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CAD: Primary & Secondary Prevention Flashcards

1
Q

What was the important point from MIRACL trial?

A

Lipitor has benefit as early as 16 weeks in pt’s w/ prior MI

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2
Q

What do fibrates do to cholesterol? Do they decrease CV events?

A

Dec TG, Inc HDL

YES

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3
Q

What age (by gender) is a risk factor for CAD?

A

Men >45

Women > 55 (or early menopause)

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4
Q

Define family hx of CAD

A

1st degree relative
Male < 55
Woman < 65

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5
Q

What is considered a CAD risk equivalent

A

Risk factors that confer 10 yr risk for CHD > 20%

PAD/AAA/symptomatic carotid dz

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6
Q

Components of Framingham risk score

A 
Age
SBP
TC
HDL
smoker
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7
Q

NCEP ATP III: LDL goal and when to start Rx for high risk (>20% 10y risk)

A

Goal LDL<100

Start Rx at 100

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8
Q

NCEP ATP III: LDL goal and when to start Rx for moderately high risk (10-20% 10y risk)

A

LDL goal<130

Rx at 130

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9
Q

What % of total calories should saturated fat be?

A

<7%

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10
Q

Recommended intake of monounsaturated fats

A

Upto 20% of total calories

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11
Q

Recommended intake of total fat

A

25-35% of total calories

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12
Q

Recommended intake of fiber

A

20-30 grams per day

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13
Q

Recommended intake of cholesterol

A

<200mg/d

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14
Q

When instituting TLC for lipid lowering, how often do u bring pt’s back?

A

Q6 weeks for 3 visits, then q4-6 mo’s

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15
Q

How will statins effect cholesterol panel?

A

Dec LDL
dec TG
Inc HDL

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16
Q

Name 2 statins that are not lipophilic

A

Rosuvastatin

Pravastatin

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17
Q

Which statin is safe to use with erythromycin and ketoconazole?

A

Pravastatin

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18
Q

Which statins use Cytochrome 2C9?

A

Rosuvastatin
Fluvastatin

(“RF”)

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19
Q

Which statin does not use CYP450?

A

Pravastatin

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20
Q

Most statins bind completely to proteins. Which one does so only 50% of the time?

A

Pravastatin

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21
Q

Which statins use CA4 cytochrome system?

A

Lovastatin
Simvastatin
Atorvastatin
Rosuvastatin (also uses 2C9)

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22
Q

Name the statins in order from most potent to least potent

A

Rosuvastatin>atorvastatin>simvastatin>pravastatin

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23
Q

What to remember about statin induced myalgias

A

Dose related

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24
Q

Drugs assoc w/ statin induced myopathy

A 
Verapamil
Amio
Nicotinic acid
Fibrates (Gemfibrozil>>Tricor)***
EtOH
P450 3A4 inhibitors
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25
Q

Risk factors assoc w/ statin induced myopathy (not including drugs)

A

Age >75
Frail/LOL
DM/CKD
periop

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26
Q

Cytochrome P450 inhibitors that are associated with statin induced myopathy

A

Cyclosporine
-conazole antifungals (ketoconazole, etc)
Macrolides (erythromycin, clarithromycin, nefazodone)
HIV PI’s
Grapefruit juice

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27
Q

What to do if statin induced myopathy?

A

Change statin or Dec dose by 1/2

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28
Q

Incidence and definition of statin induced myopathy

A

0.1%

CK> 10x ULN

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29
Q

Bile acid sequestration effect on lipid profile

A

Dec LDL by 15-30%*
Inc HDL by 3-5%
TG no effect or even increase!*

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30
Q

Do bile acid sequestration decrease mortality? Why not used?

A

Yes

GI sxs and expensive

31
Q

Absolute contraindications to bile acid seq,

A

TG> 400 mg/dl

Familial Dysbetalipoproteinemia

32
Q

Absolute contraindications to niacin

A

Severe Gout

Chronic liver dz

33
Q

Does niacin effect all lipids favorably?
Does it dec mortality?
Does it reduce CHD risk?

