CAD: Primary & Secondary Prevention Flashcards Preview

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Flashcards in CAD: Primary & Secondary Prevention Deck (73):
0

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

Yes

1

What was the important point from MIRACL trial?

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

2

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

Dec TG, Inc HDL
YES

3

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

Men >45
Women > 55 (or early menopause)

4

Define family hx of CAD

1st degree relative
Male < 55
Woman < 65

5

What is considered a CAD risk equivalent

Risk factors that confer 10 yr risk for CHD > 20%
PAD/AAA/symptomatic carotid dz

6

Components of Framingham risk score

Age
SBP
TC
HDL
smoker

7

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

Goal LDL<100
Start Rx at 100

8

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

LDL goal<130
Rx at 130

9

What % of total calories should saturated fat be?

<7%

10

Recommended intake of monounsaturated fats

Upto 20% of total calories

11

Recommended intake of total fat

25-35% of total calories

12

Recommended intake of fiber

20-30 grams per day

13

Recommended intake of cholesterol

<200mg/d

14

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

Q6 weeks for 3 visits, then q4-6 mo's

15

How will statins effect cholesterol panel?

Dec LDL
dec TG
Inc HDL

16

Name 2 statins that are not lipophilic

Rosuvastatin
Pravastatin

17

Which statin is safe to use with erythromycin and ketoconazole?

Pravastatin

18

Which statins use Cytochrome 2C9?

Rosuvastatin
Fluvastatin

("RF")

19

Which statin does not use CYP450?

Pravastatin

20

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

Pravastatin

21

Which statins use CA4 cytochrome system?

Lovastatin
Simvastatin
Atorvastatin
Rosuvastatin (also uses 2C9)

22

Name the statins in order from most potent to least potent

Rosuvastatin>atorvastatin>simvastatin>pravastatin

23

What to remember about statin induced myalgias

Dose related

24

Drugs assoc w/ statin induced myopathy

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

25

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

Age >75
Frail/LOL
DM/CKD
periop

26

Cytochrome P450 inhibitors that are associated with statin induced myopathy

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

27

What to do if statin induced myopathy?

Change statin or Dec dose by 1/2

28

Incidence and definition of statin induced myopathy

0.1%
CK> 10x ULN

29

Bile acid sequestration effect on lipid profile

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

30

Do bile acid sequestration decrease mortality? Why not used?

Yes
GI sxs and expensive

31

Absolute contraindications to bile acid seq,

TG> 400 mg/dl
Familial Dysbetalipoproteinemia

32

Absolute contraindications to niacin

Severe Gout
Chronic liver dz

33

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

Yes
No
Yes

34

AE's of niacin

Upper GI distress
Flushing
Hepatotoxicity
Hyperuricemia

35

How much do fibrates dec TG by?

20-50%

36

Do fibrates dec CHD risk

Yes (moderately)

37

AE's if fibrates

GI sxs
Gallstones
Myopathy

38

Fibrates contraindications

Severe hepatic dz or severe CKD

39

MOA of fibrates

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

40

Ezetimibe (zetia) indication

High LDL (in combo with statin or fibrate)

41

Does ezetimibe reduce CHD?

Yes

42

Which med increases HDL the most?

Niacin

43

Does metabolic syndrome inc CHD mortality?

Yes

44

Metabolic syndrome criteria

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

45

Target for hypertriglyceridemia Rx levels?

<150

46

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

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

47

4 meds that can treat high TG

Niacin
Fibrates
Omega 3 FAs
Statins

48

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

High dose Lipitor 80 better than low dose pravastatin

49

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

100
130
130
160

50

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

Non-HDL should be< 130

51

What to remember about treating TG> 500?

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

52

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

90%

53

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

When BP is >20/10 mmHg above goal

54

Is alcohol moderation a class I indication for BP control?

Yes

55

Punch line of ACCORD trial

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

56

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

Lowers incidence of nephropathy

57

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

III

58

Class IIa indication to check CRP

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

59

Class III indication for checking CRP

-asymptomatic adults at high risk for CHD
-Low risk men<60

60

Side effects of varenicline and bupropion for smoking cessation

Suicidal ideation

61

Overweight BMI
Obese BMI

25-29.9
30

62

JNC 8 RCTs for age > 60

Treat at BP 150/90

63

JNC 8 recs for age <60

Treat BP of 140/90

64

JNC 8 recs for DM

Goal BP < 140/90

65

JNC 8 initial Rx for blacks

Thiazides or CCB

66

JNC 8 initial Rx for non blacks

Thiazides, ACE/ARB, CCB

67

JNC 8 recs for CKD

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

68

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

Rosiglitazone

69

Over what age do you not start high dose statins?

75

70

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

Mod unless estimated 10yr ASCVD risk > 7.5%

71

At what LDL should you eval for secondary causes?

>190

72

What labs to check before starting statins?

LFTs
DM screen