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CAD and HTN Flashcards

1
Q

Non-HDL Calculation

A

TC - HDL

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2
Q

Lipid panels

A

taken after 9-12 hour fast

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3
Q

Friedewald equation

A

LDL = TC - HDL - TG/5

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4
Q

When can you NOT use the Friedewald equation

A

when TG > 400 mg/dL

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5
Q

normal non-HDL

A

< 130

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6
Q

normal LDL

A

< 100

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7
Q

normal HDL for men and women

A

< 40 (men) & < 50 (women)

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8
Q

normal TG

A

< 150

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9
Q

drugs that increase LDL and TG

A
  • Diuretics
  • Efavirenz
  • Steroids
  • Immunosuppressants
  • Atypical antipsychotics
  • Protease inhibitors
    retinoids
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10
Q

drugs that increase LDL only

A
  • Fish oils (except vascepa)
  • Anabolic steroids
  • Fibrates
  • Progestins
    SGLT2 inhibitors
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11
Q

drugs that increase TG only

A
  • IV lipid emulsions
  • Propofol
  • Bile acid sequestrants
  • Estrogen
  • Tamoxifen
  • Clevidipine
    betablockers
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12
Q

conditions that raise LDL and/or TG

A

Obesity, poor diet, hypothyroidism, alcoholism, smoking, diabetes, renal/liver disease, nephrotic syndrome
Pregnancy, PCOS, anorexia

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13
Q

when is ASCVD not needed to be calculated

A

patients with clinical ASCVD, diabetes, or LDL > 190

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14
Q

Red yeast rice

A

naturally occurring, HMG-CoA reductase inhibitor

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15
Q

Which statin should be given for secondary prevention in those with clinical ASCVD

A

high intensity (if patient > 75 and LDL is 70-189 mg/dL can consider moderate)

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16
Q

Which statin should be given for primary prevention in those with primary elevation of LDL > 190 mg/dL

A

high intensity

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17
Q

Which statin should be given for primary prevention in those with diabetes and are 40-75 years with LDL between 70-189 & multiple ASCVD risk factors

A

high intensity

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18
Q

Which statin should be given for primary prevention in those with diabetes and are 40-75 years with LDL between 70-189 with regardless of 10 year ASCVD risk

A

moderate intensity

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19
Q

Which statin should be given for primary prevention in those 40-75 years with LDL between 70-189 & have 10-year ASVCD risk > 20%

A

high intensity

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20
Q

Which statin should be given for primary prevention in those 40-75 years with LDL between 70-189 & have 10 year ASCVD risk 7.5-19.9% + risk enhancing factors

A

moderate intensity

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21
Q

high intensity statins

A

atorvastatin 40-80 & rosuvastatin 20-40

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22
Q

Equivalent statin doses: Pharmacists Rock At Saving Lives and Preventing Fatty deposits

A

*pitavastatin 2 mg
*Rosuvastatin 5 mg
*atorvastatin 10 mg
*simvastatin 20 mg
*lovastatin 40 mg
*pravastatin 40 mg
*fluvastatin 80 mg

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23
Q

managing myalgias with statins: reduce the risk

A

avoid drug interactions, including OTC products; do not use simvastatin 80 mg/day; do not use gemfibrozil + statin

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24
Q

managing myalgias with statins: managing myalgias

A

*hold statin, check CPK, investigate other possible causes
*after 2-4 weeks: re-challenge with the same statin or decrease dose.
*if myalgias return, discontinue statin. Once muscle symptoms resolve, use a low dose of a different statin and gradually increase dose

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25
Q

MMR

A

myalgias, myopathy, myositis, rhabdomyolysis

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26
Q

amlodipine and atorvastatin, lovastatin, simvastatin

A

can increase concentration (max 20 mg/day)

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27
Q

Statin drug interactions: G PACMAN

A

grapefruit, protease inhibitors, azole antifungals, cyclosporine & cobicistat, macrolides (not azithromycin), amiodarone, Non-DHP CCBs

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28
Q

Grapefruit, protease inhibitors, azole antifungals, cyclosporine, cobicistat, macrolides (except azithromycin)

A

do not use with simvastatin or lovastatin

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29
Q

max daily dose of simvastatin and lovastatin with amiodarone

A

20 mg & 40 mg

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30
Q

max daily dose of simvastatin and lovastatin with non-DHP CCB

A

10 mg & 20 mg

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31
Q

PCSK9 & PCSK9 inhibitors

A

increases LDL receptor degradation
block the ability of PCSK9 to bind to the LDL receptor

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32
Q

Ezetimibe

A

Zetia - inhibits absorption of cholesterol in the small intestine

33
Q

Bile acid sequestrants

A

bind bile acids in the intestine, forming a complex that is excreted in the feces. Results in partial removal of the bile acids from the enterohepatic circulation, preventing their reabsorption

34
Q

HTN stage 1

A

130-139 or 80-90

35
Q

HTN stage 2

A

> 140 or >90

36
Q

Drugs that increase HTN

A

Amphetamine and ADHD drugs, cocaine, decongestants (pseudoephedrine, phenylephrine), erythropoiesis-stimulating agents, immunosuppressants (cyclosporine), NSAIDs, systemic corticosteroids

37
Q

Natural products that reduce blood pressure

A

garlic, fish oil, coenzyme Q10, L-arginine

38
Q

When to start HTN treatment

A
  • stage 2 HTN
  • stage 1 HTN and:
    clinical CVD, 10 year ASCVD risk > 10%, does not meet BP goal after 6 months of lifestyle
39
Q

BP goal for patients on HTN tx

A

< 130/80 mmHg

40
Q

HTN drug selection: non-black patients

A

thiazide, DHP, CCB, ACEi or ARB

41
Q

HTN drug selection: black

A

thiazide or DHP CCB

42
Q

HTN drug selection: CKD (all days)

A

ACEi or ARB (to slow progression to ESRD)

43
Q

HTN drug selection: diabetes with albuminuria

A

ACEi or ARB

44
Q

HTN drug selection: diabetes with CAD

A

ACEi or ARB

45
Q

Which HTN drugs have a boxed warning for fetal toxicity?

