secondary prevention of CAD Flashcards

1
Q

when is secondary prevention needed?

A

patients with confirmed CAD or vascular equiv

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2
Q

what is goal of secondary prevention

A

prevent plaque rupture and progression

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3
Q

secondary prevention with pharm

A

1) anti-platelet (P2y112 inhibitor or theienopyridines/thromboxane synthetase inhib) = block activ/adhesion from PLT
2) beta blocker
3) RAAS inhibitors

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4
Q

what drug paired with aspirin reduces MI and stent thrombosis

A

thienopyridines

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5
Q

thienopyridines + aspirin reduce ___

A

MI and stent thrombosis

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6
Q

guidelines for class 1 antiplatelet

for all CAD patients

A

ASA 75-162 mg

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7
Q

guidelines for class 1 antiplatelet

for all ACS or PCI

A

Thienopyridines + aspirin

1 yr after event

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8
Q

guidelines for class 1 antiplatelet

for post bypass surgery

A

asa 100-325 mg

for at least 1 yr

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9
Q

guidelines for class 1 antiplatelet

for post stroke

A

ASA alone

Clopidogrel alone

or combined apsirin + dipyridamole daily

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10
Q

guidelines for class 1 antiplatelet

for symptomatic PAD patients

A

asa alone

clopidogrel alone

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11
Q

guidelines for class 1 antiplatelet

if requiring warfarin for something else

A

low dose asa and monitor BLEEDING

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12
Q

effects of beta blockers

A

1) decr HR
2) decr contractility
3) decr conduction velocity
4) decr systemic BP

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13
Q

class 1 beta blocker guideline

when to use

A

ALL PATIENT WITH

1) LVSD <40%
2) HF SX IN LAST 3 YRS
3) MI/ACS in last 3 yrs

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14
Q

class IIa beta blocker guideline

when to use

A

1) LVSD <40% even without HF sx

2) hx of MI/ACS

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15
Q

effects of RAAS blockers

A

1) vasodilation
2) natriuresis
3) decr sympathetic
4) decr cardiac remodeling

especially LVSD and diabetics

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16
Q

class 1 RAAS inhibitor guideline

ACEI

A

LVSD <40%
DM
HTN
CKD

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17
Q

class 1 RAAS inhibitor guideline

ARB

A

ACEI intolerant

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18
Q

class 1 RAAS inhibitor guideline

aldosterone inhibitor

A

LVSD <40% after MI receiving therapeutic beta blocker and ACEI/ARB + HF or diabetes

AVOID WITH RENAL FAILURE OR HYPERKALEMIA

19
Q

HOW TO CONTROL blood pressure

A

1) decr saturated fat/sodium <2.4 g/day
2) RAAS inhibitor (ACEI/ARB)
3) beta blocker
4) diuretic
5) calcium channel blocker
6) direct vasodilator

20
Q

class 1 blood pressure guideline

< 60 y/o

21
Q

class 1 blood pressure guideline

> 60 y/o

22
Q

are non-statin lipid treatments effective?

A

no

bile-acid binding agents
niacin
fibrates

23
Q

does decreasing BP below 140/90 show benefit?

A

no as long as < 140/90

25
class 1 lipid guideline when to use
ALL CAD
26
class 1 lipid guideline drugs for high dose statin
atorvastatin 80mg | rosuvastatin 20-40 mg
27
class 1 lipid guideline drugs for mod dose
atorvastatin 10-20 mg rosuvastatin 5-10 mg pravastatin 40-80 mg simvastatin 20-40 mg
28
which patients are not proven for use with statin
NYHA Class 3-4 Hemodialysis Myopathy/myalgias new onset DM, rhabdo
29
___ control DOES NOT REDUCE MI AND MAY CAUSE HARM
glycemic control
30
glycemic control does not ___
does not reduce MI outcome | may cause harm
31
class 1 diabetes guideline
lifestyle mod with PCP
32
class IIa diabetes guideline
metformin first line
33
class IIb diabetes guideline
HbA1c <7%
34
depression treatment in CV events
improves depression symptom NOT CARDIAC EVENTS
35
class IIa depression guideline
just assess depression
36
class IIb depression guideline
treat depression to improve mental health not outcome
37
how does smoking affect atherosclerosis
1) oxid LDL 2) inflamm 3) decr HDL 4) endothelial dysfunction, decr NO
38
class 1 smoking guideline
STOP SMOKING no exposure to secondhand smoke
39
obesity is defined by both ___
bmi waist size
40
weight loss strategies diet component
caloric restriction nutrition counseling physical activity MACRONUTRIENTS LESS IMPORTANT
41
weight loss strategies meds
orilstat
42
weight loss strategy bariatric surgery
bmi >40 or >35 with co-morbidities
43
class 1 weight control guideline
goal bmi = 18.5-24.9 waist <35 women lose 5-10% of body weight initially
44
class 1 physical activity guideline
moderate to high intensity 30-60 min per day 5 day per week