CAD Flashcards

Question

What are lipid lowering medications?

Answer 1

``` HMG Co-A Reductase Inhibitors “statins” –only agent with improved outcomes date Goal individualized based on risk PCSK9 Inhibitors (if statin intolerant or familial hyperlipidemia) alirocumab Injectable 75mg-150mg every 2 weeks evolocumab Injectable 420mg-monthly 140mg-every 2 weeks ```

Answer 2

Antiplatelet Agents– all patients with CAD should be treated with a platelet inhibitor: Aspirin (81 mg/day)-irreversible inhibitor of platelet cyclooxygenase activity and thereby interferes with platelet activation. In those patients allergic to aspirin, Plavix (clopidogrel) can be used -blocks ADP receptor–mediated platelet aggregation. Prasugrel (effient), Brillinta (ticagrelor) -newer agents Dual Antiplatelet Therapy (DAPT) recommended: For 1 year after acute coronary syndrome For 3-6 months after drug-eluting stent placement (depends on patient’s risk factors for bleeding)

Answer 3

``` age (want < 75, ideally < 65) current tobacco smoker DM MI at presentation prior PCI or MI stent diameter <3 mm paclitaxel-eluting stent CHF or LVEF <30% saphenous vein graft PCI ``` A score of ≥2 is associated with a favorable benefit/risk ratio for prolonged DAPT while a score of <2 is associated with an unfavorable benefit/risk ratio.

Answer 4

Reduce myocardial oxygen demand by decreasing heart rate, BP and contractility All patients with recurrent episodes of exertional angina should receive a beta blocker as first line therapy unless contraindicated If beta blockers are stopped, it should be done in a tapering fashion (or can precipitate angina)

Answer 5

Examples for angina: Atenolol 50–200 mg daily Metoprolol 50–200 mg twice daily * Propranolol 80–120 mg twice daily * * sustained release formulations available * these are b-blockers for which the greatest amount of clinical experience exists

Answer 6

Dosage: Should be carefully titrated to achieve a resting heart rate of 50-60 bpm and an exercise heart rate that does not exceed 90-100 bpm Side effects: bronchospasm, postural hypotension, claudication, depression, deterioration in intellectual capacity, salt retention, impotence, and potential masking of hypoglycemia

Answer 7

Important in the treatment of stable angina All patients with CAD should be prescribed sublingual or aerosol nitroglycerin to abort episodes of angina [educate them about how to take, 911] Effect of nitrates-reduction in the volume of fluid returning to the heart, improving subendocardial perfusion. Coronary vasodilation, improvement in collateral flow and afterload reduction augment this primary effect Side effect: headache

Answer 8

Can occur in some patients Results in a reduced therapeutic response A nitrate free period of at least 10-12 hours can result in enhanced efficacy If unable to provide a drug free period, then increased doses may be required for relief

Answer 9

Have antianginal effects due to direct coronary vasodilation and reduced peripheral resistance If unable to tolerate beta blockers, then calcium channel blockers are drug of choice Particularly effective in vasospasm

Answer 10

Dihydropyridines: (don’t effect conduction) Amlodipine 5–10 mg daily Felodipine 5–10 mg daily Side Effects: Headache, edema Non-dihydropyridines (effect conduction) Diltiazem Immediate release: 30–80 mg 4x daily, slow release: 120–320 mg Verapamil Immediate release: 80–160 mg tid or slow release: 120–480 mg qd Side Effects: Hypotension, dizziness, flushing, bradycardia, edema

Answer 11

Decreases late sodium current Decreases intracellular calcium overload No effect on heart rate or BP Dose: 500mg BID CAUTION-can cause QT prolongation Contraindicated in pts with prolonged QT & pts on other drugs that prolong QT (ex-sotalol) Contraindicated in pts with liver & kidney disease

Answer 12

1) Start: with 1 medication, then titrate weekly if symptoms persist 2) Next: add additional drug if necessary & titrate as needed 3) Maximal therapy-add a 3rd drug and titrate as needed

Answer 13

1. percutaneous coronary intervention | 2. CABG

Answer 14

Evaluate for the presence and status of control of major risk factors for CHD for all patients at regular intervals (approx. every 3 to 5 years). Pts with 2 or more risk factors for CHD: Calculate ten-year risk (National Cholesterol Education Program [NCEP] global risk) of developing symptomatic CHD to assess the need for primary prevention strategies Identify pts with known CHD and patients with a CHD risk equivalent PAD, DM, CKD or 10-year Framingham risk > 20%) for secondary prevention efforts

Answer 15

Patients with CAD that is stable-see annually After Acute MI-office visit in 1-2 weeks After PCI-office visit in 2-6 weeks Practitioner must be sure to receive a full report from acute care facility

Answer 16

Dietician referral may be necessary to make lifestyle modifications Exercise or Cardiac rehab referral (can reduce mortality by 25%). Cardiac rehab referral after PCI is now a National Cardiovascular Data Registry (NCDR) mandate. Home care referral may be necessary

Answer 17

What CAD means Risk factors and which one(s) the patient possesses. (write down BP, HR, lipids, Hgb A1c (<7), and weight goals) Lifestyle modifications-how these can be achieved Medication information Need to call 911 if unstable symptoms (rather than be driven by family member)What side effects can occur with meds When/what lab tests are needed Importance of making follow up visits Importance of adherence to medication regimen Involve patient AND significant others in care Importance of smoking cessation

Answer 18

Bupropion: an anxiolytic agent weak inhibitor of neuronal uptake of neurotransmitters has been effective when added to brief regular counseling sessions in helping patients to quit smoking. Varenicline first-in-class nicotine acetylcholine receptor partial agonist designed to provide some nicotine effects (easing withdrawal symptoms) blocks the effects of nicotine from cigarettes, discouraging smoking. Nicotine Inhaler Nicotine Patch