Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
| HTN, obesity, dyslipidemia, DM, smoking, inactivity, microalbuminuria, GFR < 60ml/min, Age (Men >55, WM >65), Fam Hx of CHD (Men <55yo, WM <65yo |
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Term
|
Definition
| 1) risk factors 2) identifiable causes 3)Target organ damage 4)Hx/physical exam 5)Labs (urine, blood, K, Ca, Cr) 6) ECHO |
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|
Term
| What are identifiable causes of HTN? |
|
Definition
| Apnea, drug induced, CKD, aldosteronism, renovascular disease, cushings synd/steriods, pheochromocytoma, coarctation of aorta, thyroid/parathyroid disease |
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Term
| Compelling indication for HF |
|
Definition
| Thiaz, BB, ACEI, ARB, ALDO antagonist |
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Term
| Compelling indication for HTN post MI |
|
Definition
| BB, ACEI, ALDO antagonist |
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Term
| Compelling indication high CVD risk |
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Definition
|
|
Term
| Compelling indication Diabetes |
|
Definition
| THIAZ, BB, ACEI, ARB, CCB |
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|
Term
| Compelling indication for CKD |
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Definition
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|
Term
| Compelling indication for recurrent stroke prevention |
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Definition
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Term
| Target BP for HTN (2 ranges) |
|
Definition
<140/90 for Plain HTN
<130/80 for HTN in Diabetes or CKD |
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Term
| Target BP for HTN (2 ranges) |
|
Definition
<140/90 for Plain HTN
<130/80 for HTN in Diabetes or CKD |
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|
Term
| Weight reduction of 10kg yields what decrease in BP |
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Definition
|
|
Term
| Dash diet shows what decrease in BP? |
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Definition
|
|
Term
| Dietary Na restriction of <100mmol/day (2.4gm Na or 6gm NaCl) give what BP improvment? |
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Definition
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|
Term
| What improvement does Aerobic activity for 30min most days of the week give? |
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Definition
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|
Term
| Moderation of Alcohol (Men <2 drinks/day WMen <1 drink/day) can improve BP by how much? |
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Definition
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Term
|
Definition
| Systemic vascular resistance. The pressure that the chambers of the heart generate in order to eject blood |
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Term
| What is the most common cause of increased systemic vascular resistance? |
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Definition
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Term
|
Definition
| the pressure that stretches/fills the left ventricle |
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Term
|
Definition
| venous blood pressure/rate of return which is inturn affected by venous tone and volume of blood |
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Term
| Starlings law states __________ |
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Definition
| states that the greater the volume of blood entering the heart during diastole (end-diastolic volume), the greater the volume of blood ejected during systolic contraction (stroke volume) and vice-versa. |
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Term
|
Definition
reduced volume (Diuretics)
venous vasodilation (Organic Nitrates) |
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|
Term
| What does eleveated preload cause over a period of time? |
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Definition
|
