Cardiology BCPS Exam Questions and Correct Answers

Cardiology BCPS Exam Questions and Correct Answers ------ is preferred when PCI cannot be performed within 120 minutes - ANSWER Lytics preferred when PCI cannot be performed within 120 minutes fibrinolysis and anticoagulation tx - ANSWER Those who receive lytic therapy should receive anticoagulation after fibrinolysis for at least 48 hours with IV UFH or IV/SC enoxaparin for hospitalization, up to 8 days (preferred, selected patients), or IV/SC fondaparinux for hospitalization, up to 8 days. fibrinolysis with GPI - ANSWER Benefit from adding glycoprotein IIb/IIIa inhibitors to aspirin therapy - ANSWER those with elevated biomarkers, those with diabetes, those undergoing revascularization) and in those not receiving adequate pretreatment with P2Y12-(etc: unable to tolerate plavix due to allergy) GPI and anticoag use after PCI - ANSWER After PCI, discontinue anticoagulation and continue glycoprotein IIb/IIIa inhibitors for 12-24 hours at the physician's discretion. GPI meds and duration - ANSWER Abciximab-12hr, no renal adjustment Eptifibatide-18-24hr,If CrCl 50 mL/minute, reduce infusion 50%; avoid in patients on hemodialysis; not studied in patients with SCr 4 mg/dL Tirofiban: If CrCl 30 mL/minute, reduce infusion 50% Prasugrel (Effient) CI - ANSWER TIA and stroke MD: 10 mg daily (5 mge if 60 kg; BW ≥ 75 years) CIs: TIA/stroke only used if PCI is intended Ticagrelor (Brilinta) CI - ANSWER CIs: ICH, severe hepatic disease Clopidogrel (Plavix) genetic polymorphism of - ANSWER CYP2C19 UA/NSTEMI w/ or w/o PCI - ANSWER 60-unit/kg IVB (max 4000 units), 12 units/ kg/hour IV (max 1000 units/hour) for 48 hours or end of PCI; goal aPTT of 50-70 seconds Fibrinolytic dosing - ANSWER door-to-needle time of less than 30 minutes to give fibrinolytic tx when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact, Alteplase- 3 doses/ wt based Reteplase- 2 doses Tenecteplase- 1 dose/ wt based Fibrinolytic Absolute Contraindications - ANSWER ANY prior hemorrhagic stroke Ischemic stroke within 3 months (except in past 41⁄2 hours) Intracranial neoplasm or arteriovenous malformation Active internal bleeding Aortic dissection Considerable facial trauma or closedhead trauma in past 3 months Intracranial or intraspinal surgery within 2 months Severe uncontrolled HTN (unresponsive to emergency therapy) For streptokinase,a treatment within previous 6 months (if considering streptokinase again) vasodilator - ANSWER Venous vasodilator - reduce PCWP. Arterial vasodilator - reduce SVR with compensatory increase in CI. 1. Sodium Nitroprusside:ARTERIAL =↓ SVR causing ↑CI & VENOUS=↓ PCWP Balanced arterial and venous vasodilator 2. Nesiritide:ARTERIAL =↓ SVR causing ↑CI ↓ PCWP and SVR, but greater effect on arterial vasodilation 3. Nitroglycerin: VENOUS=↓ PCWP Preferential venous vasodilator arterial vasodilator, arterial vasodilation at high doses Compelling reason for inotrope - ANSWER SBP 90 mm Hg, symptomatic hypotension, or worsening renal function