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BCACP > Cardiology I > Flashcards

Cardiology I Flashcards

1
Q

What are the serving sizes for 1 alcoholic drink?

A

-Wine: 5 oz
-Beer: 12 oz
-Distilled Spirits: 1.5 oz

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2
Q

What are contraindications to aspirin?

A

-Hypersensitivity or allergy
-History of intracranial bleeding or serious GI bleeding
-Severe kidney disease
-Severe hepatic disease

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3
Q

What patient population may benefit from aspirin for primary prevention according to the 2024 ADA guidelines?

A

-50 years + with at least one additional ASCVD risk factor
-Not at increased risk of bleeding (older age, renal disease, anemia)

-In general, not recommended for patients > 70 years

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4
Q

When should aspirin therapy for primary prevention be avoided or discontinued?

A

-Low ASCVD risk (< 7.5%)
-Higher bleeding risk
-Shorter duration of aspirin use (< 5 years)

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5
Q

What is the definition of Stage I HTN?

A

SBP 130-139
or
DBP 80-89

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6
Q

What is the definition of Stage II HTN?

A

SBP 140+
or
DBP 90+

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7
Q

What is the goal BP for all patients per the ACC/AHA guidelines?

A

< 130/80

(SBP < 130 for older adults)

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8
Q

What is the goal BP for patients w/ CKD not on dialysis per the KDIGO guidelines?

A

SBP < 120

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9
Q

How much sodium reduction is recommended for patients with HTN?

A

Goal of < 1500 mg/dL
(aim for at least a 1000 mg/day reduction)

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10
Q

What type of initial therapy is recommended for patients with Stage II HTN?

A

Combination therapy, especially if BP is > 20/10 above goal

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11
Q

When is medication therapy indicated for patients with Stage I HTN?

A

Clinical ASCVD, DM, CKD, or ASCVD risk > 10%

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12
Q

What is first-line HTN treatment for patients with history of renal transplant?

A

-DHP CCB
-ARB

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13
Q

What is first-line HTN treatment for patients with history of stroke?

A

-Thiazide
-ACE-I or ARB

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14
Q

What percentage increase in SCr is acceptable after ACE-I/ARB initiation?

A

< 30%

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15
Q

What class of BP medications can be used for Raynaud syndrome?

A

DHP CCB

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16
Q

What are contraindications to aldosterone antagonists?

A

-GFR < 30
-Potassium 5+

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17
Q

What intensity statin is indicated for secondary prevention?

A

High

(if > 75 and not at high risk, could consider moderate)

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18
Q

When are non-statin therapies considered for patients with established ASCVD but not very high risk?

A

-<50% reduction in LDL
-LDL 70 or greater on maximally tolerated statin
-Non-HDL 100 or greater on maximally tolerated statin

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19
Q

When are non-statin therapies considered for patients with established ASCVD and very high risk?

A

-<50% reduction in LDL
-LDL 55 or greater on maximally tolerated statin
-Non-HDL 85 or greater on maximally tolerated statin

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20
Q

What statin intensity is indicated for primary prevention in those 20-75 years old with LDL of 190 or greater?

A

High

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21
Q

When are non-statin therapies considered for patients with LDL of 190 or greater?

A

-<50% reduction in LDL
-LDL 100 or greater on maximally tolerated statin
-Non-HDL 130 or greater on maximally tolerated statin

22
Q

What statin intensity is indicated for primary prevention in those 20-39 years old with diabetes and LDL 70-189?

A

Moderate, if enhancers present:
-long duration of DM (T2DM > 10 years)
-albuminuria
-eGFR < 60
-retinopathy
-neuropathy
-ABI < 0.9

23
Q

What statin intensity is indicated for primary prevention in those 40-75 years old with diabetes and LDL 70-189?

A

If ASCVD risk < 7.5% AND no risk enhancers = Moderate

If ASCVD risk 7.5% or greater OR risk enhancers present = High

24
Q

What statin intensity is indicated for primary prevention in those 40-75 years old without DM or ASCVD and LDL 70-189?