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Term
|
Definition
|
|
Term
| What are the determinants of Blood Pressure? |
|
Definition
Cardiac Output (CO) Systemic vascular resistance (SVR) or peripheral resistance (PR)
CO x SVR = BP |
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Term
|
Definition
| venous vatherterization, checks heart valves. Can measure preload at the pulmonary capillaries |
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Term
|
Definition
| Arterial catheterization, looks for coronary blocages/atherosclerosis by injecting dye and taking a picture |
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Term
| What are two ways to measure/calculate/estimate the EF? |
|
Definition
|
|
Term
| What is the difference in antiplatelet therapy with a Bare Metal Stent and a Drug Eluting Stent? |
|
Definition
BMS: ASA and Plavix for 1 month
DES: ASA and Plavix for atleast 1yr |
|
|
Term
| Why do drug eluting stents require longer drug therapy |
|
Definition
| the drug being eluted that inhibits clot formation also inhibits endothelialization |
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|
Term
|
Definition
| abnormal sound caused by blood rushing past an obstacle (atherosclerosis). Bruits are indicative of PAD |
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|
Term
| what causes Hepatomegally? |
|
Definition
| fluid build up due to CHF |
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|
Term
| What is the significance of juglar venous destention? |
|
Definition
| JVD is caused by increased fluid buildup from CHF |
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|
Term
| What is a Heart murmur? (S3 gallop) |
|
Definition
| Signifies failing left ventrical. Indicative of CHF |
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|
Term
| What is the purpose of a fundiscopic exam in HTN/CHF pt? |
|
Definition
| Changes in the optic disk or vessles in retina can be indicators of long-trem uncontrolled BP. This prevents people from taking medicine right before their exam and looking like they are controlled when they are not |
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Term
| What dose a treadmill test do? |
|
Definition
| It monitors BP/HR at rest and then sees how the heart reacts to exercise. Detects atherosclerosis. May cause angina to occure (inc O2 demand) |
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|
Term
| What does a treadmill test Dx? |
|
Definition
| Atherosclerosis, angina, the likelihood of dieing w/in the next yr due to coronary heart synd |
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|
Term
| What might be a substitute for a treadmill test (for apmuties or PAD pt) |
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Definition
|
|
Term
| What are 2 drugs used in a drug induced stress test? |
|
Definition
| Dipyridamol and Adenosine |
|
|
Term
|
Definition
| The energy expiditure from sitting still doing nothing |
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|
Term
| If you can do a treadmill test and do the 20% incline at 5.5mph what are the odds of death within the next yr from heart disease? |
|
Definition
|
|
Term
| What is the BRUCE protocol for treadmill tests? |
|
Definition
| 3 minute stages of increased activity (incline and speed) to achieve >85% of age-predicted HR |
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|
Term
| What are reasons for termination of a treadmill test? |
|
Definition
| SBP drop >10mmHg, mod-severe angina, syncope (fainting), Pt desire to stop, sustained ventricular tachycardia, ST elevation |
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|
Term
| What is a transesophageal ECHO good for? (TEE) |
|
Definition
| Better images of the atrium to determine clots, afib, valvular endocarditis |
|
|
Term
| What information does an ECHO not provide? |
|
Definition
| Electrical activity (like EKG) |
|
|
Term
| What does MUGA stand for? |
|
Definition
| multi-gated acquisition of nuclear material |
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|
Term
|
Definition
| Determine EF, used by oncologists to monitor chemo effects on heart |
