Cardiology part 1 Flashcards
(41 cards)
What is percentage is low risk, intermediate risk, and high risk on the framingham score?
low risk = less than 10%
intermediate risk = LESS than 20%
high risk = above 20%
When would you start a statin in an individual who is in the LOW risk framingham group?
- if their LDL-C is > 5.0
- if they score 5%-9.9% and their LDL-C is 3.5> AND family history of premature CAD
when would you start a statin the intermediate risk group on the framingham score (10%-19.9%)
- LDL-C is >3.5
- Men > 50 with one risk factor ( low HDL, tobacco, HTN, high waist circumference)
- Women greater than 60 with one risk factor mentioned above
- Anyone in this group that has family history of premature CAD
When would you start a statin in a high risk framingham score group ( greater than 20%)
everyone in this group gets started on statins
When would you consider add on therapy for dyslipidemia?
After starting statin therapy if a patient still has an LDL-c above 2.0 OR they did not obtain a 50% reduction in their initial LDL level then you would consider starting an add on therapy
when treating HTN in a DM patient WITH nephropathy what are your first line meds?
ACE inhibitor
ARB
when treating HTN in a DM pt that does NOT have nephropathy what are your first lines?
ACE-I
ARB
Thiazide
LA-CCB
when treating a patient with CAD that has HTN what are your first line?
ACE - I
ARB
when treating HTN in a patient with stable angina what are your first line
B-Blockers
LA-CCB
when treating HTN in patient with CHF what are your first line medications?
ACE-I OR ARB AND B-blocker +/- diuretic
What medications are used to improve symptoms of angina and quality of life?
nitrates
B-blockers
Calcium channel blockers -> non DHP
what are the side effects of nitrates?
headaches (usually resolves if the patient persists with therapy)
Tachycardia
Hypotension
not often first line due to saftey profile
what are the side effects of b-blockers?
fatigue
hypotension
bradycardia
what are the side effects of CCB non DHP
headache, dizziness, bradycardia, heartblock
List the medications used for secondary prevention of ACS first line
ASA + clopidogrel X3-12 months then asprin alone
when would prasugrel and Ticagrelor be used and what are they?
anti-platelet/ clotting medications
They are often used in hospital in combination with ASA for patients with acute coronary syndrome who have had a percutaneous coronary intervention (PCI)
What are the side effect of Dipyridamole/ASA
This medication is used to treat CVA in secondary prevention and the side effects are bleeding, headache, and diarrhea
individuals are more likley to stop taking this medication over 5 years compared to asprin
more expensive, less likley to be used.
In an individual with NO CV risk factors (low risk group) when would you consider starting antihypertension medication?
what are you BP target range
if systolic is greater than 160 and diastolic is greater than 100
The target is less than 140/90
for patients with diabetes when would you consider starting antihypertensive medication? and what are the BP goals with treatment
bp greater than 130/80
and the goal of therapy is to have less than 130/80
When performing an OBPM (office blood pressure measurement with provider in the room can be electric) at what number would you be concerned for hypertension?
if OBPM is measured at 140/90 or greater than you need to perform Ambulatory Blood Pressure Monitoring (ABPM wears device for 24 hr period) or Home blood pressure monitoring (self monitors twice. daily)
OR if the AOBP is greater than 135/80 (this is where the provider leaves the room while BP is being measured)
if the mean is greater than 135/80 then you may diagnose the patient with HTN
remember you wouldnt start medication unless they were 160/100 OR have risk factors like DM
When treating hypertension based on a patient’s illness when would you use Diuretics and list them
Diuretics would be used as first line in patients who have diabetes with no kidney issues OR in individuals with Cerebral vascular accident hx like a stroke OR to as combo therapy to treat CHF
with CVA hx you would combine Thiazide with ACE-I
examples include: Thiazide (hydrochlorothiazide) , chlorthalidone, indapamide, spironolactone
Patients who have HTN and hx of CVA (stroke) what first line meds would you start them on?
combo ACE-i and Diuretic (thiazide)
in which comorbidities are ACE-Inhibitors used as first line to treat HTN?
- DM with or without kidney issues
- Coronary Artery Disease (heart injury due to cholesterol build up)
- Prior- MI
- CHF (with b-blocker, and maybe diuretic)
- CVA (with thiazide)
in which comorbidities are ARB used as first line to treat HTN?
- DM w/without kidney issues
- CAD
- CHF
- CVA
** note the difference is that it wouldn’t be first line to treat prior MI that would be ACE
