Unit 10 Cardiovasular Pt. 1

Question 0

What baseline lab tests does the provider order when initiating statin therapy?

Answer 0

Baseline lipid panel

Baseline LFTs

Question 1

Most statin drugs are part of which CYP enzyme class?

Answer 1

CYP3A4

Question 2

What lab tests will the provider run to assess adherence to statin therapy?

Answer 2

Follow up lipid panel every 3-12 months for “ongoing monitoring”

Question 3

Statin drugs and CYP3A4 inhibitors such as Cipro, Clarithromycin, azole antifungals, CCBs, and Fibrates such as Gemfibrozil will increase the risk of

Answer 3

Statin-induced myopathy, with rhabdomyolysis and acute renal failure.

Question 4

A CYP2C9 inhibitor that will increase the anticoagulant effect of warfarin is :

Answer 4

Alcohol.

Avoid with warfarin for increased risk of bleeding.
Also avoid certain azoles: fluconazole(Diflucan) and miclonazole(Monistat); Bactrim, Septra, Prozac, Flagyl.

Question 5

When using statins and/or anticoagulant meds, sometimes it takes _______or so to see an important interaction with muscle pain or bleeding.

Answer 5

2 weeks

Question 6

If a patient has gastritis or other structural bowel problems, avoid :

Answer 6

NSAIDs, Aspirin, and Warfarin

Can instigate or increase bleeding from these sources. Judicious attention is important in early detection of bleeding.

Question 7

CYP3A4 inducers decrease drug concentration and reduce the anticoagulant effect :

Answer 7

Antiseizure meds: Tegretol, Phenytoin
HIV meds
St. John's wort
Corticosteroid: dexamethasone (Decadron)
rifampin

Question 8

If a patient has an ASCVD risk of >7.5% what initial therapy is indicated?

Answer 8

High dose therapy. statin drug

Question 9

Patient is recommended for high dose statin therapy if their LDL is greater than _____.

Answer 9

> 190 mg/dL

Question 10

High dose treatment options for statin therapy:

Answer 10

Atorvastatin (Lipitor) 40-80mg

Rosuvastatin (Crestor) 20-40mg

Question 11

Rather. Than a targeted number for the LDL treatment focuses on:

Answer 11

A percentage reduction in the level of LDL.

Patient centered treatment target.

Question 12

Niacin and fenofibrate therapy offer no benefit and should be considered in patients:

Answer 12

Who do not respond as expected to statins or
Are unable to tolerate recommended statin dose intensity or
Experience statin intolerance.

Question 13

Mechanism of action: Heparin

Answer 13

Prevents of slows formation of new thrombi.
Has no effect on existing clots.
Monitored by PTT.
(LMWH can’t be monitored by PTT but has a more predictable anticoagulant effect)

Question 14

Mechanism of action: Wafarin

Answer 14

Competitively blocks vitamin K binding sites.
Inhibits synthesis of vit K dependent coagulation factors: VII, IX, X, II.
Prevents extension of existing thrombus and formation of new thrombi. Does not reverse ischemic damage to already established thrombus.

Question 15

Mechanism of action: aspirin

Answer 15

Platelet inhibitor.

Prevents platelet aggregation through inhibiting cyclooxygenase in platelets and endothelial cells.

Question 16

Mechanism of action: Clopidogrel

Answer 16

Platelet inhibitor.

Inhibits binding of ADP to its platelet receptor and ADP mediated activation of IIb/IIa complex.

Question 17

To prevent venous thromboembolism treatment is :

Answer 17

Compression stockings, intermittent compression devices, or UFH or LMWH. Especially important in post op pts.
Aspirin not recommended !!!

Question 18

If a patient has had a previous TIA and/or ischemic stroke preventative therapy is :

Answer 18

Aspirin and warfarin

If pt. had recent TIA INR goal is 2-3

Question 19

To prevent atrial fibrillation in persistent AF the patient will be prescribed:

Answer 19

Warfarin with INR goal 2-3

Unless pt is <65 then patient will take ASA 325mg/day.
Pt takes both warfarin and ASA if they have a hx of rheumatic mitral valve disease, prosthetic heart valve, or hx of systemic emboli.

Question 20

Women requiring long term warfarin anticoagulation who are considering pregnancy should

Answer 20

Substitute with UFH or LMWH as soon as pregnancy is achieved.
Maintained for at least 6 wks postpartum.

Question 21

Low dose unfractionated heparin or low molecular weight heparin is used for prophylaxis of

Answer 21

DVT

Question 22

Patients should not use generic interchangeably with brand name Coumadin because of the decreased

Answer 22

Bioavailability

Question 23

Warfarin therapy should be stopped temporarily and a source of over anticoagulation should be assessed if the INR is greater than:

Answer 23

> 5

Question 24

5-10 mg Vitamin K should be given to prevent life-threatening bleeding, or emergent surgery for an INR greater than:

Answer 24

> 9

Question 25

A patient is treated with a platelet inhibitor such as Aspirin daily for primary prevention of :

Answer 25

MI, cerebrovascular disease, indicate in men >50yo

81mg daily

Question 26

What tests monitor heparin therapy and which tests monitor warfarin therapy ?

Answer 26

PTT: monitors heparin therapy

PT and INR: monitors warfarin therapy

Question 27

Initial dose of warfarin to be prescribed :

Answer 27

5-10 mg
( 2.5mg for elderly)
Give 3 doses subsequently before monitoring.
Monitor INR q3-4 days until goal is reached then weekly decreasing dose every 2 weeks.

Question 28

Warfarin is a pregnancy category :

Answer 28

X
Placental transfer of medication: LBW, growth retardation, spontaneous abortion,stillbirth, high risk OBGYN referral of pt is already on Warfarin and became pregnant.