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6030 Primary Care Test 2 Complete ☑️ > Module 4 (a) > Flashcards

Module 4 (a) Flashcards

1
Q

Cardiovascular Dz Prevention

-Recommendations?

A

Look at article**

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2
Q

CVD

-Modifiable Risk Factors

A
  1. Smoking
  2. Dyslipidemia
  3. DMT2
  4. Increased waist to hip ratios
  5. Physical inactivity
  6. Poor diet
  7. HTN
  8. Psychosocial stress
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3
Q

ASCVD Risk Assessment

-What is it?

A
  1. Estimate a patients initial 10-year ASCVD risk in ages 40-79 yrs old ***
    - You can only do LIFETIME risk not 10 year risk outside of the age range
  • Low risk (<5%)
  • Borderline Risk (5-7.5%)
  • Intermediate risk (>/=7.5-20%)
  • High risk (>/=20%)
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4
Q

ASCVD

-Risk?

A
  1. Most Potent risk factor for ASCVD over age 50 is diabetes
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5
Q

Diabetes T2DM Med Management

-SGLT-2 & GLP-IR

A
  1. SGLT-2
    - Significant reduction in ASCVD events and HF
    - “Flozin” meds
  2. GLP-IR Agonists
    - Found to significantly reduce ASCVD events w/ T2DM and high risk
    - “utide” meds
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6
Q

Lipids

-Labs to monitor

A
  1. Fasting Lipid panel and CMP
  2. Follow up in 4-12 wks to check adherence and for med changes
  3. Check yearly once stable
  4. Check CMP and CK if pt is symptomatic of liver dz or has myalgias
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7
Q

Lipid Labs

-Total cholesterol?

A
  1. Total cholesterol below 200 mg/dl is Optimal; High is above 240 mg/dl
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8
Q

Lipid Labs

-LDL-C?

A
  1. LDL below 100 mg/dl is Optimal; VERY HIGH is above 190 mg/dl

Treat to the LDL

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9
Q

Lipid Labs

-HDL?

A
  1. HDL above 60 is optimal; Very low is below 40
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10
Q

Lipid Labs

-Triglycerides

A
  1. Below 150 is Optimal; Very high is above 500

If Triglycerides come back high, question if patient was fasting**

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11
Q

Hypertriglyceridemia

-FIBRATES

A
  1. Fasting serum Triglyceride level > 400mg/dl
  2. FIBRATES decrease triglyceride values by 35-50% and increase HDL levels 5-20%
  3. NO FIBRATES to pt’s with severe hepatic or renal dysfunction
  4. Complication risk is Increased when used with Statins
  5. MONITOR LFT’s to detect and prevent liver damage
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12
Q

Hypertriglyceridemia

-Complications

A
  1. HTG is the 3rd most common cause of acute pancreatitis after alcohol and gallstones
  2. If Triglyceride level is persistently above 886 mg/dl, start drug therapy to lower risk of pancreatitis
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13
Q

Hypertriglyceridemia

-Management

A
  1. Statins
  2. Bile Acid sequestrants
  3. Nicotinic acid
  4. Fibric acids
  5. Cholesterol absorption inhibitors
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14
Q

Hyperlipidemia

-Primary Prevention

A
  1. Assess risk factors beginning in childhood
  2. Age <19 w/ familial hypercholesterolemia = START STATIN
  3. Age 20-39 = estimate lifetime risk and promote healthy lifestyle
    - Consider statin in those w/ family hx of premature ASCVD and LDL-C >/= 160
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15
Q

Hyperlipidemia

-Treatment Guideline (High Intensity)

A
  1. Ages 20-75 + LDL-C >/=190 mg/dl = high intensity statin w/out risk assessment
  2. T2DM >/= 10 yrs, T1DM >/=20 years, renal dz, retinopathy, PVD with ABI <0.9
    - High intensity statin w/ aim to lower LDL by 50%
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16
Q

Hyperlipidemia

-Treatment Guideline (Moderate Intensity)

A
  1. Ages 40-75 + T2DM = Moderate intensity statin

- Use risk assessment to see if patient needs high intensity statin

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17
Q

Hyperlipidemia

-Treatment Guideline CAD

A

If a patient has known coronary disease, they need to be on a statin.

Treatment guidelines are for patient w/out known coronary artery disease

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18
Q

Breakdown of Risk and Treatment

-Borderline Risk

A
  1. 5-7.5%
    - Reduce present modifiable factors
    - Discuss moderate intensity statin
    - Consider coronary artery calcium score
19
Q

Breakdown of Risk and Treatment

-Intermediate Risk

A
  1. > 7.5-20%
    - Use moderate intensity statin
    - Use High intensity statin if Pt has increased Risk factors (Risk stratification w/ CAC if risk is uncertain

*Coronary artery calcium score (CAC)

20
Q

Breakdown of Risk and Treatment

-High Risk

A
  1. > /= 20%
    - Risk discussion to initiate high intensity statin
    - Goal to reduce LDL by >/=50%
21
Q

Coronary Artery Calcium Score (CAC)

-CAC scores?

