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PANRE-LA > Cardiology Risk Factors > Flashcards

Cardiology Risk Factors Flashcards

1
Q

Mnemonic for Cardiac risk factors?

A

SAD-CHF

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2
Q

What does SAD CHF represent?

A

Smoking, Age, Diabetes, Cholesterol, HTN, Family History

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3
Q

List the Mnemoic for the venous cardiac risk factors?

A

D S H

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4
Q

What does D S H stand for in regards to Venous cardiac risk factors?

A

Damage to the extremity, Stasis, Hypercoagulable states. This is also known as Virchow’s triad

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5
Q

List the three main venous diseases

A

CVT, PE and Budd-Chiari Syndrome (venous thrombosis of the portal vein)

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6
Q

Differentiate primary and secondary prevention

A

Primary Prevention: You don’t have the disease yet, but take precautions. Secondary. You’ve had an event or condition, and interventions that follow as a results. Think SABA for post MI

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7
Q

What disease process is key in regards to secondary prevention?

A

Diabetes. Think of this is as equivalent to coronary artery disease. Thresholds for meds like statins and ACE’s are much lower

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8
Q

For purposes of the test, what is considered a normal BMI?

A

25 kg/m2 or less

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9
Q

For purposes of the test, what is considered overweight?

A

25-29 kg/m2

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10
Q

For purposes of the test, what is considered obese?

A

> 30 kg/m2

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11
Q

Based on 2020 guidelines on smoking cessation, what medication is recommended?

A

Varencicline for those ready to quit

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12
Q

A nicotine patch can be used with Varencicline T or f?

A

True

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13
Q

For a smoker who is not ready to quit, what medication might be considered?

A

Varencicline, This may reduce both cravings and tobacco use. Thus triggering quitting.

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14
Q

What is the duration now recommended for varencicline use?

A

More than 12 weeks

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15
Q

When is the peak of Nicotine withdrawal?

A

3 days and subside over 4 wks

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16
Q

Best way to quit smoking is…

A

combination of both CBT and pharmacotherapy (30% success rate over 6 months)

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17
Q

Name 3 first line pharmacotherapies for smoking cessation

A

Varencicline, Nicotine replacement, Buproprion

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18
Q

Buzzwords with Varencicline side effects

A

insomnia and abnormal dreams

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19
Q

Urine spec gravity in Diabetes insipidus

A

1.005 or less. Think ‘DI-lute’

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20
Q

Urine Spec gravity for DM

A

Concentrated… 1.035 or greater

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21
Q

Metabolic Syndrome is also known as…

A

Syndrome X or Insulin resistance Syndrome,. The pt makes insulin yet does not use it.

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22
Q

Mnemonic for the 5 markers needed to have metabolic syndrome

A

FAT Bro Heba

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23
Q

List the 5 markers for metabolic syndrome

A
  1. Fasting Blood glucose >100,
  2. ABD Obesity> 40 inches for a Male, 35 for female
  3. Triglycerides >150mg/dL
  4. BP> 130/86
  5. HDL< 40 in male and 50 in female
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24
Q

How many of the 5 markers are needed to set the dx of Metabolic syndrome?

A

three

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25
Q

Pearl: Triglycerides are only significant to us not so much for heart disease as the effect is not really known. It’s significance is relevant to what other disease state?

A

Pancreatitis

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26
Q

What ‘Robot’ is used to diagnose diabetes?

A

R2, F3

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27
Q

What are the R2 F3 criteria for DM?

A
  1. Random Blood Glucose >200 +symptoms (polyuria, polydipsia and vision changes.
  2. 2-hour GTT >200
  3. Fasting glucose >126 (x2)
  4. 3 Month HBA1C > 6.5%
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28
Q

In primary care, what is a good way to remember the systems we need to constantly monitor?

A

I heart beenie weenies (eyes, Heart, Kidneys and feet/toes)

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29
Q

What do we do for the eyes in DM prevention?

A

Annual dilated eye exams

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30
Q

What do we do for heart prevention in DM?

A

Aggressively manage RF, Cholesterol, smoking

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31
Q

What do we do for kidney prevention in DM?

A

ACE I

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32
Q

What do we do for feet kidney prevention in DM?

A

Annual neuropathy tests.

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33
Q

What is a cause of high sugars in the AM?

A

Did not have enough long acting insulin at night Dawn’s phenomenon. Increase medications

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34
Q

What is somogyi effect?

A

After insulin administration, the body went crazy with it overnight and dropped the sugar really low. This causes a reflex effect where sugar goes way high in morning. think SIMOOOOOOGEE

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35
Q

Describe treatment strategy for Somogyi

A

Back off the insulin because the insulin is causing a large reaction

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36
Q

List the three main antagonists to insulin and where they are manufactured

A

Glucagon: Pancreas; Cortisol: Andrenal, GH Pituitary

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37
Q

Describe DKA

A

Hyperglycemia with metabolic acidosis

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38
Q

What type of pt get’s DKA?

A

Only type I diabetics

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39
Q

What is the classic breathing pattern in DKA?

