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Cardiovascular > Clinical Questions > Flashcards

Clinical Questions Flashcards

1
Q

What is the desirable LDL level?

A

< 100

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2
Q

What is the desirable HDL level?

A

Men >/= 40
Women >/= 50

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3
Q

What is the desirable TG level?

A

< 150

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4
Q

What medications increase LDL and TG?

A

Diuretics
Efavirenz
Steroids
Cyclosporine/Tacrolimus
Atypical antipsychotics (Metabolic syndrome! Olanzapine and Quetiapine)
Protease inhibitors

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5
Q

What medications increase LDL only?

A

Fish oil

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6
Q

What medications increase TG only?

A

Propofol
IV lipid emulsions
Bile acid sequestrants

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7
Q

What natural supplements help lower TG or chosterol?

A

Red yeast rice can naturally lower cholesterol

OTC fish oil can lower TG (increases LDL)

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8
Q

A 43 year old male patient with diabetes has and LDL of 90 mg/dL. We do not his ASVCD risk, but he is a non-smoker and has no other comorbidities besides his hypertension, diabetes, and hyperlipidemia. What would be your recommendation to help lower his LDL?

A

Moderate intensity statin.
Rosuvastatin 10 mg
Atorvstatin 20 mg
Simvastatin (Zocor) 20 mg
Lovastatin (Altoprev) 40 mg
Pravastatin (Pravachol) 80 mg

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9
Q

A 74 yo patient comes in with lab results:
LDL 85
HDL 38
TG 130
His ASCVD risk is 10%. What would you treatment recommendation be?

A

Moderate intensity statin
Rosuvastatin 10 mg
Atorvstatin 20 mg
Simvastatin (Zocor) 20 mg
Lovastatin (Altoprev) 40 mg
Pravastatin (Pravachol) 80 mg

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10
Q

A 65 yo female patient comes in with labs:
LDL 120
HDL 32
TG 160
PMH: smoker, COPD, HTN, Obsesity,

Her ASVCD risk is 15%.

What treatment would you recommend?

What if her ASVCD was 21% then what would you recommend?

A

Moderate intensity

ASCVD > 20% recommend High intensity statin:
Rosuvastatin 20 mg
Atorvastatin 40 mg

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11
Q

What LDL level would indicate immediate treatment of high intensity statin?

A

> /= 190

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12
Q

At what age in diabetic patients do you start to consider statin therapy?

A

40 years old

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13
Q

What is the statin equivalent doses?

A

Pitavastatin 2 mg
Rosuvastatin 5 mg
Atorvastatin 10 mg
Simvastatin 20 mg
Lovastatin 40 mg
Pravastatin 40 mg
Fluvastatin 80 mg

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14
Q

A patient is on Simvastatin 40 mg, but can no longer be on it due to drug interaction with Pacerone. What would be the dose equivalent of Rosuvastatin or Atorvastatin? What intensity are these?

A

Rosuvastatin 10 mg
Atorvastatin 20 mg

Medium intensity

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15
Q

How much of a decrease in LDL do you expect with statin therapy?

A

20 - 55%

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16
Q

A 55 yo patient has HLD. He is currently on Pravachol 80 mg. His PMH includes: Obesity, HTN. His LDL today is 150. What would your recommendation be?

After 3 months on your recommendation, his LDL is still 120.

A

Increase to a high intensity statin

Add Ezetimibe

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17
Q

A patient is on Crestor 40 mg daily and Zetia 10 mg daily for primary hypercholesterolemia. During follow-up the LDL was 110 mg/dL. What would be your next recommendation?

A

Add PSK9 inhibitor
- Alirocumab (Praluent)
-Evolocumab (Repatha)

18
Q

A patient is taking Cardizem, Prilosec, Zetia, and Zocor. What drug interaction do you need to watch out for? What are to dosing recommendations?

A

Cardizem (Diltiazem) and Zocor (Simvastatin)

CYP3A4 inhibitor with substrate

MAX Simvastatin dose is 10 mg/day (lova 20 mg/day)

19
Q

A patient is taking Pacerone, Naproxen, Zetia, and Zocor. What drug interaction do you need to watch out for? What are to dosing recommendations?

