Cardiology Risk Factors Flashcards
Mnemonic for Cardiac risk factors?
SAD-CHF
What does SAD CHF represent?
Smoking, Age, Diabetes, Cholesterol, HTN, Family History
List the Mnemoic for the venous cardiac risk factors?
D S H
What does D S H stand for in regards to Venous cardiac risk factors?
Damage to the extremity, Stasis, Hypercoagulable states. This is also known as Virchow’s triad
List the three main venous diseases
CVT, PE and Budd-Chiari Syndrome (venous thrombosis of the portal vein)
Differentiate primary and secondary prevention
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
What disease process is key in regards to secondary prevention?
Diabetes. Think of this is as equivalent to coronary artery disease. Thresholds for meds like statins and ACE’s are much lower
For purposes of the test, what is considered a normal BMI?
25 kg/m2 or less
For purposes of the test, what is considered overweight?
25-29 kg/m2
For purposes of the test, what is considered obese?
> 30 kg/m2
Based on 2020 guidelines on smoking cessation, what medication is recommended?
Varencicline for those ready to quit
A nicotine patch can be used with Varencicline T or f?
True
For a smoker who is not ready to quit, what medication might be considered?
Varencicline, This may reduce both cravings and tobacco use. Thus triggering quitting.
What is the duration now recommended for varencicline use?
More than 12 weeks
When is the peak of Nicotine withdrawal?
3 days and subside over 4 wks
Best way to quit smoking is…
combination of both CBT and pharmacotherapy (30% success rate over 6 months)
Name 3 first line pharmacotherapies for smoking cessation
Varencicline, Nicotine replacement, Buproprion
Buzzwords with Varencicline side effects
insomnia and abnormal dreams
Urine spec gravity in Diabetes insipidus
1.005 or less. Think ‘DI-lute’
Urine Spec gravity for DM
Concentrated… 1.035 or greater
Metabolic Syndrome is also known as…
Syndrome X or Insulin resistance Syndrome,. The pt makes insulin yet does not use it.
Mnemonic for the 5 markers needed to have metabolic syndrome
FAT Bro Heba
List the 5 markers for metabolic syndrome
- Fasting Blood glucose >100,
- ABD Obesity> 40 inches for a Male, 35 for female
- Triglycerides >150mg/dL
- BP> 130/86
- HDL< 40 in male and 50 in female
How many of the 5 markers are needed to set the dx of Metabolic syndrome?
three
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?
Pancreatitis
What ‘Robot’ is used to diagnose diabetes?
R2, F3
What are the R2 F3 criteria for DM?
- Random Blood Glucose >200 +symptoms (polyuria, polydipsia and vision changes.
- 2-hour GTT >200
- Fasting glucose >126 (x2)
- 3 Month HBA1C > 6.5%
In primary care, what is a good way to remember the systems we need to constantly monitor?
I heart beenie weenies (eyes, Heart, Kidneys and feet/toes)
What do we do for the eyes in DM prevention?
Annual dilated eye exams
What do we do for heart prevention in DM?
Aggressively manage RF, Cholesterol, smoking
What do we do for kidney prevention in DM?
ACE I
What do we do for feet kidney prevention in DM?
Annual neuropathy tests.
What is a cause of high sugars in the AM?
Did not have enough long acting insulin at night Dawn’s phenomenon. Increase medications
What is somogyi effect?
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
Describe treatment strategy for Somogyi
Back off the insulin because the insulin is causing a large reaction
List the three main antagonists to insulin and where they are manufactured
Glucagon: Pancreas; Cortisol: Andrenal, GH Pituitary
Describe DKA
Hyperglycemia with metabolic acidosis
What type of pt get’s DKA?
Only type I diabetics
What is the classic breathing pattern in DKA?
Kussmaul breathing with acetone breath
A quick way to remember metabolic acidosis is that
It has 3 up and 3 down
What is the 3 that are up in metabolic acidosis
Potassium, Anion Gap and Respiratory rate
What are the 3 that are down in metabolic acidosis?
PH, Bicarb and CO2
Mnemonic for treatment of DKA?
VEGA
What is the VEGA treatment for DKA?
Volume, Electrolyte replacement (K+) Glucose and Acidosis (last 3 treated with an insulin drip
For our purposes what 3 conditions cause metabolic acidosis?
Ketones, Uremia, Sepsis. Think KUS in kusmaul breathing
What will a dipstick UA show in someone with DKA?
Increased spec grav, Ketonuria and increase glucose
What is a ‘HONK-er
Hyperosmolar non ketotic state. Complication of Type II DM
Indications for pharmacotherapy in DM
At an A1C >7.5%. Always do lifestyle mods
What is the key side effect with Metformin?
GI
Metformin contraindicated in a pt with a GFR of <XX?
30
3 main classes of meds to treat DM
Sponge squeezers (secretagogues)
Ceiling meds Biguanides
Decrease reabsorption meds
List sponge squeezers Direct
Direct: Sulfonylureas and meglitinides
List sponge squeezers Indirect
Indirect: GLP-1 Mimics and DPP-4 blockers
Describe key features of Sulfonylureas and example meds
Think of it like taking oral insulin. Danger is increased lipids and hypoglycemia.
-Glyburide, glipizide and glimepiride
Describe key features of Meglitinides and example meds
Think of it like a short acting insulin.
-Taken at meal time.
- Less hypoglycemia
-repaglinide, nateglinide
Describe key features of GLP-1 Mimics and examples
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
Describe key features of DPP-4 blockers
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
Describe key features of biguianides ‘ceiling medications’ This is Metformin
-Does not lower blood sugar, just prevents it from getting too high.