|
|
Term
| What information other than the EF can be gathered from a left heart cath? |
|
Definition
| Need for stent, balloon angioplasty, PTCA (percutaneous transluminal coronary angioplasty, stent placement, need for CABG (coronary artery bypass grafting |
|
|
Term
| The four main branches of coronary arteries |
|
Definition
Right
Left main and Left circumflex
Left anterior decending (LAD) |
|
|
Term
| Where do clots leaving the atrium tend to go? What diagnostic Tx can be used to predict this? |
|
Definition
| Straight shot to the corotids and cause stroke. TEE can be used to Dx |
|
|
Term
| Where do clots leaving the atrium tend to go? What diagnostic Tx can be used to predict this? |
|
Definition
| Straight shot to the corotids and cause stroke. TEE can be used to Dx |
|
|
Term
| What are some CHD risk equivalents? |
|
Definition
| Diabetes, PAD, abdominal aortic anyurism, CAD (coroted), framingham >20% |
|
|
Term
| What is PAD a predictor for? |
|
Definition
|
|
Term
| When do you screen for heart diseases? |
|
Definition
<50yo w/diabetes and 1 risk factor
50-69 for smokers OR diabetics w/o RF
>70 anyone |
|
|
Term
| How much exposure to two risk factors is enough to cause atherosclerosis? |
|
Definition
| 9mo, neonates have died from atherosclerosis due to intrauterine exposure to two or more RF |
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|
Term
| What is ABI and how is it useful? |
|
Definition
| Ankle brachial index- a measure of SYSTOLIC BP in the ankle (compares to brachial BP). If the ratio is less than 0.9 it is diagnostic for PAD |
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|
Term
|
Definition
|
|
Term
|
Definition
| Claudication, atypical leg pain, Some are asymptomatic |
|
|
Term
|
Definition
Life style: manage smoking and RF
Tx: HTN treatment and antiplatelet therapy (to prevent MI and stroke) |
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|
Term
|
Definition
|
|
Term
| ASA dose in PAD, MI, CHD etc |
|
Definition
|
|
Term
|
Definition
| 300mg loading dose 75mg qd |
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|
Term
| Pletal/cilostazol indication and dose |
|
Definition
Phosphodiesterase inhibitor used in prevention of claudication (PAD pt)
Dose: 100mg BID (50mg bid w/ 3A4 or 2C9 drugs) |
|
|
Term
| Side effect possible w/ Atiplatelets and cilostazol |
|
Definition
| ASA and Plavix mixed with cilostazol causes inc risk for bleed. May be used as alternate for Plavix w/ ASA for stent |
|
|
Term
| When might Cilostazol be used with ASA? |
|
Definition
| Stenting with need for improved claudication, it replaces plavix in this combo |
|
|
Term
| Pentoxafyline indication and dose |
|
Definition
| Indicated in but not recommended in claudicaion!! |
|
|
Term
| What are the risks and benefits of ASA |
|
Definition
Pro: Cheap, effective, Most GI side effects can be cured w/ PPIs
Con: Ulcers, GI upset, Not as effective as Plavix |
|
|
Term
| Clopedigrel pros and cons |
|
Definition
Pro: Works better than ASA (slightly)
Con: skin/rash (DC w/ rash), expensive |
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|
Term
| Both ASA and Plavix are what type of platelet inhibitors? |
|
Definition
|
|
Term
| What is the halflife of platelets? If irreversible antiplatelet drug is put on hold 5 days before a proceedure what will the platelet level/fxn be? |
|
Definition
|
|
Term
| Ticlopidine indication, dose, SE |
|
Definition
|
|
Term
| Verapamil indication, dose and SE |
|
Definition
|
|
Term
| What is the significance of the CAPRIE trial? |
|
Definition
| Trial w/ ASA and Plavix head to head, lead to FDA indication for Plavix. Plavix normally reserved for ASA intolerant pt???? |
|
|
Term
| What is the #1 recommended treatment for intermittent claudication? |
|
Definition
|
|
Term
| What is intermittent claudication? |
|
Definition
| pain in legs initiated by activity that increases oxygen demand in muscle but atherosclerosis of PAD will not allow adequate blood flow resulting in ischemia that causes the pain |
|
|
Term
| What type of stent is used in PAD? (*hint only stent vascular surgeons use) |
|
Definition
|
|
Term
