Step II Three questions if you've got a minute

[kedhegard]

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1. Is Step 2 adaptive (harder as you go if you're doing well)?


2. PTCA or tPA first for MI w/o contraindications?


3. Allcomers included...first line therapy for HTN? (I've read ACE-I's vs Lasix)


Thanks for any help. Just some stuff I can't seem to find a definite answer about.

 

[Gfunk6]

1. Is Step 2 adaptive (harder as you go if you're doing well)?


2. PTCA or tPA first for MI w/o contraindications?


3. Allcomers included...first line therapy for HTN? (I've read ACE-I's vs Lasix)


Thanks for any help. Just some stuff I can't seem to find a definite answer about.

1. No. There are some tweaks but adaptation isn't one of them.

2. MKSAP 2 says PTCA if you are in a major tertiary care center, otherwise tPA should be fine.

3. For isolated systolic HTN, consensus seems to be thiazide diuretics.

 

[md/mph'06]

1)Agreed
2)Agreed
3)Agreed

took step2ck 6/22. still waiting on scores...

1. Is Step 2 adaptive (harder as you go if you're doing well)?


2. PTCA or tPA first for MI w/o contraindications?


3. Allcomers included...first line therapy for HTN? (I've read ACE-I's vs Lasix)


Thanks for any help. Just some stuff I can't seem to find a definite answer about.

 

[eddoc]

3. Allcomers included...first line therapy for HTN? (I've read ACE-I's vs Lasix)

depends, if pt has DM, then ACE-I's are first line, if pt has a hx of prior MI, then beta blockers are tx of choice. for the most part, thiazides are first line, especially with no other co-morbidities.

 

[Espion]

3. Allcomers included...first line therapy for HTN? (I've read ACE-I's vs Lasix)

depends, if pt has DM, then ACE-I's are first line, if pt has a hx of prior MI, then beta blockers are tx of choice. for the most part, thiazides are first line, especially with no other co-morbidities.

Thiazides are also good if you have a little old lady with osteoporosis.

PTCA if at a tertiary center (or, apparently, within 30 minutes of one); just make sure you give the patient clopidogrel, ticlodipine or somesuch med (I've even seen abciximab) as well as the usual stuff.

If you have a diabetic you are considering for PTCA...go for the CABG. Restenosis rates are higher in diabetics.

And t-PA + IV heparin is better than either one alone (and beware the old man s/p intracranial hemorrhage...its amazing how well my brain skips over details like that when I'm reading a question the size of a novella).