Secondary Prevention (complete)

Question 1

What is used for the pharmacologic guidelines?

Answer 1

• Anti-platelets
• Beta-blockers
• RAAS inhibitors

Question 2

What is used for pharmacologic and lifestyle guidelines?

Answer 2

• BP control
• Lipid mgmt
• Diabetes mgmt
• Depression screening and mgmt
• Smoking cessation

Question 3

What is used for lifestyle guidelines?

Answer 3

• Weight mgmt

- Physical activity

Question 4

What is used in the ‘other’ category?

Answer 4

Cardiac rehab

Flu vx

Question 5

What does Class I mean?

Answer 5

Therapy should be reformed

Question 6

What does Class IIa and IIb mean?

Answer 6

assigned when there is debate over benefit of the therapy

Question 7

What does Class III mean?

Answer 7

Therapy should not be performed

Question 8

What are the Class I antiplatelet guidelines for all CAD pts?

Answer 8

Aspirin 75-162mg

Question 9

What are the Class I antiplatelet guidelines for all pts w/ ACS or PCI?

Answer 9

For 1 year following event:

• Thienopyridines
• Aspirin 81-325mg

Question 10

What are the Class I antiplatelet guidelines for post-bypass surgery pts?

Answer 10

Asprin 100-325mg

for 1 year

Question 11

What are the Class I antiplatelet guidelines for post-stroke pts?

Answer 11

• Aspirin alone
• Clopidogrel alone
• Combined aspirin/dipyridamole daily

Question 12

What are the Class I antiplatelet guidelines for pts w/ symptomatic PAD?

Answer 12

• Aspirin alone

OR

• Clopidogrel alone

Question 13

What are the Class I antiplatelet guidelines for a pt who requires warfarin for another indication (e.g. AF)?

Answer 13

Low-dose aspirin and monitor closely for bleeding

Question 14

What are the Class I beta-blocker guidlines?

Answer 14

BBs in all w/ LVSD (EF <40%) and HF symptoms or MI/ACS in past 3 years

Question 15

What are the Class IIa beta-blocker guidelines?

Answer 15

• BBs in all w/ LVSD (EF <40%) even in absence of HF symptoms
• BBs in all w/ any history of MI/ACS

Question 16

What are the Class I RAAS inhibition guidelines for ACEIs?

Answer 16

Give to those w/:
- LVSD
- DM
- HTN
OR
- chronic kidney disease

Question 17

What are the Class I RAAS inhibition guidelines for ARBs?

Answer 17

• w/ LVSD

AND

• either prior MI or HF symptoms

Must be intolerant to ACEIs

Question 18

What are the Class I RAAS inhibition guidelines for aldosterone inhibition?

Answer 18

• Post-MI w/ LVSD
• Are receiving therapeutic doses of BB & ACEI/ARB
  AND
• Have HF or diabetes

Avoid in those w/ renal dysfunction or significant hyperkalemia

Question 19

Which interventions can control BP?

Answer 19

• Lifestyle
• Low sat fat/Na diet
• RAAS inhibitors
• BBs
• Diuretics
• CCBs
• Direct vasodilators

Question 20

What are the Class I BP control guidelines? (think #s)

Answer 20

Age <150/90

Question 21

Which types of statins are more efficacious in reducing cardiac events?

Answer 21

High dose statins

Question 22

What are some non-statin lipid tx?

Answer 22

• Bile acid binding agents
• Niacin
• Fibrates

No evidence of efficacy

Question 23

What are the Class I lipid guidelines for all CAD pts?

Answer 23

• High dose (atorvastatin 80mg or rosuvastitin 20-40mg) in pts ≤75yo

Question 24

What are some negating factors (don’t know what else to call it) in the 2013 Class I lipid guidelines?

Answer 24

• No need to titrate med to LDL
• No indication for non-statin lipid lowering therapies
• Not proven in HF NYHA Class III-IV
• Not proven in hemodialysis pts

Question 25

What are some unclear relationships (lol) with Class I lipids guidelines?

Answer 25

- Myopathy/myalgies (~5-15%) - New-onset DM (0.1-0.3%) - Rhabdo in 0.01% - Hemorrhagic CVA in 0.01%

Question 26

Diabetes confers the same mortality risk as what?

Answer 26

Prior MI

Question 27

What are the Class I diabetes guidelines?

Answer 27

- Life modifications | - Coordination w/ PCP

Question 28

What are the IIa diabetes guidelines?

Answer 28

- Metformin First-line pharmacologic therapy

Question 29

What are the IIb diabetes guidelines?

Answer 29

- HbA1c <7% can be considered

Question 30

Depression is associated with _____ cardiac outcomes

Answer 30

Worse

Question 31

What are the Class IIa depression guidelines?

Answer 31

- Assessment of depression

Question 32

What are the Class IIb depression guidelines?

Answer 32

- Tx for depression does not appear to improve cardiac outcomes - Is beneficial for overall mental health

Question 33

How does smoking promote atherosclerosis?

Answer 33

- Oxidizes LDL - Inflammatory - Decreases HDL - Causes endothelial dysfunctions - Causes reductions in NO

Question 34

What are the Class I smoking guidelines?

Answer 34

Just stop fucking smoking easier said than done though...

Question 35

What are the Class I weight control guidelines?

Answer 35

- Goal BMI = 18.5 - 24.9 - Goal waist circumference (men) = <35 in - Initial goals of weight loss should be 5-10% of body weight

Question 36

What are the Class I physical activity guidelines?

Answer 36

- Moderate to high-intensity exercise for 30-60 min/day | - At least 5, ideally 7, days/week