A

Kussmaul breathing with acetone breath

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40
Q

A quick way to remember metabolic acidosis is that

A

It has 3 up and 3 down

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41
Q

What is the 3 that are up in metabolic acidosis

A

Potassium, Anion Gap and Respiratory rate

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42
Q

What are the 3 that are down in metabolic acidosis?

A

PH, Bicarb and CO2

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43
Q

Mnemonic for treatment of DKA?

A

VEGA

44
Q

What is the VEGA treatment for DKA?

A

Volume, Electrolyte replacement (K+) Glucose and Acidosis (last 3 treated with an insulin drip

45
Q

For our purposes what 3 conditions cause metabolic acidosis?

A

Ketones, Uremia, Sepsis. Think KUS in kusmaul breathing

46
Q

What will a dipstick UA show in someone with DKA?

A

Increased spec grav, Ketonuria and increase glucose

47
Q

What is a ‘HONK-er

A

Hyperosmolar non ketotic state. Complication of Type II DM

48
Q

Indications for pharmacotherapy in DM

A

At an A1C >7.5%. Always do lifestyle mods

49
Q

What is the key side effect with Metformin?

A

GI

50
Q

Metformin contraindicated in a pt with a GFR of <XX?

A

30

51
Q

3 main classes of meds to treat DM

A

Sponge squeezers (secretagogues)
Ceiling meds Biguanides
Decrease reabsorption meds

52
Q

List sponge squeezers Direct

A

Direct: Sulfonylureas and meglitinides

53
Q

List sponge squeezers Indirect

A

Indirect: GLP-1 Mimics and DPP-4 blockers

54
Q

Describe key features of Sulfonylureas and example meds

A

Think of it like taking oral insulin. Danger is increased lipids and hypoglycemia.
-Glyburide, glipizide and glimepiride

55
Q

Describe key features of Meglitinides and example meds

A

Think of it like a short acting insulin.
-Taken at meal time.
- Less hypoglycemia
-repaglinide, nateglinide

56
Q

Describe key features of GLP-1 Mimics and examples

A

GLP-1 mimics incretins which we usually make naturally to increase insulin production and decrease stomach motility.
- Exampels are ‘tides’ exenatide, liraglutide, lixesentide, albiglutide, dulaglutide

57
Q

Describe key features of DPP-4 blockers

A

DPP-4 is an enzyme that normally chews up GLP-1 and so a blocker helps by prolonging GLP-1 action.
-Januvia
sitagliptin
onglyza
saagliptin

58
Q

Describe key features of biguianides ‘ceiling medications’ This is Metformin

A

-Does not lower blood sugar, just prevents it from getting too high.

59
Q

What are the contraindications to using Metformin

A

Meet four men Kidney, Liver

60
Q

List the CI for kidney for Metformin

A

GFR <30 and low perfusions risk (CHF, shock)

61
Q

List the CI for Liver for Metformin

A

Concurrent or progressive liver disease
Alcohol use

62
Q

Describe decreased absorbers and a neat way to remember

A

Alpha glucosidase inhibitors. “A car with Bose speakers’
Acarbose and miglitol

63
Q

Describe SGLT-2 inhibitors

A

SGLT-2 absorbs sugar from our kidneys (about 90%). Sucks Glucose back’. My urine is ‘gaflozine with sugar’
pee out sugar

64
Q

Comons SE of SGLT-2 inhibitors

A

Yeast infections, weakens bones, kidney problems

65
Q

PROs and CONs Oral diabetic agents: Sulfonylureas

A

PRO: Rapidly effective. CON: Weight gain; hypoglycemia.

66
Q

PROs and CONs Oral diabetic agents:
GLP-1 receptor agonist (daily to weekly injections)

A

PRO: Weight loss. reduction in major adverse cardiovascular events in pts with established CVD. CON: Requires injection, frequent GI side effects and expensive

67
Q

PROs and CONs Oral diabetic agents: SGLT2 Inhibitors

A

PRO: Weight loss, reduction in systolic blood pressure, reduced CV mortality in CVD. Improved renal outcomes in nephropathy pts CON: Vaginal candidiasis, urinary tract infection, bone fracutures. lower limb amputations, acute kidney injury, DKA. Long term safety not established.

68
Q

PROs and CONs Oral diabetic agents: DPP-4 inhibitor

A

PRO: weight neutral CON: Possible risk of HF with saxagliptin, expensive.

69
Q

PROs and CONs Oral diabetic agents:
Alpha-Glucosidase inhibitor

A

PRO: Weight neutral CON: Frequent GI side effects. TID dosing

70
Q

List the three ways to dx HTN

A

Asymptomatic, hypertensive urgency and hypertensive emergency

71
Q

HTN: List the three categories of asymptomatic HTN (with numbers)

A

Elevated B/P: SBP 120-129 w/normal DBP
Stage I HTN: SBP 130-139 DBP 80-89
Stage II HTN: SBP >140 or DBP>90

72
Q

HTN: Define Hypertensive Emergency

A

SBP>180 or DBP>120 (No Symptoms)

73
Q

HTN: Define Hypertensive Emergency

A

SBP>160 or >DBP >100 with known end organ damage (LVH, renal failure, retinopathy, CAD)

74
Q

HTN: Lifestyle modifications. What are the recommended maximums for Salt and potassium intakes

A

Salt: 3.6 g/d
Potassium: 4.7 g/d

75
Q

With regard to CV risk, what is the major determinant with regard to HTN

A

The degree of B/P reduction, not the choice of med.

