a: Disopyramide, Quinidine, Procainamide 1b: Lidocaine, Mexiletine 1c: Flecainide, Propafenone Double Quarter Pounder, Lettuce Mayo, Fries Please! Class II: Beta Blockers Class III: Potassium Channel Blockers Dronedarone, Dofetilide, Sotalol, Ibutilide, Amio Class IV: Non DHP CCBs

Drugs that can Prolong QT Interval

Antiarrhythmics- Class 1a, 1c, and 3

Antiinfectives- Macrolides, antimalarials, azole antifungals, quinolones

Antidepressants- SSRIs, TCAs, Miraz, Trazodone, Venlafaxine

Antiemetics- Zofran, Droperidol, Metoclopramide, Promethazine

Antipsychotics- First and second gen

Oncology meds- androgen deprivation therapy, tyrosine kinase inhibitors, arsenic

Other- Methadone- Ranolzaine, Loperamide, Donepezil, Hydroxyzine, solifenacin, fingolimod

Amio can only be in a ____ conatiner

NON-PVC

The preferred antiarrhythmics to maintain NSR in patients with HFrEF are ?

dofetilide and amiodarone

Drug induced lupus

hydralazine, procainamide, quinidine

Digoxin range for afib vs HF

AFIB: 0.8-2ng/ml

HF: 0.5-0.9

ACC/AHA Heart Failure Stages

A- at risk without symptoms 

B- Structural heart disease and/or elevated biomarkers without signs or symptoms

C- Structural heart disease with prior or current symptoms

D- Advanced HF w/severe sx or recurrent hospitalizations despite maximal treatment

NYHA Functional Classes

I- no limitations on physical activity

II- comfortable at rest by ordinary physical activity causes sx (walking up stairs)

III- Comfortable at rest, but minimal exertion causes HF sx (bathing)

IV- Sx at rest

Entresto target dose

97/103 BID

Enalapril, Lisinopril, Quinapril, Ramipril target doses for GF

Ramipril: 10 QD

Enalapril: 10-20 BID

Lisinopril: 20-40mg QD

Quinapril: 20BID

R E L Q

Metoprolol abd Carvedilol target dose for HF

Metoprolol succinate 200mg QD Carvedilol, 25 BID (≤ 85kg); 50 BID (>85kg), 80mg QD (controlled release)

Dapagliflozin, Empagliflozin target dose for GF

10 QD

Do no start if efgr <20-25

Spironolactone taget dose for HF

25-50mg QD

Hyperkalmia, do not start if K>5

Furosemide ? = Torsemide ? = Bumex ?

Furosemide 40= Torsemide 20= Bumex 1

When to use ivabradine

HR >70 OK- adjunct if symptomatic on full GDMT

Dig and amio drug interaction and signs of toxicity

N/V, green halos, vision blurry, confusion, (Antidote DigiFab), reduce by 50% if starting amio

Alteplase dosing and criteria for use in stroke

Dose: 0.9mg/kg 90mg max

MOA: Converts plasminogen to plasmin

Sx onset ≤4.5 hours No internal bleeds Severe HTN >185/110 ( can be lowered with IV labetolol, nicardipine) Hx of stroke in the past 3 months LMWH in the past 24 hours Warfarin use with INR >1.7 DOAC use BG <50

Antiplatelets for stroke

• Clopidogrel + ASA 21-90 days (did not receive alteplase)

• Start ASA 24 hours after fibrinolytic therapy

When to use warfarin

Use in moderate to severe mitral stenosis or a mechanical heart valve

Use if triple positive antiphospholipid syndrome

Warfarin tablet colors and strengths

Pink- 1mg

Lavender- 2mg

Green- 2.5mg

Brown- 3mg

Blue- 4mg

Peach- 5mg

Teal- 6mg

Yellow- 7.5mg

White- 10mg

Please Let Greg Brown Bring Peaches To Your Wedding !

What agent are tehse antidotes for?

Protamine
Idarucizumab (praxbind)
Vit K, Phytonadione (Mephyton
PCC (Kcentra)

Protamine	UFH, LMWH
Idarucizumab (praxbind)	Dabigatran
Vit K, Phytonadione (Mephyton	Warfarin
PCC (Kcentra)	Warfarin

CHA2DS2VASC

≥2 males, ≥3 females start DOACv

C- CHF H- HTN A- Age ≥ 75 (2) D- DM S- Stroke/TIA prior (2) V- Vascular disease (MI, PAD) A- Age 64-74 Sc- Female

Zestoretic

Lisinopril + HCTZ

Hyzaar

Losartan + HCTZ

Benicar HCT

Omesartant + HCTZ

Diovan HCT

Valsartan + HCTZ

Lotrel

Benazepril + Amlodipine

Exforge

Valsartan + Amlodipine

Tenoretic

Atenolol + Chlorthalidone

Ziac

Bisoprolol + HCTZ

Maxzide

Triamterene + HCTZ