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Thera > Cardiology part 1 > Flashcards

Cardiology part 1 Flashcards

1
Q

What is percentage is low risk, intermediate risk, and high risk on the framingham score?

A

low risk = less than 10%
intermediate risk = LESS than 20%
high risk = above 20%

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2
Q

When would you start a statin in an individual who is in the LOW risk framingham group?

A
  1. if their LDL-C is > 5.0
  2. if they score 5%-9.9% and their LDL-C is 3.5> AND family history of premature CAD
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3
Q

when would you start a statin the intermediate risk group on the framingham score (10%-19.9%)

A
  1. LDL-C is >3.5
  2. Men > 50 with one risk factor ( low HDL, tobacco, HTN, high waist circumference)
  3. Women greater than 60 with one risk factor mentioned above
  4. Anyone in this group that has family history of premature CAD
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4
Q

When would you start a statin in a high risk framingham score group ( greater than 20%)

A

everyone in this group gets started on statins

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5
Q

When would you consider add on therapy for dyslipidemia?

A

After starting statin therapy if a patient still has an LDL-c above 2.0 OR they did not obtain a 50% reduction in their initial LDL level then you would consider starting an add on therapy

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6
Q

when treating HTN in a DM patient WITH nephropathy what are your first line meds?

A

ACE inhibitor
ARB

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7
Q

when treating HTN in a DM pt that does NOT have nephropathy what are your first lines?

A

ACE-I
ARB
Thiazide
LA-CCB

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8
Q

when treating a patient with CAD that has HTN what are your first line?

A

ACE - I
ARB

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9
Q

when treating HTN in a patient with stable angina what are your first line

A

B-Blockers
LA-CCB

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10
Q

when treating HTN in patient with CHF what are your first line medications?

A

ACE-I OR ARB AND B-blocker +/- diuretic

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11
Q

What medications are used to improve symptoms of angina and quality of life?

A

nitrates
B-blockers
Calcium channel blockers -> non DHP

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12
Q

what are the side effects of nitrates?

A

headaches (usually resolves if the patient persists with therapy)

Tachycardia

Hypotension

not often first line due to saftey profile

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13
Q

what are the side effects of b-blockers?

A

fatigue
hypotension
bradycardia

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14
Q

what are the side effects of CCB non DHP

A

headache, dizziness, bradycardia, heartblock

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15
Q

List the medications used for secondary prevention of ACS first line

A

ASA + clopidogrel X3-12 months then asprin alone

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16
Q

when would prasugrel and Ticagrelor be used and what are they?

A

anti-platelet/ clotting medications

They are often used in hospital in combination with ASA for patients with acute coronary syndrome who have had a percutaneous coronary intervention (PCI)

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17
Q

What are the side effect of Dipyridamole/ASA

A

This medication is used to treat CVA in secondary prevention and the side effects are bleeding, headache, and diarrhea

individuals are more likley to stop taking this medication over 5 years compared to asprin

more expensive, less likley to be used.

18
Q

In an individual with NO CV risk factors (low risk group) when would you consider starting antihypertension medication?

what are you BP target range

A

if systolic is greater than 160 and diastolic is greater than 100

The target is less than 140/90

19
Q

for patients with diabetes when would you consider starting antihypertensive medication? and what are the BP goals with treatment

A

bp greater than 130/80

and the goal of therapy is to have less than 130/80

20
Q

When performing an OBPM (office blood pressure measurement with provider in the room can be electric) at what number would you be concerned for hypertension?

A

if OBPM is measured at 140/90 or greater than you need to perform Ambulatory Blood Pressure Monitoring (ABPM wears device for 24 hr period) or Home blood pressure monitoring (self monitors twice. daily)

OR if the AOBP is greater than 135/80 (this is where the provider leaves the room while BP is being measured)

if the mean is greater than 135/80 then you may diagnose the patient with HTN

remember you wouldnt start medication unless they were 160/100 OR have risk factors like DM

21
Q

When treating hypertension based on a patient’s illness when would you use Diuretics and list them

A

Diuretics would be used as first line in patients who have diabetes with no kidney issues OR in individuals with Cerebral vascular accident hx like a stroke OR to as combo therapy to treat CHF

with CVA hx you would combine Thiazide with ACE-I

examples include: Thiazide (hydrochlorothiazide) , chlorthalidone, indapamide, spironolactone

22
Q

Patients who have HTN and hx of CVA (stroke) what first line meds would you start them on?

A

combo ACE-i and Diuretic (thiazide)

23
Q

in which comorbidities are ACE-Inhibitors used as first line to treat HTN?

A
  1. DM with or without kidney issues
  2. Coronary Artery Disease (heart injury due to cholesterol build up)
  3. Prior- MI
  4. CHF (with b-blocker, and maybe diuretic)
  5. CVA (with thiazide)
24
Q

in which comorbidities are ARB used as first line to treat HTN?

A
  1. DM w/without kidney issues
  2. CAD
  3. CHF
  4. CVA

** note the difference is that it wouldn’t be first line to treat prior MI that would be ACE

25
Q

in which comorbidities are Beta-blockers used as first line to treat HTN?

A

Patients less than 60
Stable angina
Prior- MI

26
Q

in which comorbidities are Long acting- CCB used as first line to treat HTN?

A
  1. DM without nephropathy
  2. Stable Angina
27
Q

what are some examples of ACE-I

A

meds that end in “pril”

Ramipril

28
Q

what are some examples of ARBs?

A

meds that end in “TAN”

valsrtan

29
Q

what are some examples of long acting calcium channel blockers?

A

meds that end in PINE

amlodiPINE
FelodiPINE

30
Q

what are some examples of beta blockers?

A

meds that end in OLOL

31
Q

what medication has a side effect of cough?

A

ACE-Inhibitors these are used to treat HTN and end in PRIL

32
Q

What HTN medications can cause hyperkalemia and hypokalemia?

A

Hyperkalemia ACE-i and ARB

hypo - Thiazide

33
Q

what HTN medication would you try to avoid in someone who has ashtma?

A

Betablockers as it can cause bronchoconstriction

34
Q

What is the drug of choice for secondary stroke prevention ?

A

Antiplatlet agents = ASA

35
Q

when would you use the antiplatlet clipidogrel over ASA for secondary prevention of stroke/TIA?

A

generally first line ASA, and you may use clipidogrel if patient has allergy to ASA

You may combine both ONLY in the acute setting 21-30 days, NOT in long term!

36
Q

Why is Dipryidamole/ASA used as a second line option for secondary prevention of stroke/TIA

A

DIpryidamole/asa antiplatlets are technically superior to just ASA but it has to be taken twice daily and it causes headaches

therefore patients are les compliant on this medication compared to ASA

37
Q

when would you choose antiplatlet over anticoagulants for secondary prevention of stroke?

A

it depends on the etiology of the stroke

if the stroke is cardioembolic (MI, Cardiac valve problems, arrythmia, a fib, prosthetic cardiac valves) then you would select anticoagulant

if the stroke is not related to a cardiac specific issue listed above you would select antiplatlet

38
Q

secondary stroke prevention during pregnancy

A

warfarin (anticoagulant) is teratogenic so avoid

first choice anticoagulant would be: low molecular weight heparin

First choice antipatlet: ASA low dose

39
Q

how often/when is dyslipidemia screened for?

A

every five years for individuals older than 40 OR anyone with risk factors

40
Q

how often do you screen for diabetes?

A

anyone greater than 40 done every 3 years OR those with risk factors can be done earlier

41
Q

Would you use compression stocking in an individual with pre-existing peripheral vascular disease?

A

no it is not appropriate

Thera (6 decks)

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