cardiology test 1

ACEi or ARB

what is the drug preference in diabetes?

ACEi or ARB

what is the drug preference in HFrEF?

DHP CCB or thiazides

what is first line for HTN in AA?

ACEi or ARB or BB

what is second line for HTN in AA?

aldosterone receptor blocker : spirnolactone

what is the drug of choice for resistant HTN ?

ACE, ARB, CCB or thiazide

what is first line for HTN in < 55 yrs old

CCB or thiazide

what is first line for HTN in > 55 yrs old?

BB

what is second line for HTN in < 55 yrs old?

ACE, ARB, BB

what is second line for HTN > 55 yrs?

ACE/ ARB bc renal protecting

what is the drug preference in CKD?

labetalol, methyldopa

what is first line for prego?

BB unless they are cardio selective

what drugs are contraindicated in asthma/ lung conditions?

methyldopa

what medication is contraindicated in liver disease?

IV nicardipine or IV labetalol

what are the drugs of choice for HTN emergency?

clonidine

captopril

nifedipine

what are the drugs of choice for HTN urgency?

midodrine

fludrocortisone

what drugs can be given to help with hypotension?

cholesterol (LDL)

what is the main causal agent of ASCVD?

atherosclerosis

what is the leading cause of death in the US?

apoproteins

what carries lipids?

HDL

what cholesterol is the smallest and densest , consisting for mainly apoproteins and cholesterol?

LDL

which cholesterol carries the most cholesterol?

VLDL

what cholesterol is the largest, least dense and consisits mostly of TGs?

apolopoprotein B-100

what protein carries fat and cholesterol thru your body?

age

lab values for lipid panels are ____ dependent?

TG/5 = cholesterol in VLDL

becomes inaccurate when TG > 150mg/dL

what is the formula to measure the amount of cholesterol in VLDL?

lopoprotein (a)

what is the subfraction of LDL that is genetically determined?

>30-50 mg/dL

elevated levels of lipoprotein (a) > ____ were linkd to CVD risk?

statin use

what is favored for ppl with elevated lipoprotein (a)?

familial hypercholesterolemia ( causes high LDL levels)

what genetic defect involves absent or defective LDL receptors ?

statin

what drug is given for familial hypercholestolemia?

familial chylomicronemia syndrome

what genetic disorder is a mutation of LPL genes that disrupts the breakdown of fats causing TG accumulation?

familial chylomicronemia syndrome

what genetic disorder can cause pancreatitis, hepatosplenomegaly, xanthomas, abd pain?

statins

what is the inital tx for familial hypercholesterolemnia?

very low fat diet ( <20 gm per day)

what is the tx for familail chylomicronemia syndrome?

familial combine hyperlipidemia

what genetic condition causes increase in total cholesterol, LDL, TG , and decrease in HDL?

hepatic overproduction of LDL and VLDL

what is believed to be the cause of familial combined hyperlipidemia?

obesity, premature CHD, xanthelasmas

what are the clinical manifestations of familial combined hyperlipedemia?

familial defective apolipoprotein B-100

what genetic condition causes increased total cholesterol due to defective LDL receptors?

tendon xanthomas , premature CHD

what are the clinical manifestations of familial defective apo B-100?

cirrhosis, malignancy , hyperthyroidism

what are the only 3 secondary conditions that decrease total cholesterol?

acute pancreatitis

severe elevation of TG induces ___?

tendon xanthomas (Achilles, patella, hand)

high LDL concentration cause?

lipemia retinalis

extremely high TG >2000 can cause?

statins

what is the main med used for people with high lipids for secondary prevention?

20 yrs

what age does high cholesterol screening begin?

coronary artery calcium score (CAC)

what is the best test for additional risk stratification for high lipids?

LDL > 190 mg/dL

give a statin

those with a LDL > _____ are recommended for tx regardless of their 10 yr risk score

low risk : < 4.9%

borderline : 5-7.4%

intermediate : 7.5-20%

high risk : > 20%

what are the % for each ASCVD 10 yr risk categories?

people with no existing or history of ASCVD

who is the ASCVD risk scoring used for?

LDL cholesterol

statins are used to reduce___?

exercise

quit smoking

diet ( low fat , higher carbs or decrease meat/ fat , increase fruits/veg or DASH or med diet)

what are the other measures to help reduce high lipids?

>1000

if TG are > ____ its more likely to cause pancreatitis

1. lifestyle changes= first line

2. statin

3. add fibrate ± omega (icosapent ethyl)

what are the steps for tx of hypertriglyceridemia?

1. adults w/ DM

2. existing ASCVD

3. LDL > 190 mg/dL

4. 10 yr risk of ASCVD > 7.5

what are the 4 groups of ppl that should be on a statin?

fibrate

omega -3

which meds decrease TG?

statins

what is first line for lipid disorders?

atrorvastatin

rosuvastatin

decrease LDL by > 50%

what are the 2 high intensity statins and what does high intensity mean?

decrease LDL by 30-50%

what indicates a moderate intensity statin?

ezetimibe

what is second line for high lipid disorders?

ezetimibe

what med should be added to a max statin if LDL is still not at goal?

PCSK9 inhibitors (“ cumab”)

what is third line for lipid disorders?

omega-3 ( icosapent)

what med decreases unstable angina by 25% in statin-treated patients w/ TG >135?

bile acid binding resins (“cole” cholestyramine, colesevelam, colestipol)

what med can cause TG to increase ?

bile acid binding resins

what lipid medication is safe in pregnancy ?

bile acid binding resins

what shouldnt be given as a lipid drug for patients on warfarin?

fibrates

( gemfibrozil and fenofibrate (preffered))

what drug is the best at decreasing TG?

diabetes and TG > 150

icosapent should be used for patients w/ ___ and ___?

niacins ( nicotinic acid)

what was the first lipid lowering agent associated w/ reduction in total mortaility?

niacins ( nicotinic acid) give ASA or NSAID to stop it

what drug causes prostaglandin mediated flushing? how to stop it?