| Two other type of surgical vascular procedure to help with PAD |
|
Definition
Aortofemoral bypass graft
Fempop bypass graft |
|
|
Term
| True or false: an asymptomatic PAD patient has no risk for stroke or MI |
|
Definition
| False- asymptomatic patients are at risk too (although technically slightly less per |
|
|
Term
| What is the recommendation for PAD pt w/ coronary or cerbrovascular disease? |
|
Definition
| Lifelong antiplatelet therapy (Grade 1A) |
|
|
Term
| What level of evidence is lifelong antiplatelet therapy in PAD sufferes with cerebrovascular disease or cornoary disease? |
|
Definition
|
|
Term
| In PAD patients without coronary or cerebrovascular disease what is recommended? |
|
Definition
| ASA 75-100mg OVER clopidogrel (Grade 2B |
|
|
Term
| What grade recommendation is it for PAD pt w/o coronary or cerebral vascular disease to take 75-100mg ASA OVER clopidogrel? |
|
Definition
|
|
Term
| What is recommended for PAD patients without coronary or cerebrovascular disease that are ASA intolerant? |
|
Definition
| Clopidogrel is recommended over ticlopidine (Grade 1B) |
|
|
Term
| What grade of evidence is the administration of clopidogrel over ticlopidine in PAD pt w/o coronary or cerebrovascular disease whom are ASA intolerant |
|
Definition
|
|
Term
| What is recommended against in PAD pt with intermitent claudication? |
|
Definition
| AGAINST anticoagulation (not antiplatelet) therapy (Grade 1A) |
|
|
Term
| What level of recomendation is it that PAD pt w/ claudication should not be on anticoagulants? |
|
Definition
|
|
Term
| What is the recommendation for PAD pt w/ mod/severe disabling claudication who aren't surg candidates and exercise doesn't help? |
|
Definition
|
|
Term
| What grade of recommendation is it that persons w/ PAD and mod-severe disabling claudication that aren't candidates of surgery and exercise doesn't help should be on cilostazol? |
|
Definition
|
|
Term
| Cilostazol is not recommended in whom? |
|
Definition
| Persons with less-disabling claudication (Grade 2A) |
|
|
Term
| What grade of rec is it that persons with less-disabling claudication should NOT be on cilostazol? |
|
Definition
|
|
Term
| What drug is recommended AGAINST for claudication? |
|
Definition
| Penyoxifylline (Grade 2B) |
|
|
Term
| What grade of recommendation is it that persons with claudication shouldn't take pentoxifylline? |
|
Definition
|
|
Term
| For patients with claudication what is recommended against? |
|
Definition
| anticoagulants (Grade 1A) |
|
|
Term
| What grade of evidence is it that persons with claudication should not be on anticoagulants? |
|
Definition
|
|
Term
|
Definition
| Diabetes, Hypercholesterolemia, HTN, hyperhomocystinemia, 10mg/dl inc in TC |
|
|
Term
| Antiplatelet therapy and ASA (75-325mg) recomendation (In PAD) |
|
Definition
|
|
Term
| Plavix level of rec (In PAD) |
|
Definition
|
|
Term
| Name 3 drug classes used in antianginal therapy |
|
Definition
| Organic nitrates, BB, CCB |
|
|
Term
| Name two mechanical antianginal therapies |
|
Definition
Angioplasty w or w/o stent (PTCA)
Coronary artery bypass grafting (CABG) |
|
|
Term
| Name some organic nitrates and how they work |
|
Definition
Isosorbide dinitrate, Isosorbide
mononitrate, NTG, Na nitroprusside
|
|
|
Term
| Explain BB use in angina and name some BB used for angina |
|
Definition
|
|
Term
| Explain CCB use in angina and name some CCB used in angina |
|
Definition
|
|
Term
|
Definition
| Atherosclerosis restricts blood flow to heart, increased activity increases the myocardial oxygen supply, but due to atherosclerosis the demands cannot be met leading to ischemia which causes pain |
|
|
Term
| What is the difference between stable and unstable angina? |
|
Definition
Stable- atherosclerosis w/ thick fibrous cap
Unstable- the cap is thin and has inflammatory cells which ruptures and causes leakage of inflamatory cells etc which leads to platelet aggregation and clotting |
|
|
Term
| What are some risk factors for plaque rupture/destabilization of angina? |
|
Definition
| Cap fatigue, Atheromatous (lipid) core, cap thickness/consistency, cap inflammation, smoking, cholesterol, DM, homocysteine, fibrinogen, impaired fibrinolysis |
