CVD

Question 1

Post-MI PCI tx

Answer 1

DAPT x1-3 years
BB x3 years
ACEi
Statin (high dose)

Question 2

Post-STEMI no PCI tx

Answer 2

Clopidogrel x 30 days
ASA
ACEi
Nitrates for ischemia

Question 3

Antiplatelets

Answer 3

ASA

P2Y12 Inhibitors: Clopidogrel, Ticagrelor, Prasugrel

Question 4

DAPT

Answer 4

Dual Antiplatelet Therapy

ASA 81mg + Clopidogrel 75mg (or Ticagrelor 90mg BID)

Question 5

PCI

Answer 5

Percutaneous Coronary Intervention
procedure used to open clogged heart arteries
pt may say they had angioplasty, catheter or stent put in

Question 6

ASA for primary prevention

Answer 6

may use in ages 40-70yo at low risk of bleeding ie. pt doesn’t have history of bleeding, CKD, uncontrolled HTN, pt isn’t on NSAIDs, steroids, anticoagulants

Question 7

HF triple therapy

Answer 7

ACEi
BB
MRA (spironolactone, eplerenone)
Dapagliflozin now quadruple tx
*all reduce hospitalizations and mortality

Question 8

HF meds if sx despite triple tx

Answer 8

Entresto (Sacubatril/Valsartan) 
Ivabradine
Hydralazine/Isosorbide Dinitrate
Digoxin 
*all reduce hospitalizations (except digoxin) and mortality

Question 9

Entresto

Answer 9

(Sacubatril/Valsartan)
for sx despite HF triple tx
need 36h washout from ACEi
CI in pregnancy

Question 10

Ivabradine

Answer 10

for sx despite HF triple tx (NYHA II-III)
must be in sinus rhythm & HR >70bpm (bc it reduces HR)
AE: bradycardia, visual disturbances

Question 11

Hydralazine/Isosorbide Dinitrate

Answer 11

for sx despite HF triple tx (NYHA III-IV) or alternative in ACE/ARB intolerant or Black pts
vasodilates, AE: hypotension, tachycardia, headache

Question 12

Digoxin

Answer 12

for sx despite HF triple tx (NYHA III-IV)
dose based on age, wt, renal fxn & monitor levels in dehydrating illness, dose increases or toxicity
AE: delerium, n/v/d, visual disturbances

Question 13

Statin indicated conditions

Answer 13

clinical atherosclerosis
abdominal aortic aneurysm
diabetes mellitus
CKD
LDL>5

Question 14

Statin targets

Answer 14

LDL<2 or 50% reduction

Question 15

Statins with CYP3A4 DDI

Answer 15

rosuvastatin, simvastatin, lovastatin

Question 16

Bile acid resins

Answer 16

cholestyramine, cholestipol, colesevelam
2nd line for dyslipidemia, preferred in pregnancy (statins CI in pregnancy)
AE: GI (constipation, heartburn, bloating)
DDI: malabsorption of vitamins, seperate 1h before or 4-6h after)

Question 17

Fibrates

Answer 17

gemfibrozil, fenofibrate, bezafibrate
used to lower TG or in combo with statins for dyslipidemia
AE: GI (take w food), renal dysfxn

Question 18

Niacin (B3)

Answer 18

used to lower TG and LDL
do not combine with statin
AE: flushing, hyperglycemia

Question 19

Ischemic stroke tx and secondary prevention

Answer 19

alteplase IV if <4.5h from stroke onset, otherwise antiplatelets: after ruling out hemorrhage
ASA (if not on it prior)
Clopidogrel
ASA/dipyridamole
ASA+Clopidogrel in 1st 21-30 days
anticoagulants: only if antiplatelets CI in ischemic stroke tx or for 2ndary prevention of cardiogenic stroke

Question 20

angina tx

Answer 20

nitrate spray sl q5m max 3x for all pts
CCB 1st line
BB 1st line in HF or MI
long acting nitrates 2nd line

Question 21

nitrates

Answer 21

nitrate spray sl q5m max 3x for all pts w angina
nitrates po or patch 2nd line for angina sx
10-12h nitrate free interval needed to prevent tolerance
AE: transient headache, hypotension, tachycardia, dizziness, flushing

