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 […]
Guideline Materials and Tips
Anticoagulant Conversion Guide
Hypertensive Urgency and Emergencies (INC Aortic Dissection)
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
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
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 […]
AHA Lipid Guidelines
Risk Group Intensity of Therapy Desired LDL-C Lowering Moderate ASCVD Moderate Intensity Statin 30-50% Established ASCVD or DM + 10 year risk > 7.5% High-intensity statin >50% High-Intensity Statins atorvastatin – 40-80 mg rosuvastatin – 20-40 mg Moderate Intensity Statins atorvastatin – 10-20 mg rosuvastatin – 5-10 mg simvastatin – 20-40 mg pravastatin – 40-80 mg lovastatin […]
Unusual Cases of MI
Right MI Right MI is preload dependent, avoid nitro and morphine (both decrease preload) Early PCI is recommended unless liver or pulmonary failure or cancer, acute chest pain and low likelihood of ACS, patients who will not consent to revascularization. These patient patients should get ASA or clopidogrel or ticagrelor. Cocaine-Induced MI Acute cocaine use is […]
Pharmacoeconomic Studies
The easy thing is to memorize this chart and pick out the keywords from the questions. These are easy to get correct. Method: Cost-minimization Drugs are equal Only cost is considered. For example, choosing which ACEI goes on the formulary Cost-effectiveness Drugs are not equal, $$$ Looking at outcomes (decrease in BP, decrease in glucose). […]
Unsafe Abbreviations
Read through the ISMP’s Unsafe Abbreviation Guide. It’s more comprehensive than the Joint Commission’s and they overlap. Here are a few things you should know. You may use range orders according to your hospital protocol. PRN range orders must include a symptom. Pain PRN meds must include some type of scale. You shouldn’t have multiple […]
References to Know
There may be questions on the test about “where would you go to find [info]” or “Which online database would this study be found in.” The are easy to guess if you know at least what most databases contain and how often they are updated. Medline: Most of us know how Medline works, but: Know […]