A

Pacerone (amiodarone) and Zocor (Simvastatin

CYP3A4 inhibitor with substrate

MAX simvastatin dose is 20 mg/day (Lova 40 mg/day)

20
Q

When are fish oils indicated?

A

adjunct to diet when TG are >/= 500

*** Vascepa is indicated in high risk (ASCVD) diabetic patients when TG are 150 - 499

21
Q

What treatment for high TG can prolong the bleeding time when use in combination with warfarin?

A

Fish oils - Lovaza and Vascepa

22
Q

What formulation of Niacin is the best?

A

Niaspan

decreased flushing and hepatotoxicity!!!

23
Q

What do all 3 formulations of Niacin need to be taken with?

A

FOOD

**take Niaspan with a low fat snack at bedtime

24
Q

What natural supplements may help at lowering BP?

A

Fish oil
Coenzyme Q10
L-arginine
garlic

25
Q

When do you START treatment for HTN?

A

Stage 2
>/= 140 / >/= 90

or
Stge 1
130 - 139 / 80 - 89
PLUS
- clinical CVD (stroke, HF, or CAD)
- ASCVD >/= 10
- does not meet BP goal after 6 months of lifestyle modifications

26
Q

What are the first line therapies for HTN?

A

ACEis
ARBs
DHP CCBs
Thiazide diuretics

27
Q

What is the BP goal in HTN?

A

< 130/80

28
Q

What is the first line HTN treatment in black patients?

A

Thiazide or DHP CCB

*** have less renin for ACE/ARB to be as effective

29
Q

When should you IMMEDIATELY start 2 HTN drug therapy?

A

when BP > 150/90

30
Q

What HTN medications should you NOT use in pregnancy?

A

ACE/ARB/ alkiskiren

preferred medications include:
- labetalol
- nifedipine

31
Q

What is considered hypertensive emergency?

A

ACUTE TARGET ORGAN DAMAGE with high blood pressure

> /= 180/120

32
Q

What is the BP goal when a patient is in hypertensive emergency?

A

decrease BP by 25% within first hour than stabilize BP to less than 160/100 in 2-6 hours

33
Q

What medications may be used in hypertensive emergency?

A

Chlorothiazide
Clevidipine
Diltiazem
Enalaprilat
Esmolol (Brevibloc)
Hydralazine
Labetalol
Metoprolol tartrate
Nicardipine (Cardine IV)
Nitroglycerin
Nitroprusside
Propanolol
Verapamil (Calan)

34
Q

What beta blocker must be taken with food?

A

Coreg!

35
Q

ACC/AHA stage of heart failure

A

A - risk of developing heart failure (HTN, ASCVD, DM)

B - Pre-HF with abnormal cardiac function or elevated biomarkers WITHOUT signs or symptoms

C - structural cardiac abnormalityes with prior or current symptoms of HF (SOB, fatigue, edema)

D - Advanced HF with severe symptoms at rest and recurrent hospitalizations

36
Q

NYHA Functional Classes

A

I - no limitations of activity, exercise does not cause symptoms

II - Ordinary physical activity (walking up stairs) results in symptoms

III - very minimal activity (bathing, dressing) causes symptoms

IV - symptoms at rest

37
Q

Left sided symptoms

A
  • SOB when lying flat (orthopnea)
  • Paroxysmal noctural dyspnea
  • Bibasilar rales (crackling)
  • S3 gallop heart sound
  • Hypoerfusion (cool extremities)
38
Q

Right sided symptoms

A
  • Peripheral edema
  • Ascites
  • Jugular Vein Distension (JVD)
  • Hepatojugular reflux (HJR)
  • Heptaomegaly (enlarged liver due to fluid

FLUID

39
Q

What natural products reduce heart failure?

A

Fish Oil
Hawthorn
Coenzyme Q10

40
Q

How much should you restrict the sodium in heart failure?

A

< 1500 mg/day

41
Q

What drugs cause or worsen heart failure?

A

DI NATION
D- DPP4 inhibitor
I- immunosuppressants (TNF inhibitors)
N- non-DHP CCB
A-Antiarrhythmics (Class 1 agents)
T- Thiazolidinediones (edema risk)
O- oncology medications (Doxorubcin)
N - NSAIDs

Others: steroids, amphetamines, alcohol

Cardiovascular (6 decks)

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