|
|
Term
| what can increase oxygen supply in angina? |
|
Definition
| Mechanical intevention: PTCA, CABG |
|
|
Term
| What can decrease oxygen demand? |
|
Definition
| antianginal drugs (Nitrates, CCB, BB) |
|
|
Term
| What decreases oxygen supply in angina? |
|
Definition
| atherosclerosis, coronary vasospasm, reduced hemoglobin |
|
|
Term
| What increases oxygen demand in angina? |
|
Definition
| Increased HR, inc contractility, inc pressure (preload, afterload) |
|
|
Term
| What controls symptoms in angina? |
|
Definition
| Antianginal drugs, PTCA, CABG |
|
|
Term
| Stable angina can go unstable in a matter of _________ |
|
Definition
| seconds! the plaque ruptures and clot forms occluding the blood vessel, AKA acute coronary synd |
|
|
Term
| What is thought to cause atherosclerosis? |
|
Definition
|
|
Term
| What are statins thought to do in atherosclerosis prevention |
|
Definition
| 1) anti-intlammation 2)harden fibrotic cap |
|
|
Term
| Describe chest pain associated w/ chronic stable angina? |
|
Definition
| dull chest pain. a pressure or squeeze |
|
|
Term
| What is the location of anginal pain? |
|
Definition
| Substernal, center of chest, it can move/radiate (left arm, kneck, jaw) |
|
|
Term
| Duration of anginal attacks |
|
Definition
| 5-10min often stops when activity ceases |
|
|
Term
|
Definition
| relief acquired with rest NORMALLY, if no relief in 5minutes CALL 911! |
|
|
Term
| When to call 911 with angina |
|
Definition
| if first NTG doesn't work |
|
|
Term
|
Definition
| Prevent ACS/death, alleviate acute symptoms, prevent recurrent symptoms, avoid/min adverse tx effects |
|
|
Term
| True or False: antianginal drugs not only improve symptoms, but also outcomes |
|
Definition
|
|
Term
| Which drugs prevent CHD associated with angina? |
|
Definition
|
|
Term
| What are 5 features of anginal pain? |
|
Definition
| dull chest pain, substernal/center of chest location, may radiate, lasts 5-10min, dyspenea, relief promply upon rest |
|
|
Term
| What are two main goals of anginal treatment? |
|
Definition
| Prevent MI/stroke, decrease Sx |
|
|
Term
| What drug regimin should an anginal patient be on? |
|
Definition
| ASA (or plavix), BB or CCB |
|
|
Term
| True or false: Stenting only decreases anginal pain but does not improve outcomes |
|
Definition
|
|
Term
| What are the two ways to fix angina? |
|
Definition
| Increase supply (stent) or decrease demand (Drugs) |
|
|
Term
| True or false: Some antianginal drugs increase supply |
|
Definition
|
|
Term
| True or false: There is no benefit when ASA and Plavix are used together in anginal patients |
|
Definition
|
|
Term
| How are Organic Nitrates supplied and how do they act |
|
Definition
Paste, patch, tablet, spray
Venous vasodilators DECREASE PRELOAD which causes a decreased oxygen demand by myocardium. |
|
|
Term
| Imdur (or Ismo) generic name, dose and indication |
|
Definition
Isosorbid mononitrate
Imdur is ER- 240mg/day max
Ismo is IR- 40mg/day max
|
|
|
Term
| Isosordil generic name, dose and indication |
|
Definition
|
|
Term
| Why are nitrates dosed such that there is a "nitrate free period"? |
|
Definition
| To prevent nitrate tolerance from developing |
|
|
Term
| How do betablockers affect angina? |
|
Definition
| Decrease HR which decreases contractility which decreases O2 demand (decreases HR, contractility and load) |
|
|
Term
| How do non-dihydropyridine CCB work in angina? |
|
Definition
| Decrease HR which decreases contractility which decreases O2 demand (decreases HR, contractility and load) |
|
|
Term
| Name some non-dihydropyridines |
|
Definition
|
|
Term
| Dihydropyridines only affect 1 determinate what is it? |
|
Definition
|
|
Term
| Name the 3 dihydropyridines indicated in angina |
|
Definition
| amlodipine, nicardipine, and nifedipine |
|
|
Term
| True or false: A pt is on Verapamil and is having anginal pain. The best therapy would be add a beta blocker |
|
Definition
| False, never souble up on nondihydropyridine CCB and BB. You would want to add a dihydropyridine like amlodipine or felodipine (an "ine") |