A
  1. Score of 0
    - Can avoid statins and recheck CAC in 5-10 yrs. (Make sure pt doesn’t smoke)
  2. Score 1-100
    - Reasonable to initiate moderate intensity statin
  3. Score >100
    - >75th percentile; Use a statin at any age
22
Q

Coronary Artery Calcium Score (CAC)

-More Info

A
  1. A score of ZERO does not imply zero risk
  2. ALWAYS incorporate w/ other known risk factors
  3. Doesn’t replace a stress test
23
Q

Primary Prevention of ASCVD

-Aspirin Use?

A
  1. Consider low dose aspirin (75-100mg daily) for

- 40-70 yr old adults who have higher risk for ASCVD but NO increased risk of bleeding

24
Q

Primary Prevention

-Weight Control

A
  1. Obesity BMI >/= 30
  2. Overweight BMI 25-29.9
    - Both Obesity and overweight increase risk for ASCVD, HF, A fib, compared to normal weight
  3. Meaningful weight loss is considered >/= 5% of initial weight
    - 5-10% loss can result in improvement in BP, lipids, glucose and can delay T2DM
    - Document DMI and waist circumference during each visit.
25
Q

Primary Prevention

-Physical activity recommendation

A
  1. 150 min/wk of moderate intensity
  2. 75 min of vigorous-intensity exercise
    - 50% of patients are considered sedentary

Moderate activity = brisk walking, biking, dancing, yoga, swimming recreationally
Vigorous activity = Jogging/running, biking >10 mph, tennis, swimming laps

26
Q

HTN

-Non-modifiable (Relative) Risk Factors

A
  1. CKD
  2. Family Hx
  3. Increased Age
  4. Low socioeconomic status
  5. Male
  6. Obstructive Sleep apnea
  7. Psychosocial stress
27
Q

HTN

-Risk Factors

A
  1. Obesity
  2. Metabolic Syndrome
  3. High dietary Fat
  4. Smoking
  5. Stress
  6. Genetic
28
Q

HTN Can be a Risk Factor for?

A
  1. CVA
  2. MI, HF
  3. Aneurysms
  4. PAD
  5. Cognitive dysfunction
  6. Dementia
  7. Nephropathy (renal Failure)
  8. Retinopathy
29
Q

Secondary HTN

-Causes

A
  1. # 1 Cause of Secondary HTN is RENOVASCULAR DZ (Renal artery stenosis)
30
Q

Secondary HTN

-Common Causes

A
  1. Obstructive sleep apnea
  2. Renal parenchymal dz
  3. Primary aldosteronas
  4. Renal artery stenosis
31
Q

Secondary HTN

-Uncommon Causes

A
  1. Pheochromocytoma
  2. Cushing’s dz
  3. Hyperparathyroidism
  4. Aortic coarctation
32
Q

HTN

-Medication and Substances that increase BP

A
  1. Alcohol
  2. Amphetamines
  3. Antidepressants (SNRI’s NOT SSRI’s)
  4. Herbal supplements (St. John’s wart
  5. Oral contraceptives
  6. NSAIDS
  7. Cocaine, meth
  8. Systemic steroids
33
Q

True Resistant HTN

-Definition

A
  1. Pt is on max doses of all meds + a spironolactone
34
Q

HTN

-Initial Treatment Non-Black

A
  1. Non-Black patient + or - DM:

- Start Diuretic, CC or ACE/ARB

35
Q

HTN

-Initial Treatment Black Patients

A
  1. Start Thiazides-like diuretics or a CCB

2. Add an ACE-I/ARB later if they have DM

36
Q

HTN

-Initial Treatment w/ HFrEF, or CAD

A
  1. BB
  2. ACE/ARB
  3. Amlodipine
37
Q

HTN

-Most likely Initial Treatment

A
  1. Thiazide diuretic (HCTZ
  2. CCB’s
  3. ACE-I or ARB’s

Start with one of these and MAX the dose then add a second one if needed

38
Q

HTN

-Follow up

A
  1. See patient every 3-6 months

2. Yearly if BP is under control

39
Q

HTN

-BP treatment goal?

A

<130/80 **

40
Q

Apparent Resistant HTN

-Definition

A

Uncontrolled clinic BP despite being prescribed 3 or more anti-HTN meds or require prescriptions of four or more drug to control BP

41
Q

True Resistant HTN

-Definition

A
  1. Uncontrolled clinic BP w/ med adherence
    AND
  2. Uncontrolled BP confirmed by 24-hr ambulatory BP monitoring
42
Q

Pseudo-resistant HTN

A

Poorly-controlled HTN that appears resistant but is actually other factors:

  1. Inaccurate Cuff size (Small = high; Large = low)
  2. Poor adherence to meds
  3. Suboptimal med therapy
  4. Poor adherence to lifestyle and dietary approaches
  5. White coat HTN
43
Q

Refractory HTN

A
  1. Uncontrolled on maximal medical therapy
    -Defined as 5 or more medications including Chlorthalidone and MRA
    —Spironolactone
44
Q

HTN

-When to Refer

A
  1. Uncontrolled on 3 full doses or maximum tolerance
  2. Secondary causes
  3. Autonomic failure w/ or tho static hypotension but HTN when supine

6030 Primary Care Test 2 Complete ☑️ (8 decks)

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