76
Q

HTN: List the initial recommendation for choice of med.

A

-Thiazide diuretics
-Long-acting CCB
-ACE or ARB

77
Q

What are the indications for Beta blockers (Mnemonic first)

A

CHEM

78
Q

CHEM for indications for BB in HTN

A

Cardiac: a.CHF b.rate control (fib/aflutter) c. Ischemia (post AMI and Angina pectoris)
H: Hyperthyroidism
E: Essential tremor
M:Migraine

79
Q

Best way to remember 12 causes of secondary HTN

A

5, 4, 3 Starting in the head, trunk and abdomen

80
Q

List 5 secondary HTN causes originating above the clavicles.

A

-Pseudotumor cerebri
-Sleep Apnea
-Thyroid
-Parathyroid
-Cushing’s.. steroids

81
Q

List 4 secondary HTN causes mid body.

A

-Hyperaldosterinism
-pheochromoscytoma
-Renal Artery Stenosis
-Renal Disease

82
Q

List the 3 secondary HTN causes in the bottom of the torso

A

-Pregnancy
-High estrogen
-coarctation

83
Q

Key findings in pseudotumor cerebri

A

Sx:H/a and vision complaints. Dx: papilledema and CN VI palsy. Treated with Lasix/steroids

84
Q

Cushing’s SSSSSyndrome is from:

A

Steroids

85
Q

Cushing’s Disease is from:

A

aDenoma

86
Q

List the triad of Hyperaldosteronism

A

-Hypertension
-Unexplained hypokalemia
-Metabolic acidosis

87
Q

What condition should the following types of patients be tested for even if normokalemic?
-Drug resistant HTN
-HTN with sleep apnea
-HTN with fib
-HTN and family hx of early onset HTN
-HTN with adrenal incidentaloma

A

Hyperaldosteronism

88
Q

Pheochromocytoma is a tumor of the _________________ tissue found in or out of the adrenal gland

A

Chromaffin

89
Q

A key feature of pheochromocytoma is:

A

Paroxysmal hyper sympathetic states (palpations/HTN/HA/Anxiety)

90
Q

PEARL what are the three most common iatrogenic causes of acute kidney injury?

A
  • ACE inhibitors
  • NSAIDS
  • IV contrast
91
Q

List the 3 forms of pregnancy induced hypertension.

A

-Pregnancy Induced Hypertension (PIH) after 20 wks. give methyldopa
-Pre-Eclampsia (Give magnesium, monitor reflexes)
-Eclampsia (Take the baby)

92
Q

What anatomic defect is a significant RF for coarctation of the aorta?

A

Bicuspid aortic valve. buzzword is ‘berry’aneurysm

93
Q

For HTN Emergency, how long do we have to lower the blood pressure? What about urgency?

A

-1 hour
-no time limit but do something

94
Q

In treating HTN, what are the three major categories?

A

Diuretics, blocker and dilators

95
Q

List the three major types of diuretics

A

Thiazides, Loop and K+ Sparing

96
Q

Major side effect with Thiazides?

A

Think ‘SLUR’ (Sugar, Lipids, uric acid/renal)

97
Q

Major side effects with loop diuretics?

A

Drops K+/Tinnitus

98
Q

Major side effects with K+ diuretics?

A

Raises K+

99
Q

List the ‘Dilator’ meds for HTN (5)

A

ACEI
ARB
Nitro
Hydrazaline
Minoxidil

100
Q

SE from ACEI

A

Angioedema, cough/K+/renal strain. Another way ACEI (Angiodema, Cough, Electrolytes and intrinsic renal dz)

101
Q

SE from ARB

A

Renal strain and K+

102
Q

SE from Nitroglycerin

A

Hypotension/Avoid with ED meds

103
Q

SE from hydrazaline

A

OK in pregnancy, can get lupus rash

104
Q

List the blocker medications

A

-Alpha Blockers Central and peripheral
-Beta Blockers
-Calcium blockers

105
Q

PEARL 3 things NSAIDS do that needs to consider.

A
  1. Mess with mucus membranes (can exacerbate ulcer, leading to perforation 2. constrict afferent blood vessels to the kidney by blocking prostaglandins
  2. decrease platelet and so contraindicated in anyone with blood thinners.
106
Q

Patients with known CAD/CVA and PAD, LDL levels >190 and Risky non diabetics (10 yr risk of greater that 7.5%) all can benefit from what class of medications?

A

Statins

107
Q

What are the three major hyper-coagulable states?

A

-High estrogen (pregnancy/BCP/Hormone replacement)
-Cancer
-Genetics

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