|
|
Term
| How do you know if BB dose is maximized for pt? |
|
Definition
| resting HR should be 55-65 this is also true for nondihydro CCB |
|
|
Term
| Why is Diltiazem preffered over verapamil? |
|
Definition
| Verapamil is very constipating! |
|
|
Term
| What 7 parameters are used in the framingham calculation? |
|
Definition
| Gender, age, TC, smoking status, HDL, systolic BP, if treated for HTN |
|
|
Term
| How do you calculate LDL? |
|
Definition
LDL = TC - HDL - (TG/5)
(ONLY reliable if TG <400) |
|
|
Term
| Define LDL low risk category |
|
Definition
RF 0-1
LDL goal <160
Initiate TLC if LDL >160
Consider drug Tx if LDL >190 |
|
|
Term
|
Definition
RF 2+ and <10% framingham
LDL goal <130
Initiate TLC if LDL >130
Consider drug Tx if LDL >160 |
|
|
Term
| Define LDL moderate-high risk |
|
Definition
RF 2+ and framingham 10-20%
LDL goal <100
Initiate TLC if LDL >100
Consider drug Tx if LDL >100-129 |
|
|
Term
|
Definition
RF CHD or equiv and framingham >20%
LDL goal <100
Initiate TLC if LDL >100
Consider drug Tx if LDL >100 |
|
|
Term
| Define LDL very high risk |
|
Definition
RF CHD w/ recent MI or CV and DM
LDL goal <70
Initiate TLC if LDL >70
Consider drug Tx if LDL >70 |
|
|
Term
| What are the general trends for statins? |
|
Definition
LDL decease 20-60%
HDL increase 2-15%
TG decrease 5-50% |
|
|
Term
| Statins in order of most potent to least |
|
Definition
Remeber RASLF
Rosuvastatin (Crestor)
Atorvastatin (Lipitor)
Simvastatin (Zocor)
Lovastatin (Mevacor)
Fluvastatin (Lescol) |
|
|
Term
| What are the trends for bile acid sequestarants? (Colestipol, cholestryramine etc) |
|
Definition
LDL decrease 8-30%
HDL increase 3-5%
TG may increase |
|
|
Term
| Bile acid sequestrants in order from most potent to least |
|
Definition
Cholestyramine and Colestipol same
Colesevelam |
|
|
Term
| Trends of Cholesterol absorption inhibitors (ezetimibe) |
|
Definition
LDL decreases 18%
HDL increases 1%
TG decrease 8% |
|
|
Term
| What is the only cholesterol absorption inhibitor? |
|
Definition
| Zetia (Ezetimibe) also found in vytorin (w/ simv) |
|
|
Term
| What are the trends for Nicotinic Acid? |
|
Definition
LDL decreases 5-25%
HDL increases 14-40%
TG decrease 11-60% |
|
|
Term
| Nicotinic acid drugs from most potent to least potent |
|
Definition
|
|
Term
| Trend of fibric acid derivatives |
|
Definition
LDL decrease 30-45%
HDL increase 9-30%
TG decrease 23-60% |
|
|
Term
|
Definition
Fenofibrate (better LDL)
Gemfibrozil (better HDL and TG) |
|
|
Term
|
Definition
LDL INCREASES 45%
HDL increases 9%
TG decreases 45% |
|
|
Term
| Which drugs are best for TG? |
|
Definition
Fibric acids
Niacin ER
Lovaza (inc LDL) |
|
|
Term
| What drug increases LDL while lowering TG? |
|
Definition
|
|
Term
| Which drugs increase HDL the most? |
|
Definition
| Niacin and gemfibrozil (then fenofibrate) |
|
|
Term
| Which drugs decrease LDL the most? |
|
Definition
| Atorvastatin, rosuvastatin, vytorin, simvastatin |
|
|
Term
|
Definition
| N/C/D, abdominal pain. DC if LFT ?3x upper limit |
|
|
Term
| Bile acid sequestrants ADE |
|
Definition
| N/C, bloating, flatulence (less w/ colesevelam), impaired fat sol vitamin absorption |
|
|
Term
|
Definition
|
|
Term
|
Definition
| flushing, itching, GI, HA, hepatotoxicity, hyperglycemia, hyperuricemia |
|
|
Term
| Which drug do you not use in gout patients for cholesterol? |
|
Definition
|
|
Term
| Which drug do you use with caution in diabetics for hyperlipidemia? |
|
Definition
|
|
Term
| Fibric acid derivatives ADE |
|
Definition
| N/D, abd pain, rash. Inc of rhabdomyolysis when w/ a statin. assocaited w/ gallstones, myositis, hepatitis |
|
|
Term
| What are the CHD risk factors? |
|
Definition
Age: M >45yo FM >55yo
Fam Hx of CHD: M <55yo FM <65yo
HTN: > 140/90
HDL: <40
Smoking within last month |
|
|
Term
| What compenent of the TLC diet loweres LDL by increased intake? |
|
Definition
| Plant stanols and sterols |
|
|
Term
| How much does dietary therapy normally lower LDL? |
|
Definition
|
|
Term
| Baseline for statin therapy |
|
Definition
LFT 6wk, 12wk and then anual
Possibly CK |
|
|
Term
|
Definition
Elevated CK?
