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Digital PharmD

Informatics in Pharmacy

Cardiology

QT Prolongation

August 13, 2018 By Dr. G, PharmD

Low Mg, Ca or K can all cause QT prolongation

Acute Decompensated Heart Failure

August 12, 2018 By Dr. G, PharmD

Treatment Options: Preload Reduction   *Patients with diastolicdysfunction (right MI) are oftenpreload dependent, so usewith caution Loop diuretics Vasodilators Nitrogen – primarily venodilation Nitroprusside and BNP Analogs (nesiritide) are arterial and venous. Morphine ACEI, ARB, Aldosterone antagonists Afterload Reduction Vasodilators ACEI, ARB, Aldosterone antagonist Positive Inotrope Beta 1 agonist (dobutamine) Misc (high dose dopamine) Type 3 […]

Choosing Antiarrhythmics

August 12, 2018 By Dr. G, PharmD

In heart failure: only amiodarone and dofetilide Wolfe Parkinson White: procainamide or ibutilide Hypothyroid: non-DHP, avoid beta blockers Pregnancy: digoxin, non-DHP, no warfarin or heparin Do not use fenoldopam in patients with stroke, dopamine agonist can cause cerebral vasodilation and reduced blood flow to the brain 1a agents cause Torsades, usually avoid in structural heart disease 1b agents have […]

Acute Coronary Syndrome

August 12, 2018 By Dr. G, PharmD

Anticoagulant Overview: STEMI, PPCI UHF, bivalirudin   STEMI, fibrinolytic UHF, enoxaparin, fondaparinux bivalirudin not studies with lytics NSTE-ACS, early invasive enoxaparin, bivalirudin, fondaparinux, UFH if you’re going to cath lab, allif placing a stent, no fondaparinux NSTE-ACS, ischemia-guided enoxaparin, fondaparinux, UFH   Stop heparin after the intervention. Everyone with ACS gets dual anti-platelets for 12 […]

Congestive Heart Failure (CHF)

August 12, 2018 By Dr. G, PharmD

Stages of CHF: Stages of CHF NYHA Functional Class A High risk of heart failure but no structural disease or symptoms. none B Structural heart disease but without signs or symptoms of HF. I Asymptomatic HF. No limitations in physical activity caused by HF symptoms. C Structural heart disease with prior or current symptoms of […]

Atrial Fibrillation

August 12, 2018 By Dr. G, PharmD

CHA2DS2-VasC Scoring CHF or LVEF <40%   Points HTN 1 Age >=75 2 Diabetes 1 Stroke, TIA, thromboembolism 2 Vascular Disease 1 Age 65-74 years 1 Sex female 1 If score is: 0 – Don’t need ASA or oral anticoagulant (OAC) 1 – ASA 2+ – OAC CHA₂DS₂-VASc Score for Atrial Fibrillation Stroke Risk (another way […]

Anticoagulant Conversion Guide

August 12, 2018 By Dr. G, PharmD

Hypertensive Urgency and Emergencies (INC Aortic Dissection)

August 12, 2018 By Dr. G, PharmD

Hypertensive Urgency SBP >=180 or DBP >=110 No target organ damage Can lower over several hours or days.  May not even admit. Can use oral agents like captopril, clonidine, nifedipine or labetalol. Hypertensive Emergency SBP >=180 or DBP >=110 Target organ damage (vision, neuro, kidneys, heart, etc) Avoid sudden or drastic decrease in BP Always […]

Hypertension

August 12, 2018 By Dr. G, PharmD

Blood pressure goals: Pre: < 140 and <90 (lifestyle modifications) Stage 1 HTN 140-159 or 90-99 (lifestyle and medications) Stage 2 HTN > 160 or >100 (lifestyle and 2 meds) JNC 8 When to start treatment Goal >=60 years old >=150/90  <150/90 <60 years old >=140/90 <140/90 >=18 years old + DM or CKD >=140/90 […]

Beta-Blockers

August 12, 2018 By Dr. G, PharmD

  B1 Selective Blockers Non-Selective Blockers (B1 and B2) Mixed Blockers (Beta and alpha) Hydrophilic acebutolol, atenolol, bisoprolol (both), esmolol nadolol, pindolol, sotalol   Lipophilic bisoprolol (both), metoprolol, nebivolol propranolol carvedilol, labetalol Some points: Avoid mixed and non-selective agents in asthma.  Alpha blockade causes vasodilation, decreases peripheral resistance, and causes no reflex tachycardia. (acronym: Can Let No […]

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020