What are the contraindications to using Metformin
Meet four men Kidney, Liver
List the CI for kidney for Metformin
GFR <30 and low perfusions risk (CHF, shock)
List the CI for Liver for Metformin
Concurrent or progressive liver disease
Alcohol use
Describe decreased absorbers and a neat way to remember
Alpha glucosidase inhibitors. “A car with Bose speakers’
Acarbose and miglitol
Describe SGLT-2 inhibitors
SGLT-2 absorbs sugar from our kidneys (about 90%). Sucks Glucose back’. My urine is ‘gaflozine with sugar’
pee out sugar
Comons SE of SGLT-2 inhibitors
Yeast infections, weakens bones, kidney problems
PROs and CONs Oral diabetic agents: Sulfonylureas
PRO: Rapidly effective. CON: Weight gain; hypoglycemia.
PROs and CONs Oral diabetic agents:
GLP-1 receptor agonist (daily to weekly injections)
PRO: Weight loss. reduction in major adverse cardiovascular events in pts with established CVD. CON: Requires injection, frequent GI side effects and expensive
PROs and CONs Oral diabetic agents: SGLT2 Inhibitors
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.
PROs and CONs Oral diabetic agents: DPP-4 inhibitor
PRO: weight neutral CON: Possible risk of HF with saxagliptin, expensive.
PROs and CONs Oral diabetic agents:
Alpha-Glucosidase inhibitor
PRO: Weight neutral CON: Frequent GI side effects. TID dosing
List the three ways to dx HTN
Asymptomatic, hypertensive urgency and hypertensive emergency
HTN: List the three categories of asymptomatic HTN (with numbers)
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
HTN: Define Hypertensive Emergency
SBP>180 or DBP>120 (No Symptoms)
HTN: Define Hypertensive Emergency
SBP>160 or >DBP >100 with known end organ damage (LVH, renal failure, retinopathy, CAD)
HTN: Lifestyle modifications. What are the recommended maximums for Salt and potassium intakes
Salt: 3.6 g/d
Potassium: 4.7 g/d
With regard to CV risk, what is the major determinant with regard to HTN
The degree of B/P reduction, not the choice of med.
HTN: List the initial recommendation for choice of med.
-Thiazide diuretics
-Long-acting CCB
-ACE or ARB
What are the indications for Beta blockers (Mnemonic first)
CHEM
CHEM for indications for BB in HTN
Cardiac: a.CHF b.rate control (fib/aflutter) c. Ischemia (post AMI and Angina pectoris)
H: Hyperthyroidism
E: Essential tremor
M:Migraine
Best way to remember 12 causes of secondary HTN
5, 4, 3 Starting in the head, trunk and abdomen
List 5 secondary HTN causes originating above the clavicles.
-Pseudotumor cerebri
-Sleep Apnea
-Thyroid
-Parathyroid
-Cushing’s.. steroids
List 4 secondary HTN causes mid body.
-Hyperaldosterinism
-pheochromoscytoma
-Renal Artery Stenosis
-Renal Disease
List the 3 secondary HTN causes in the bottom of the torso
-Pregnancy
-High estrogen
-coarctation
Key findings in pseudotumor cerebri
Sx:H/a and vision complaints. Dx: papilledema and CN VI palsy. Treated with Lasix/steroids
Cushing’s SSSSSyndrome is from:
Steroids
Cushing’s Disease is from:
aDenoma
List the triad of Hyperaldosteronism
-Hypertension
-Unexplained hypokalemia
-Metabolic acidosis
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
Hyperaldosteronism
Pheochromocytoma is a tumor of the _________________ tissue found in or out of the adrenal gland
Chromaffin
A key feature of pheochromocytoma is:
Paroxysmal hyper sympathetic states (palpations/HTN/HA/Anxiety)
PEARL what are the three most common iatrogenic causes of acute kidney injury?
- ACE inhibitors
- NSAIDS
- IV contrast
List the 3 forms of pregnancy induced hypertension.
-Pregnancy Induced Hypertension (PIH) after 20 wks. give methyldopa
-Pre-Eclampsia (Give magnesium, monitor reflexes)
-Eclampsia (Take the baby)
What anatomic defect is a significant RF for coarctation of the aorta?
Bicuspid aortic valve. buzzword is ‘berry’aneurysm
For HTN Emergency, how long do we have to lower the blood pressure? What about urgency?
-1 hour
-no time limit but do something
In treating HTN, what are the three major categories?
Diuretics, blocker and dilators
List the three major types of diuretics
Thiazides, Loop and K+ Sparing
Major side effect with Thiazides?
Think ‘SLUR’ (Sugar, Lipids, uric acid/renal)
Major side effects with loop diuretics?
Drops K+/Tinnitus
Major side effects with K+ diuretics?
Raises K+
List the ‘Dilator’ meds for HTN (5)
ACEI
ARB
Nitro
Hydrazaline
Minoxidil
SE from ACEI
Angioedema, cough/K+/renal strain. Another way ACEI (Angiodema, Cough, Electrolytes and intrinsic renal dz)
SE from ARB
Renal strain and K+
SE from Nitroglycerin
Hypotension/Avoid with ED meds
SE from hydrazaline
OK in pregnancy, can get lupus rash
List the blocker medications
-Alpha Blockers Central and peripheral
-Beta Blockers
-Calcium blockers
PEARL 3 things NSAIDS do that needs to consider.
- Mess with mucus membranes (can exacerbate ulcer, leading to perforation 2. constrict afferent blood vessels to the kidney by blocking prostaglandins
- decrease platelet and so contraindicated in anyone with blood thinners.
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?
Statins
What are the three major hyper-coagulable states?
-High estrogen (pregnancy/BCP/Hormone replacement)
-Cancer
-Genetics