Brown urine? (myoglobinuria) |
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Term
| If you get rhabdo on a statin what should you do? |
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Definition
DC offending agent
Not rule out all statins, try another after recovery |
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Term
| Which is the primary target for most hyperlipidemia? (LDL, HDL, TG, TC) |
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Definition
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Term
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Definition
| inhibition of mevolonic acid (rate limiting step in cholesterol) AKA HMG-CoA reductase inhibitors |
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Term
| Which statins use the 3A4 pathway? |
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Definition
| Simvastatin, Atorvastatin, Lovastatin (SAL) |
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Term
| How often should lipids be checked while adjusting therapy? |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| What do resins alter and what is there place in therapy? |
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Definition
| LDL rdxn, can be used in liver dysfxn, may cause inc in TG |
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Term
| What does Ezetimibe alter? |
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Definition
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Term
| What are two serious, dose related, side effects of statins? |
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Definition
| Rhabdomylysis, LFT/liver damage |
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Term
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Definition
| Double the dose get 6% more rdxn |
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Term
| What is a major 2C9 interaction with a statin? |
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Definition
| Warfarin and Fluvastatin or Rosuvistatin |
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Term
| Drugs utilizing the same pathway as a statin will increase liver toxicity and dose related side effects |
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Definition
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Term
| Which two statins do NOT need to be renally doses? |
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Definition
| Atorvastatin and fluvastatin |
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Term
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Definition
| there are no clear evidences for LDL redxn in some trials, but it does do well with a statin |
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Term
| What is a problem with Bile acid sequestrants? |
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Definition
| They can bind to other drugs, must be taken sepprately. Also fiber is good fro the constipation and cramping |
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Term
| Lifestyle change for hyperlipidemia |
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Definition
Exercise
<200mg/day exogenous cholesterol in diet
<7% coloric intake from fat
High fiber
Plant sterols and stanols |
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Term
| What are plant sterols and stanols in? |
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Definition
margarin, benicol, orange juice
2gm/day dec LDL by 5% |
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Term
| Fiber sources and reduction |
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Definition
oatmeal, metamucil, barley
10-25gm/day = 10% rdxn |
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Term
| When should you start monitoring cholesterol? |
|
Definition
| age 20 then q5yr (earlier w/ fam hx) |
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Term
| Does a fasting lipid panel directly measure LDL? |
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Definition
| NO it can be calculated though |
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Term
| What drugs might increase LDL? |
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Definition
| Progestins, anabolic and cortico steroids, cyclosporine and thiazides |
|
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Term
| what drugs might increase TG? |
|
Definition
| Estrogens, proease inhibitors, corticosteroids, isotretinoin, atypical antipsychotics, BB, Thiazides |
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Term
| Which drugs might decease HDL? |
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Definition
| Progestins, protease inhibitors, corticosteroids, cyclosporine, BB |
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|
Term
| Framingham <10, 10-20, >20 |
|
Definition
<10 moderate risk when w/ 2+ RF
10-20 mod-high risk when w/ 2+ RF
>20 CHD risk equivalent |
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|
Term
| normal TG and very high TG |
|
Definition
Normal 150
Very high 500- causes pancreatitis |
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Term
| What are the requirements for metabolic synd? |
|
Definition
| 3 or more of the following: M40" Asian M or FM35" Asian FM 31" waist; TG >150; HDL <40; BP > 130/85 OR HTN tx; Fasting glucose >100 or antidiabetic agents; apple shaped body (wt around waist) |