A

ASCVD <5% = None

ASCVD 5-<7.5% = Moderate, if risk enhancers present
-family history of premature ASCVD
-persistently elevated LDL 160 or greater
-CKD
-metabolic syndrome
-inflammatory disease
-persistently elevated TG (175 or greater)

ASCVD >7.5-20% = Moderate, if risk enhancers present

ASCVD > 20% = High

25
Q

How should you interpret CAC scores to choose statin intensity doses?

A

0 = Hold statin therapy

1-99 and < 75th percentile = Moderate

100+ and > 75th percentile = Moderate-to-High

> 1000 = High

26
Q

What is the definition of very-high risk ASCVD?

A

Several major ASCVD events (recent ACS, history of MI, ischemic stroke, or symptomatic PAD)

OR

One major ASCVD event and several high-risk conditions
-Age 65+
-History of CABG or PCI
-DM
-HTN
-CKD
-Current smoking
-History of CHF

27
Q

Which treatment is recommended for moderate hyper-TG (175-499)?

A

If 40-75 years old and ASCVD is > 7.5% = statin

28
Q

Which treatment is recommended for severe hyper-TG (500+)?

A

If 40-75 years old and ASCVD is > 7.5% = statin

29
Q

Which treatment is recommended when TG > 1000?

A

Omega-3 fatty acids or fibrate therapy

30
Q

What is the definition of statin intolerance?

A

Unacceptable muscle-related symptoms that resolve with discontinuation of statin and occur with re-challenge on at least 2-3 statins

31
Q

Which medication should not be combined with a PCSK9 inhibitor?

A

Inclisiran (small interfering ribonucleic acid agent)

32
Q

What are contraindications to fenofibrate therapy?

A

-Significant renal or hepatic dysfunction
-Gallbladder disease
-Biliary cirrhosis

33
Q

What is a benefit of icosapent ethyl over other omega-3 prescriptions?

A

Does not contain DHA and will not increase LDL

34
Q

What are the 2017 AHA performance measures for MI?

A

-Aspirin prescribed at discharge
-P2Y12 receptor inhibitor prescribed at discharge
-Beta blocker prescribed at discharged
-High intensity statin prescribed at discharge
-ACE-I or ARB for those with LB systolic dysfunction

35
Q

How long should DAPT be continued for post-ACS?

A

6-12 months
(shorter duration if higher bleeding risk)

36
Q

Which P2Y12 inhibitors are preferred for those with NSTE-ACS who are treated with medical therapy alone?

A

-Ticagrelor
-Clopidogrel

37
Q

Which P2Y12 inhibitors are preferred for those with ACS treated with PCI?

A

-Ticagrelor
-Clopidogrel
-Prasugrel

38
Q

What are contraindications to prasugrel therapy?

A

-Prior stroke or TIA
->75 years old
-< 60 kg

39
Q

Which medication can be added to aspirin in those with CCD without an indication for DAPT or OAC who are at high ischemic/low bleed risk?

A

Rivaroxaban 2.5 mg BID

40
Q

When would triple antithrombotic therapy considered/appropriate?

A

Up to 30 days after PCI in those at high thrombotic risk and low bleed risk
-Previous MI
-Presence of CV risk factors
-Extensive CVD

41
Q

Which patients may see reduced effectiveness of clopidogrel?

A

Reduced-function CYP2C19*2

42
Q

Which commonly used medications can interfere with clopidogrel?

A

Omeprazole and esomeprazole
(uses pantoprazole)

43
Q

How long before an elective non-cardiac procedure does aspirin need to be held?

A

7 days (if clinically necessary)

44
Q

How long before an elective non-cardiac procedure does clopidogrel need to be held?

A

5 days

45
Q

How long before an elective non-cardiac procedure does ticagrelor need to be held?

A

3-5 days

46
Q

How long before an elective non-cardiac procedure does prasugrel need to be held?

A

7 days

47
Q

How long should DAPT be used following a stroke?

A

21-90 days

48
Q

What ABI is consistent with a diagnosis of PVD?

A

0.9 or less

49
Q

Which antiplatelet medications can be used in PVD?

A

-Aspirin
-Clopidogrel

50
Q

What medication is used in PVD to help improve symptoms of claudication and increase walking distance?

A

Cilostazol

BCACP (20 decks)

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