secondary prevention of CAD

Question 1

when is secondary prevention needed?

Answer 1

patients with confirmed CAD or vascular equiv

Question 2

what is goal of secondary prevention

Answer 2

prevent plaque rupture and progression

Question 3

secondary prevention with pharm

Answer 3

1) anti-platelet (P2y112 inhibitor or theienopyridines/thromboxane synthetase inhib) = block activ/adhesion from PLT
2) beta blocker
3) RAAS inhibitors

Question 4

what drug paired with aspirin reduces MI and stent thrombosis

Answer 4

thienopyridines

Question 5

thienopyridines + aspirin reduce ___

Answer 5

MI and stent thrombosis

Question 6

guidelines for class 1 antiplatelet

for all CAD patients

Answer 6

ASA 75-162 mg

Question 7

guidelines for class 1 antiplatelet

for all ACS or PCI

Answer 7

Thienopyridines + aspirin

1 yr after event

Question 8

guidelines for class 1 antiplatelet

for post bypass surgery

Answer 8

asa 100-325 mg

for at least 1 yr

Question 9

guidelines for class 1 antiplatelet

for post stroke

Answer 9

ASA alone

Clopidogrel alone

or combined apsirin + dipyridamole daily

Question 10

guidelines for class 1 antiplatelet

for symptomatic PAD patients

Answer 10

asa alone

clopidogrel alone

Question 11

guidelines for class 1 antiplatelet

if requiring warfarin for something else

Answer 11

low dose asa and monitor BLEEDING

Question 12

effects of beta blockers

Answer 12

1) decr HR
2) decr contractility
3) decr conduction velocity
4) decr systemic BP

Question 13

class 1 beta blocker guideline

when to use

Answer 13

ALL PATIENT WITH

1) LVSD <40%
2) HF SX IN LAST 3 YRS
3) MI/ACS in last 3 yrs

Question 14

class IIa beta blocker guideline

when to use

Answer 14

1) LVSD <40% even without HF sx

2) hx of MI/ACS

Question 15

effects of RAAS blockers

Answer 15

1) vasodilation
2) natriuresis
3) decr sympathetic
4) decr cardiac remodeling

especially LVSD and diabetics

Question 16

class 1 RAAS inhibitor guideline

ACEI

Answer 16

LVSD <40%
DM
HTN
CKD

Question 17

class 1 RAAS inhibitor guideline

ARB

Answer 17

ACEI intolerant

Question 18

class 1 RAAS inhibitor guideline

aldosterone inhibitor

Answer 18

LVSD <40% after MI receiving therapeutic beta blocker and ACEI/ARB + HF or diabetes

AVOID WITH RENAL FAILURE OR HYPERKALEMIA

Question 19

HOW TO CONTROL blood pressure

Answer 19

1) decr saturated fat/sodium <2.4 g/day
2) RAAS inhibitor (ACEI/ARB)
3) beta blocker
4) diuretic
5) calcium channel blocker
6) direct vasodilator

Question 20

class 1 blood pressure guideline

< 60 y/o

Answer 20

< 140/90

Question 21

class 1 blood pressure guideline

> 60 y/o

Answer 21

< 150/90

Question 22

are non-statin lipid treatments effective?

Answer 22

no

bile-acid binding agents
niacin
fibrates

Question 23

does decreasing BP below 140/90 show benefit?

Answer 23

no as long as < 140/90

Question 24

a

Answer 24

a

Question 25

class 1 lipid guideline

when to use

Answer 25

ALL CAD

Question 26

class 1 lipid guideline

drugs for high dose statin

Answer 26

atorvastatin 80mg

rosuvastatin 20-40 mg

Question 27

class 1 lipid guideline

drugs for mod dose

Answer 27

atorvastatin 10-20 mg
rosuvastatin 5-10 mg
pravastatin 40-80 mg
simvastatin 20-40 mg

Question 28

which patients are not proven for use with statin

Answer 28

NYHA Class 3-4
Hemodialysis
Myopathy/myalgias
new onset DM, rhabdo

Question 29

___ control DOES NOT REDUCE MI AND MAY CAUSE HARM

Answer 29

glycemic control

Question 30

glycemic control does not ___

Answer 30

does not reduce MI outcome

may cause harm

Question 31

class 1 diabetes guideline

Answer 31

lifestyle mod with PCP

Question 32

class IIa diabetes guideline

Answer 32

metformin first line

Question 33

class IIb diabetes guideline

Answer 33

HbA1c <7%

Question 34

depression treatment in CV events

Answer 34

improves depression symptom

NOT CARDIAC EVENTS

Question 35

class IIa depression guideline

Answer 35

just assess depression

Question 36

class IIb depression guideline

Answer 36

treat depression to improve mental health not outcome

Question 37

how does smoking affect atherosclerosis

Answer 37

1) oxid LDL
2) inflamm
3) decr HDL
4) endothelial dysfunction, decr NO

Question 38

class 1 smoking guideline

Answer 38

STOP SMOKING

no exposure to secondhand smoke

Question 39

obesity is defined by both ___

Answer 39

bmi

waist size

Question 40

weight loss strategies

diet component

Answer 40

caloric restriction

nutrition counseling
physical activity

MACRONUTRIENTS LESS IMPORTANT

Question 41

weight loss strategies

meds

Answer 41

orilstat

Question 42

weight loss strategy

bariatric surgery

Answer 42

bmi >40 or >35 with co-morbidities

Question 43

class 1 weight control guideline

Answer 43

goal bmi = 18.5-24.9

waist <35 women

lose 5-10% of body weight initially

Question 44

class 1 physical activity guideline

Answer 44

moderate to high intensity 30-60 min per day 5 day per week