Fm 2 Flashcards
RF for CV and guidelines for assessing
Many risk factors have been independently associated with cardiovascular disease (CVD) including:
sedentary lifestyle
stress
premature family history
excess alcohol use
and many more (e.g. obesity, poor diet, low selenium levels, high homocysteine levels, etc.)
American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend assessing major ASCVD risk factors every four to six years in adults age 20 to 79 who are free of ascvd
Also ask:
Leg pain with activity may indicate claudication, a manifestation of peripheral atherosclerotic disease.
Chest pain with activity may indicate angina pectoris, a manifestation of coronary artery atherosclerosis.
Smoking interventions 5
Interventions that improve quit rates:
Quit rates are highest when patients are engaged in a group setting.
Oral medications are somewhat effective at helping people stop smoking, with quit rates at 12 months 1.5 to 3 times the placebo quit rate.
When combined with medication, a series of one-on-one counseling sessions (as in a physician’s office) enhances quit rates.
Providing practical problem-solving skills, assistance with social supports, and use of relaxation/breathing techniques can increase quit rates.
Choosing medication to assist with smoking cessation:
Many physicians prefer prescribing bupropion to help smokers quit. Due to side effects, varenicline is often reserved for those that have failed bupropion or if a patient specifically requests it.
Medications Available to Help Patients Quit Smoking 3
Small, short-term studies comparing varenicline with bupropion show varenicline at least as effective and probably slightly more effective.
Bupropion (Wellbutrin, Zyban, Budeprion)
Mechanism: Norepinephrine and dopamine reuptake inhibitor.
Use: It is started a week before the quit smoking date. The dose is titrated up and maintained for two to three months. It may be used in conjunction with nicotine-replacement methods, especially those that can be titrated during the day.
Adverse effects: Bupropion has been associated with an increase in suicide in adolescents and young adults.
Contraindications: It should not be used in patients with seizures and with caution in those with significant renal or hepatic impairment.
Varenicline (Chantix)
Mechanism: Nicotine receptor blocker.
Use: Started a week before the quit date, titrated up, and maintained for two to three months. Should NOT be used with nicotine replacement.
Adverse effects: Associated with an increase in suicide. The dose should be lowered for those with renal insufficiency. Nausea, the most common side effect, may be lessened by taking it with food.
Nicotine replacement
Comes in multiple delivery forms.
Available without prescription: Gum, patch, and lozenge
Require prescription: transdermal patch, inhaler, nasal spray, and sublingual tablet
These treatments are generally indicated for tobacco users who require daily use and have some nicotine addiction. All are to be started after the last use of tobacco on the quit date.
The patch comes in different strengths, which are gradually decreased over weeks. The other methods require the user to self-titrate the dose, gradually decreasing their use until they are able to stop. Although not FDA approved for heavier smokers (>1 pack per day), the patch may be combined with a short-acting form of nicotine replacement for additional relief of urges and cravings.
BMI use, importance and other measurements (3) that can be used
Use:
BMI is used clinically because actual measurement of percent body fat is difficult.
Importance:
BMI is important because high total body fat is a risk factor for Type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease.
Other measurements:
Body fat distribution may provide additional risk stratification for coronary artery disease beyond BMI. Waist circumference and waist-hip ratio, as indicators of abdominal adiposity, are independent risk factors for coronary artery disease. Consider measuring these in overweight patients to further determine risk and need for weight loss.
Signs of Dyslipidemia 3 and Atherosclerosis 2
Changes associated with dyslipidemia: Corneal arcus (white or blue ring around the iris), xanthelasmas (yellowish deposits on eyelid), acanthosis nigricans
Changes associated with atherosclerosis:
Decreased peripheral pulses, carotid bruit
The ABCDE of Suspicious Skin Lesions
Asymmetry Border irregularity Color non-uniform Diameter > 6 mm Evolution or change over time
Zoster and pneumovax (PPSV23) vaccination
One dose of zoster vaccine is recommended when patients turn 60
Pneumococcal polysaccharide vaccine for 65 and older and people at high risk like smokers and other high risk groups (sickle cell disease, Hodgkin etc)
HCV screening
Hepatitis C virus infection: screen in persons at high risk for infection (needles - healthcare, tattoo, iv drug user, blood transfusions, less extent sex.) Offer one-time screening for HCV infection to adults born between 1945 and 1965.
When to test for genital herpes?
What to test for in sexually active person 4, considering 2 more?
Genital herpes testing should only be performed on symptomatic individuals.
HIV, syphilis, chlamydia, and gonorrhea. Consider hepatitis B and C screening as well.
PSA Screening: Benefits and Harms
Recommended against by usfpstf and other ppl say to let pt decide
The potential benefit of PSA screening is that it may lead to prolonged life from early detection and treatment of prostate cancer. In addition to the potential benefit of early detection of malignant prostate cancer, some men may receive psychological reassurance that they probably do not have prostate cancer or they have probably caught it early so it can be treated.
A potential harm of PSA screening is serious complication (such as erectile dysfunction, urinary incontinence, bowel dysfunction) or even death from treatment of a prostate cancer that would not have caused symptoms if left undetected during his lifetime. Another potential harm is pain and discomfort associated with prostate biopsy and psychological effects of false-positive test results.
Colon Cancer Screening Options
The USPSTF recommends screening for colorectal cancer beginning at age 50 years and continuing until age 75 years using:
fecal occult blood testing q 1 yr
sigmoidoscopy q 5 yrs
colonoscopy q 10 yrs
Assess Risk for Cardiovascular Disease 3
lipid panel (B) is strongly recommended. The ACC/AHA Cholesterol Guidelines recommend reassessing patients' ASCVD risk (including HDL and total cholesterol) every four to six years. Given that they recommend treating with statins all patients over 21 with an LDL-c > 190 mg/dL, it is reasonable to check fasting lipids in all adults over 21 every four to six years. Ideally, these are drawn in the fasting state at least eight hours after the last food intake. Non-fasting triglycerides may be significantly higher than fasting, but the total cholesterol, LDL-C, and HDL-C generally do not vary that much. LDL cholesterol can be determined via calculation based on other components of the lipid panel, or it can be directly measured. A "measured" LDL is often done when the patient's triglycerides are very high, invalidating LDL calculations.
Screen for Diabetes: Glucose (A) is strongly recommended.
Uspstf guide - They gave a B recommendation to screening for Type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mmHg.
Ada guide -asymptomatic adults without risk factors should begin screening at age 45.
Screen for Chronic Kidney Disease
Renal function and serum electrolytes (F) are indicated in this situation, since Mr. Reynolds has elevated blood pressure.
Indications for Exercise Stress Testing in males
Asymptomatic male patients over 45 years of age with one or more risk factors (hypercholesterolemia, hypertension, smoking, or family history of premature coronary artery disease) may obtain useful prognostic information from exercise testing.
ECG Changes That Suggest Coronary Artery Disease 3
Horizontal ST segment depression or downsloping ST segment
Suggests cardiac ischemia
Convex ST segment elevation
Suggests acute myocardial injury
Q waves that are greater than 25% of succeeding R wave and greater than 0.04 seconds Indicate infarction (death to heart tissue)