Question 22

traditional tx for VTE

Answer 22

LMWH (dalteparin, enoxaparin, nadroparin, tinzaparin)

LMWH or fondaparinux or UFH x5days/until warfarin INR>2

Question 23

newer tx for VTE

Answer 23

Rivaroxaban
Apixaban
LMWH x5d then Dabigatran
LMWH x5d then Edoxaban

Question 24

duration of VTE tx

Answer 24

provoked = 3mths
(obesity, surgery, hosp, cancer, thrombophilias, pregnancy, COCs)
unprovoked = 3-6mths to indefinite

Question 25

duration of VTE prophylaxis

Answer 25

at least 10-14 days for total knee replacement, total hip replacement, hip fracture surgery, high risk general/abdominal surgery

Question 26

VTE prophylaxis med options

Answer 26

LMWH or DOAC* x5d then switch to ASA | *rivaroxaban and apixaban demonstrated superiority over enoxaparin

Question 27

Warfarin

Answer 27

for VTE tx: target INR 2-3 measured q3d-q3m preferred when DOACs unsuitable due to renal failure (CrCl<30), valvular disease, DDI (PGP, 3A4) or unstable condition AE: bleeding, hair loss, blue fingers, skin necrosis reversal with vit K1, prothrombin complex concentrate

Question 28

UFH

Answer 28

unfractionated heparin IV or SC for VTE tx target aPPT 1.5-2.5xULN preferred when unstable, planned invasive procedure, renal failure (CrCl<30), peri-thrombolytic AE: 5% risk of HIT, hyperkalemia, osteoporosis reversal with protamine sulfate

Question 29

LMWH

Answer 29

low molecular weight heparin for DVT tx or prophylaxis SC and more predictable wt based dosing than UFH AE: 1% risk of HIT, lower risk of osteoporosis

Question 30

Fondaparinux

Answer 30

indirect factor Xa inhibitor alternative to LMWH in VTE, can be used in HIT SC wt based dosing renally cleared

Question 31

DOAC

Answer 31

direct factor Xa inhibitors: apixaban, edoxaban direct thrombin inhibitors: rivaroxaban, dabigatran for VTE tx, prophylaxis, afib

Question 32

Amiodarone

Answer 32

most effective antiarrhythmic, used in vtach or afib (rhythm control) AE: GI, derm, neuro, opth, thyroid abnormalities DDI: digoxin

Question 33

Rate control

Answer 33

used for afib target HR<100 options: BB, Digoxin (except in CAD), CCB (except in HF)

Question 34

Rate vs Rhythm control (CCS 2020 Guidelines)

Answer 34

in persistent (>7d) Afib: rate control is 1st line rhythm control preferred if diagnosed within 1y, highly sx, multiple recurrances, difficulty achieving rate control, arrhythmia induced cardiomyopathy)

Question 35

When is pill-in-pocket used for arrhythmia?

Answer 35

paroxysmal (<7d) AF | or symptomatic tachycardias (diltiazem, verapamil, BB)

Question 36

CCS Algorithm for Stroke Prevention in Afib

Answer 36

``` OAC indicated if: -age>65yo -prior stroke/TIA, HTN, HF, Diabetes ASA indicated if: -CAD or PAD ```

Question 37

Afib + PCI or ACS tx vs Afib + PCI and ACS tx

Answer 37

Afib + PCI or ACS: OAC+Clopidogrel x1y then OAC | Afib + PCI and ACS: triple tx (ASA+OAC+Clopidogrel) x1d-6m then OAC+Clopidogrel x1y then OAC

Question 38

DOACs doses for Afib vs VTE

Answer 38

AFIB: Dabigatran 150 BID; 110 BID if >80yo or high bleed risk Rivaroxaban 20mg; 15mg if CrCl 30-45 Apixaban 5 BID; 2.5 BID if 2 of: SCr>133, >80yo, <60kg Edoxaban 60; 30 if <60kg, CrCl 30-50 VTE: Rivaroxaban 15mg BID x3w then 20mg daily Apixaban 10mg BID x7d then 5mg BID LMWH x5d then Dabigatran 150mg BID; 110 if >75yo high bleed risk LMWH x5d then Edoxaban 60mg OD; 30 if <60kg, CrCl 30-50