A

Yes
No
Yes

34
Q

AE’s of niacin

A

Upper GI distress
Flushing
Hepatotoxicity
Hyperuricemia

35
Q

How much do fibrates dec TG by?

A

20-50%

36
Q

Do fibrates dec CHD risk

A

Yes (moderately)

37
Q

AE’s if fibrates

A

GI sxs
Gallstones
Myopathy

38
Q

Fibrates contraindications

A

Severe hepatic dz or severe CKD

39
Q

MOA of fibrates

A

Inhibits absorption of chol at small intestine brush border–> dec chol to liver, inc clearance from blood

40
Q

Ezetimibe (zetia) indication

A

High LDL (in combo with statin or fibrate)

41
Q

Does ezetimibe reduce CHD?

A

Yes

42
Q

Which med increases HDL the most?

A

Niacin

43
Q

Does metabolic syndrome inc CHD mortality?

A

Yes

44
Q

Metabolic syndrome criteria

A 
Need 3/5: 
BP > 130/85
FG > 100
TG> 150 mg/dl
Waist: men- 40in/women- 35in
HDL: men <50
45
Q

Target for hypertriglyceridemia Rx levels?

A

<150

46
Q

If TG>200 after LDL is treated, what to do?

A

Secondary goal for non HDL chol (total-HDL) is 30 above LDL goal

47
Q

4 meds that can treat high TG

A

Niacin
Fibrates
Omega 3 FAs
Statins

48
Q

What did the PROVE-IT trial show for death, MI, hospitalization for angina , and revasc?

A

High dose Lipitor 80 better than low dose pravastatin

49
Q

What is the LDL goal for CHD risk of high, moderately high, mod, low?

A

100
130
130
160

50
Q

In secondary prevention, if TG 200-499, what is the plan?

A

Non-HDL should be< 130

51
Q

What to remember about treating TG> 500?

A

Rx w/ fibrate or niacin too recent pancreatitis BRFORE treating LDL

52
Q

If nor intensive at age 55, what is one’s lifetime risk of developing HTN?

A

90%

53
Q

When to initiate HTN therapy with TWO drugs (JNC 7)

A

When BP is >20/10 mmHg above goal

54
Q

Is alcohol moderation a class I indication for BP control?

A

Yes

55
Q

Punch line of ACCORD trial

A

Higher mortality with intensive glucose control (HbA1C<6%)

56
Q

According to ADVANCE trial, what is the only potential benefit of intense glycemic control in DM?

A

Lowers incidence of nephropathy

57
Q

What guideline class is measurement of non-standard lipid parameters (like lipoproteins)?

A

III

58
Q

Class IIa indication to check CRP

A

Men>50, women >60 with LDL<130 and no other problems

59
Q

Class III indication for checking CRP

A
  • asymptomatic adults at high risk for CHD

- Low risk men<60

60
Q

Side effects of varenicline and bupropion for smoking cessation

A

Suicidal ideation

61
Q

Overweight BMI

Obese BMI

A

25-29.9

30

62
Q

JNC 8 RCTs for age > 60

A

Treat at BP 150/90

63
Q

JNC 8 recs for age <60

A

Treat BP of 140/90

64
Q

JNC 8 recs for DM

A

Goal BP < 140/90

65
Q

JNC 8 initial Rx for blacks

A

Thiazides or CCB

66
Q

JNC 8 initial Rx for non blacks

A

Thiazides, ACE/ARB, CCB

67
Q

JNC 8 recs for CKD

A

Rx with ACE/ARB to goal BP< 140/90

68
Q

Which med is a class III rec for DM and SIHD?

A

Rosiglitazone

69
Q

Over what age do you not start high dose statins?

A

75

70
Q

If pt is age 40-75 and DM, do you start mod or high intensity statin?

A

Mod unless estimated 10yr ASCVD risk > 7.5%

71
Q

At what LDL should you eval for secondary causes?

A

> 190

72
Q

What labs to check before starting statins?

A

LFTs

DM screen

73
Q

In primary prevention, do statins decrease CHD death, nonfatal MI and all-cause mortality?

A

Yes

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