Secondary Prevention (complete) Flashcards
What is used for the pharmacologic guidelines?
- Anti-platelets
- Beta-blockers
- RAAS inhibitors
What is used for pharmacologic and lifestyle guidelines?
- BP control
- Lipid mgmt
- Diabetes mgmt
- Depression screening and mgmt
- Smoking cessation
What is used for lifestyle guidelines?
- Weight mgmt
- Physical activity
What is used in the ‘other’ category?
Cardiac rehab
Flu vx
What does Class I mean?
Therapy should be reformed
What does Class IIa and IIb mean?
assigned when there is debate over benefit of the therapy
What does Class III mean?
Therapy should not be performed
What are the Class I antiplatelet guidelines for all CAD pts?
Aspirin 75-162mg
What are the Class I antiplatelet guidelines for all pts w/ ACS or PCI?
For 1 year following event:
- Thienopyridines
- Aspirin 81-325mg
What are the Class I antiplatelet guidelines for post-bypass surgery pts?
Asprin 100-325mg
for 1 year
What are the Class I antiplatelet guidelines for post-stroke pts?
- Aspirin alone
- Clopidogrel alone
- Combined aspirin/dipyridamole daily
What are the Class I antiplatelet guidelines for pts w/ symptomatic PAD?
- Aspirin alone
OR
- Clopidogrel alone
What are the Class I antiplatelet guidelines for a pt who requires warfarin for another indication (e.g. AF)?
Low-dose aspirin and monitor closely for bleeding
What are the Class I beta-blocker guidlines?
BBs in all w/ LVSD (EF <40%) and HF symptoms or MI/ACS in past 3 years
What are the Class IIa beta-blocker guidelines?
- BBs in all w/ LVSD (EF <40%) even in absence of HF symptoms
- BBs in all w/ any history of MI/ACS
What are the Class I RAAS inhibition guidelines for ACEIs?
Give to those w/: - LVSD - DM - HTN OR - chronic kidney disease
What are the Class I RAAS inhibition guidelines for ARBs?
- w/ LVSD
AND
- either prior MI or HF symptoms
Must be intolerant to ACEIs
What are the Class I RAAS inhibition guidelines for aldosterone inhibition?
- Post-MI w/ LVSD
- Are receiving therapeutic doses of BB & ACEI/ARB
AND - Have HF or diabetes
Avoid in those w/ renal dysfunction or significant hyperkalemia
Which interventions can control BP?
- Lifestyle
- Low sat fat/Na diet
- RAAS inhibitors
- BBs
- Diuretics
- CCBs
- Direct vasodilators
What are the Class I BP control guidelines? (think #s)
Age <150/90
Which types of statins are more efficacious in reducing cardiac events?
High dose statins
What are some non-statin lipid tx?
- Bile acid binding agents
- Niacin
- Fibrates
No evidence of efficacy
What are the Class I lipid guidelines for all CAD pts?
- High dose (atorvastatin 80mg or rosuvastitin 20-40mg) in pts ≤75yo
What are some negating factors (don’t know what else to call it) in the 2013 Class I lipid guidelines?
- No need to titrate med to LDL
- No indication for non-statin lipid lowering therapies
- Not proven in HF NYHA Class III-IV
- Not proven in hemodialysis pts
What are some unclear relationships (lol) with Class I lipids guidelines?
- Myopathy/myalgies (~5-15%)
- New-onset DM (0.1-0.3%)
- Rhabdo in 0.01%
- Hemorrhagic CVA in 0.01%
Diabetes confers the same mortality risk as what?
Prior MI
What are the Class I diabetes guidelines?
- Life modifications
- Coordination w/ PCP
What are the IIa diabetes guidelines?
- Metformin
First-line pharmacologic therapy
What are the IIb diabetes guidelines?
- HbA1c <7% can be considered
Depression is associated with _____ cardiac outcomes
Worse
What are the Class IIa depression guidelines?
- Assessment of depression
What are the Class IIb depression guidelines?
- Tx for depression does not appear to improve cardiac outcomes
- Is beneficial for overall mental health
How does smoking promote atherosclerosis?
- Oxidizes LDL
- Inflammatory
- Decreases HDL
- Causes endothelial dysfunctions
- Causes reductions in NO
What are the Class I smoking guidelines?
Just stop fucking smoking
easier said than done though…
What are the Class I weight control guidelines?
- Goal BMI = 18.5 - 24.9
- Goal waist circumference (men) = <35 in
- Initial goals of weight loss should be 5-10% of body weight
What are the Class I physical activity guidelines?
- Moderate to high-intensity exercise for 30-60 min/day
- At least 5, ideally 7, days/week