A

ACEi, ARB, and aliskiren

46
Q

in pregnant patients with chronic HTN when should they receive drug treatment

A

> 160/>105

47
Q

which drugs are recommended for HTN in pregnant patients

A

labetolol and nifedipine XL (sometimes methyldopa but may be less effective at lowering BP)

48
Q

Thiazide diuretics

A

inhibit sodium reabsorption in the DCT causing an increased excretion of sodium, chloride, water, and potassium

49
Q

thiazide diuretic safety

A
  • contraindicated in those with an allergy to sulfa drugs
  • decreased K, Mg, Na
    -increase Ca, UA, LDL, TG, BG
  • photosensitivity and impotence
    -not effective when CrCl < 30 mL/min
50
Q

DHP CCB

A

inhibit ca ions from entering vascular smooth muscle and myocardial cells causing peripheral arterial vasodilation (decrease SVR and BP)

51
Q

common side effects of DHP CCB

A

reflex tachycardia/palpitations, headaches, flushing, peripheral edema
-gingival hyperplasia

52
Q

Nifedipine IR

A

do not use for chronic hypertension or acute BP reduction in non-pregnant adults (profound hypotension, MI and/or death)

53
Q

clevidipine (cleviprex) - HTN

A

lipid emulsion (provides 2 kcal/mL)
-do not use in those with allergy to soybeans, soy products or eggs

54
Q

non-DHP CCB

A

inhibit ca ions from entering vascular smooth muscle and myocardial cells but are more elective for myocardium than the DHP CCBs
-BP effect is due to negative inotropic and negative chronotropic effects

55
Q

Diltiazem and Verapamil

A
  • may worsen heart failure and bradycardia
  • common side effects: edema, constipation, gingival hyperplasia
    -IV:PO dose conversions are not 1:1
56
Q

all CCBs are

A

major substrates of CYP3A4
-no grapefruit juice
-use lower doses of simvastatin or lovastatin with non-DHP CCB

57
Q

ACEi

A

block the conversion of ANG I to ANG II resulting in decreased vasoconstriction and decreased aldosterone secretion. The blocking of degradation of bradykinin - is thought to contribute to the vasodilatory effects

58
Q

ACEi safety

A
  • fetal toxicity
  • do not use with history of angioedema
  • do not use within 36 hours of entresto
  • hyperkalemia, hypotension, renal impairment, increased SCr
59
Q

ARBs

A

block ANG II from binding to the angiotensin II type-1 receptor on vascular smooth muscle preventing vasoconstriction

60
Q

ARB safety

A

no wash out period needed with entresto
-olmesartan sprue-like enteropathy

61
Q

direct renin inhibitor

A

aliskiren - do not use with ACEis or ARBs in patients with diabetes

62
Q

spironolactone

A

non-selective aldosterone receptor antagonist (potassium-sparing)

63
Q

eplerenone

A

a selective aldosterone receptor antagonist that does no exhibit endocrine side effects

64
Q

potassium-sparing diuretic safety

A

-hyperkalemia, increased SCr, dizziness
-spironolactone: gynecomastia, breast tenderness, impotence

65
Q

beta-blockers with intrinsic sympathomimetic activity

A

acebutolol, penbutolol, and pindolol

66
Q

beta-1 selective blockers

A
  • do not discontinue abruptly
  • can worsen hyperglycemia and mask hypoglycemia
  • use caution in those with bronchospastic disease (beta-1 are preferred)
  • lopressor and toprol xl are the only ones that should be taken with food
67
Q

metoprolol tartrate IV to PO ratio

68
Q

beta-1 selective blocker with NO

69
Q

propranolol (Inderal LA, Inderal XL)

A

has high lipid solubility and crosses BBB (more CNS side effects) and makes it useful for certain conditions (migraine ppx, tremor)

70
Q

Non-selective Beta-1 and Beta-2 blockers

A

used in portal HTN

71
Q

why do you need to take carvedilol with food

A

decrease the rate of absorption and the risk of orthostatic hypotension

72
Q

centrally acting alpha-2 adrenergic agonists

A

methyldopa, clonidine, and guanfacine

73
Q

contraindications to methyldopa

A

concurrent use of MAOi

74
Q

why can you not abruptly stop a2 adrenergic agonists

A

rebound HTN

75
Q

warnings for methyldopa

A

hemolytic anemia

76
Q

common side effects of a2 adrenergic agonists

A

dry mouth, somnolence, fatigue, dizziness, constipation, decreased HR, hypotension, impotence

77
Q

methyldopa

78
Q

hydralazine

A

DILE
-peripheral edema, headache, flushing, palpitations, reflex tachycardia

79
Q

minoxidil

A

potent antihypertensive
-fluid retention, tachycardia, hair growth

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