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CVD Flashcards

1
Q

In regards to BP and CV risk what happens as you age?

A

once 50 veryyyyy correlated to risk

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2
Q

Lifestyle modifications of HTN?

A

stop smoking
DASH diet
reduce alcohol
exercise

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3
Q

What did SPRINT tell us?

A

if great than 75 and no sign of ortho hypo more intensive target is better with no increase in syncope or hypotension

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4
Q

Who are high risk patients?

A

Age >756
CAD
CKD
Framingham >15

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5
Q

What is high risk BP target?

A

<120

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6
Q

What is orthostatic hypotension?

A

drop in 20mmHg after standing

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7
Q

Why might SPRINT not be applicable to elderly?

A

excluded ortho hypo, DM, stroke, MI, HF

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8
Q

WHat is considered to low for diastolic?

A

<60

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9
Q

What HTN goal if frailty of 1-3?

A

like generaly people

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10
Q

What HTN goal if frailty of 4-5?

A

weigh pros and risks

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11
Q

What HTN goal if frailty 6-9?

A

goal of under 150

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12
Q

If uncomplicated HTN what drugs?

A

thiazide, ACE, CCB

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13
Q

If DM and HTN what drugs?

A

ACE then add CCB first before thiazide

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14
Q

WHy are beta blockers not great if >60?

A

dont work as good

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15
Q

If CAD and HTN what drug?

A

ACE and CCB if needed

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16
Q

If recent MI and HTN?

A

ACE and beta blockers

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17
Q

If HF and HTN?

A

ACE and beta blockers
NO NDH-CCB

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18
Q

Which thiazide is more potent?

A

Chlorthalidone

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19
Q

What risk do thiazides have in older people?

A

more gout and electrolyte disturbances

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20
Q

What labs must be monitored for ACE?

A

SCr and K

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21
Q

Do ACE cause low or high potassium?

A

HIGH

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22
Q

How can we minimize edema if on amlodipine?

A

split dose or hs

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23
Q

When would we maybe add verapamil to HTN treatment?

A

if a fib

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24
Q

Who cant get beta blockers and verapamil?

A

risk of heart block

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25
Compelling indications for beta blockers?
HF, a vib rate control, post MI
26
Issue with beta blockers?
exercise intolerance and doesnt work as good in older
27
Time to benefit of statins?
2 years
28
Which patient should be on high dose statin?
post MI or stroke
29
Why do we prefer moderate dose statins in older people?
more cognitive impairment and musle pain
30
What is a moderate dose of statins?
rosuvastatin 10 atorvastatin 20
31
What is high dose of statin?
rosuvastatin 20-40 atorvastatin-80
32
When does high dose statin lose a bit of their efficacy at preventing CV events?
after a year post event
33
When do we use the different agents for additional cholesterol lowering?
PCSK9- familial or need more ezetimibe fibrates if TG really high
34
When is stable CAD?
1 year of being okay
35
Meds after CAD?
ASA statin beta blockers ACE CCB Nitrates
36
How long does benefit of Beta blockers on CV events last?
up to 3 years post mi
37
Do you need patch nitrates if stable CAD?
no so taper but have rescue short acting
38
Who cant use nitrates?
viagra
39
Signs of a fib?
SOB, fatigue, chest pain, anxiety
40
What can a fib lead to?
stroke, and heart failure
41
WHat did BAFTA tell us?
warfarin much better than ASA at lowering strokes and has same bleed risk NOT ICH
42
Is ASA and clopidogrel good for everyone?
No works better but bad bleed risk
43
Pros of DOACs?
better efficacy, less ICH, no INR monitoring, less DI
44
Which DOACs have higher gi bleeds?
rivaroxaban, edoxaban, dabigatran
45
When is warfarin preffered?m
mechanical valves or severe renal
46
When should we switch warfarin to DOAC?
if bleeds, test hard, DI, stroke, adherence issue
47
What is bad with dabigatran?
bad gi
48
Counseling with rivaroxaban?
TAKE WITH FOOD
49
Best DOAC?
apixaban
50
Who should get OACif have a fib?
>65!!! prior stroke, HTN, HF, DM
51
What do we give if patient refuses OAC?
ASA and clopidogrel
52
WHat is HAS BLED score?
HTN (>160) Abnormal renal/liver Stroke Bleeding labile INR Elderly Drugs- ASA/NSAID/Alcohol
53
WHat is a bad HAS BLED score?
> or = 3
54
Is fall risk a good stop for OAC?
no need to fall 450 times to have risk outweigh benefits
55
What do you do if ACS with PCI and is high risk of CV events?
Triple therapy for 1 month then dual for a year
56
When would we prefer rate control?
if persistent and long term
57
What did the EAST-AFNET trial tell us?
Rhythm is better for disease but drug s/e is bad
58
Drugs for rhythm control?
amiodarone/sotalol
59
s/e of amiodarone?
oculopathy pulmonary and hepatic damage thyroid issues blue skin photosensitivity
60
When would we want CCB for rate control over BB?
if asthma or COPD
61
Issues with digoxin?
not as effective, bad s/e
62
what is rate target in a fib?
<100
63
s/e of digoxin?
NVD, halos, confusion
64
What is proper trough for digoxin?
<1
65
Classes of HF?
1: no limitation 2:slight limitation of exercise 3: marked limitation and even with no exercise 4:inability
66
Which med for HF to add first?
depends on indications for other things
67
Is entresto worth it?
much better lowering of Cv and hospitalizations BUT worse ortho hypo
68
When switching to entresto what must we do?
36 hour washout
69
If GFR drops 15% when starting SGLT is this okay?
yes it will revert
70
If HefPef what drug is a must?
empagliflozin lowers Cv and hospitalization
71
What drugs prolong Qtc?
antiarrhythmics atamoxetine domperidone antipsychotics SSRI TCA antibiotics antifungals

Pharm 350 (8 decks)

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