IHD - Scondary Prevention

Question 1

What is needed to add Rivaroxaban with aspirin

Answer 1

DAPT (dual Antiplatelet therapy) complete
Rica 2.5 plus aspirin best

Question 2

What is DAPT

Answer 2

Dual Antiplatelet therapy
Ticagrelor, Prasugrel and clopidogrel + aspirin

Question 3

Dual Antiplatelet therapy guidelines (PIC)

Answer 3

Question 4

How long is DAPT therapy

Answer 4

12 months

Question 5

When do continue DAPT longer than 12 months

Answer 5

Advanced age
ACS
Multiple MI
Extensive CAD
DM
CKD
LVEF <40%

Question 6

when do you favor a shorter DAPT time frame

Answer 6

History of Prior bleeding
Oral anticoag therapy
Female sex
Advance age
Low body weight
CKD
DM
Anemia
Chronic NSAID therapy

Question 7

How long are pts on BB after ACS event

Answer 7

At least 1 year (max 3)

Question 8

When do you give BB for life after a ACS event

Answer 8

LVEF ≤40% given fro life

Question 9

Which BB do you give after ACS care

Answer 9

Metoprolol
Carvedilol

Question 10

ACEi and ARBS place in therapy after a ACS attack

Answer 10

Given to almost all pt as well to reduce LV remodeling
BEWARE OF
Hypotension
Renal failure
Hyperkalemia

Question 11

What is the guideline for statins after an ASC event

Answer 11

High ASCVD risk give high intensity statin
Low ASCVD risk give
≤ 75 high intensity
> 75 moderate or high

Question 12

Why do we worry about aldosterone and which drugs do we use

Answer 12

Leads to remodeling and HTN
Use spironolactone or eplerenone
Given in the first 2 weeks

Question 13

Why spironolactone over eplerenone

Answer 13

Dose is able to be titration by 25mg up or down depending

Question 14

Eplerenone of over spironolactone

Answer 14

More data
Less Gynecomastia
More selective aldosterone blocker (less binding to progesterone and androgen)

Question 15

When do we start a SGLT2 vs GLP 1 for post ACS

Answer 15

SGLT2 - have to have diabetes already (no benefit without having DM)

GLP-1 - without diabetes shown to have benefit in CV events