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Term
| What are the odds for metabolic synd? |
|
Definition
2x more likely in diabetes
4x more likely for CHD |
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Term
| a pt that has heart disease and currently smokes is classified as _______ |
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Definition
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Term
|
Definition
|
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Term
| Niacin's greatest changes are with what? |
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Definition
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|
Term
| What two levels and what drug might need to be adjusted w/ niacin? |
|
Definition
Uric acid and glucose
antidiabetic agents |
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|
Term
| What is Niaspain contraindicated for? |
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Definition
|
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Term
|
Definition
| Yes, so watch out for it w/ a statin |
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Term
| Sustained release niacin has better what? |
|
Definition
| flushing (less), but poor LDL rdxn, and ALOT more hepatotoxic! |
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Term
|
Definition
|
|
Term
| What is the goal niaspan dose? |
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Definition
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Term
| What do fibrates lower and what does that prevent? |
|
Definition
| TG, pancreatits. Sometimes you have to use fibrates just to get low enough to get an accurate LDL |
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|
Term
| Which has less interactins fenofibrate or gemfibrozil? |
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Definition
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|
Term
| Fibrates and warfarin interact to what? |
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Definition
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|
Term
| What hyperlipidemia drug is shown to decrease MI and sudden cardiac death? |
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Definition
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Term
|
Definition
|
|
Term
| What are 3 things to watch out for with Lovaza? |
|
Definition
>3gm causes inhibition of platelet aggr
Mercury levels
Increased LDL |
|
|
Term
| What is the goal of HTN therapy? |
|
Definition
| reduce target organ damage and decrease CVD |
|
|
Term
| What form of secondary HTN is most common? |
|
Definition
|
|
Term
| How many medications would a stage II htn pt be started on? |
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Definition
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|
Term
| How many BP readings should be taken before making a clinical decision? |
|
Definition
| 2 readings 2wks apart and average the data |
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|
Term
| What are the 4 basic steps to determining HTN drug therapy? |
|
Definition
| 1) Take BP 2) Stage HTN 3) note compeling indications (if any) 4) select appropriate drug therapy |
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|
Term
| What is a compelling indication? |
|
Definition
| current disease state that has good evidcence with positive outcomes to support a particular antiHTN that will improve disease state and HTN |
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Term
| Who has a lower BP goal? what is it? |
|
Definition
CKD, DM, CAD, PAD, AAA, >10% framingham, GF <60 (proteinuria/albuminuria)
130/80 |
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|
Term
|
Definition
|
|
Term
| The lowest BP goal is 120/80, who is this for? |
|
Definition
|
|
Term
| What should Na intake be limited to per day? |
|
Definition
|
|
Term
| True or False: often times "hypertensive" type drug therapy is started before evidence of HTN just to get protective benefits |
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Definition
|
|
Term
| Which drug is best for isolate systolic htn (ISH)? |
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Definition
|
|
Term
| Which gender has more HTN? |
|
Definition
| They are almost the same, women slightly more |
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Term
| Hispanic-americans tend to have a lower incendence of HTN but what is their problem? |
|
Definition
| Tx is not up to par, often not treated to reach goal |
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|
Term
| ALWAYS incorperate what into HTN therapy? |
|
Definition
|
|
Term
| how do you dx white coat synd? |
|
Definition
| monitor BP at home, do sleep studies |
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|
Term
| What is first line in HTN? |
|
Definition
|
|
Term
| What is first line Tx for a compelling indication of LVF (left ventricular fxn) |
|
Definition
| Diuretic w/ ACEI Then add BB. If still uncontrolled use ARB or ald antagonist |
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|
Term
| What is the Tx of Pt with compelling indication of post MI |
|
Definition
BB, then add ACEI/ARB.
If still uncontrolled try aldosterone antag |
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