Cardiology I Flashcards
What are the serving sizes for 1 alcoholic drink?
-Wine: 5 oz
-Beer: 12 oz
-Distilled Spirits: 1.5 oz
What are contraindications to aspirin?
-Hypersensitivity or allergy
-History of intracranial bleeding or serious GI bleeding
-Severe kidney disease
-Severe hepatic disease
What patient population may benefit from aspirin for primary prevention according to the 2024 ADA guidelines?
-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
When should aspirin therapy for primary prevention be avoided or discontinued?
-Low ASCVD risk (< 7.5%)
-Higher bleeding risk
-Shorter duration of aspirin use (< 5 years)
What is the definition of Stage I HTN?
SBP 130-139
or
DBP 80-89
What is the definition of Stage II HTN?
SBP 140+
or
DBP 90+
What is the goal BP for all patients per the ACC/AHA guidelines?
< 130/80
(SBP < 130 for older adults)
What is the goal BP for patients w/ CKD not on dialysis per the KDIGO guidelines?
SBP < 120
How much sodium reduction is recommended for patients with HTN?
Goal of < 1500 mg/dL
(aim for at least a 1000 mg/day reduction)
What type of initial therapy is recommended for patients with Stage II HTN?
Combination therapy, especially if BP is > 20/10 above goal
When is medication therapy indicated for patients with Stage I HTN?
Clinical ASCVD, DM, CKD, or ASCVD risk > 10%
What is first-line HTN treatment for patients with history of renal transplant?
-DHP CCB
-ARB
What is first-line HTN treatment for patients with history of stroke?
-Thiazide
-ACE-I or ARB
What percentage increase in SCr is acceptable after ACE-I/ARB initiation?
< 30%
What class of BP medications can be used for Raynaud syndrome?
DHP CCB
What are contraindications to aldosterone antagonists?
-GFR < 30
-Potassium 5+
What intensity statin is indicated for secondary prevention?
High
(if > 75 and not at high risk, could consider moderate)
When are non-statin therapies considered for patients with established ASCVD but not very high risk?
-<50% reduction in LDL
-LDL 70 or greater on maximally tolerated statin
-Non-HDL 100 or greater on maximally tolerated statin
When are non-statin therapies considered for patients with established ASCVD and very high risk?
-<50% reduction in LDL
-LDL 55 or greater on maximally tolerated statin
-Non-HDL 85 or greater on maximally tolerated statin
What statin intensity is indicated for primary prevention in those 20-75 years old with LDL of 190 or greater?
High
When are non-statin therapies considered for patients with LDL of 190 or greater?
-<50% reduction in LDL
-LDL 100 or greater on maximally tolerated statin
-Non-HDL 130 or greater on maximally tolerated statin
What statin intensity is indicated for primary prevention in those 20-39 years old with diabetes and LDL 70-189?
Moderate, if enhancers present:
-long duration of DM (T2DM > 10 years)
-albuminuria
-eGFR < 60
-retinopathy
-neuropathy
-ABI < 0.9
What statin intensity is indicated for primary prevention in those 40-75 years old with diabetes and LDL 70-189?
If ASCVD risk < 7.5% AND no risk enhancers = Moderate
If ASCVD risk 7.5% or greater OR risk enhancers present = High
What statin intensity is indicated for primary prevention in those 40-75 years old without DM or ASCVD and LDL 70-189?
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
How should you interpret CAC scores to choose statin intensity doses?
0 = Hold statin therapy
1-99 and < 75th percentile = Moderate
100+ and > 75th percentile = Moderate-to-High
> 1000 = High
What is the definition of very-high risk ASCVD?
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
Which treatment is recommended for moderate hyper-TG (175-499)?
If 40-75 years old and ASCVD is > 7.5% = statin
Which treatment is recommended for severe hyper-TG (500+)?
If 40-75 years old and ASCVD is > 7.5% = statin
Which treatment is recommended when TG > 1000?
Omega-3 fatty acids or fibrate therapy
What is the definition of statin intolerance?
Unacceptable muscle-related symptoms that resolve with discontinuation of statin and occur with re-challenge on at least 2-3 statins
Which medication should not be combined with a PCSK9 inhibitor?
Inclisiran (small interfering ribonucleic acid agent)
What are contraindications to fenofibrate therapy?
-Significant renal or hepatic dysfunction
-Gallbladder disease
-Biliary cirrhosis
What is a benefit of icosapent ethyl over other omega-3 prescriptions?
Does not contain DHA and will not increase LDL
What are the 2017 AHA performance measures for MI?
-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
How long should DAPT be continued for post-ACS?
6-12 months
(shorter duration if higher bleeding risk)
Which P2Y12 inhibitors are preferred for those with NSTE-ACS who are treated with medical therapy alone?
-Ticagrelor
-Clopidogrel
Which P2Y12 inhibitors are preferred for those with ACS treated with PCI?
-Ticagrelor
-Clopidogrel
-Prasugrel
What are contraindications to prasugrel therapy?
-Prior stroke or TIA
->75 years old
-< 60 kg
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?
Rivaroxaban 2.5 mg BID
When would triple antithrombotic therapy considered/appropriate?
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
Which patients may see reduced effectiveness of clopidogrel?
Reduced-function CYP2C19*2
Which commonly used medications can interfere with clopidogrel?
Omeprazole and esomeprazole
(uses pantoprazole)
How long before an elective non-cardiac procedure does aspirin need to be held?
7 days (if clinically necessary)
How long before an elective non-cardiac procedure does clopidogrel need to be held?
5 days
How long before an elective non-cardiac procedure does ticagrelor need to be held?
3-5 days
How long before an elective non-cardiac procedure does prasugrel need to be held?
7 days
How long should DAPT be used following a stroke?
21-90 days
What ABI is consistent with a diagnosis of PVD?
0.9 or less
Which antiplatelet medications can be used in PVD?
-Aspirin
-Clopidogrel
What medication is used in PVD to help improve symptoms of claudication and increase walking distance?
Cilostazol