Cardio Exam 5 (Urmie and Jacobsen)

Under a rebate system, who is the worst off and ends up paying the most in out of pocket costs per year?

Uninsured patient

Medicare Part D formulary: how many drugs in each therapeutic class/category? eg. anticoagulants

2

Medicare Part D formulary: must have adequate coverage of types of drugs commonly needed by beneficiaries based on what?

Guidelines

Medicare Part D formulary: they must include all or nearly all drugs in six protected classes of drugs. Which is NOT a protected class

Cardiovascular drugs

T/F: plans may have deductibles, copays, coinsurance, or PA requirements on protected classes

True, as long as there isn’t a pattern of discrimination

T/F: Iowa medicaid has a restrictive formulary

False, it is very open

T/F: brand names drugs are always more expensive than generics

False, rebates can make brand name less expensive

T/F: Appealing a denied PA has a low probability of success

False, they have a high probability of success

Typical chest pain meets how many of the following critera?

• Substernal chest discomfort

• Provoked by exertion or emotional stress

• Relieved by rest or nitroglycerin

3

Atypical chest pain meets how many of the following critera?

• Substernal chest discomfort

• Provoked by exertion or emotional stress

• Relieved by rest or nitroglycerin

2

Non-cardiac chest pain meets how many of the following critera?

• Substernal chest discomfort

• Provoked by exertion or emotional stress

• Relieved by rest or nitroglycerin

1 or none

Occurs due to increased O2 demand with fixed O2 supply

Stable angina

Occurs due to abrupt decrease in O2 supply due to plaque rupture and thrombosis

Unstable angina

T/F: patients with CCD should be anticoagulated indefinitely

True

T/F: all patients with CCD should also be on an ACE inhibitor

False, only if they have another indication such as HTN, CDK, diabetes or low EF

This list of drugs is appropriate for which indication?

• Beta blocker

• CCB

• Nitrate

• Ranolazine

Chronic Coronary Disease

CCD treatment consists of…

Treating symptoms only

In the treatment of CCD, when ranolazine recommended?

In patients who remain symptomatic despite treatment with beta blockers, CCBs or long acting nitrates

Which drug should be avoided in severe PAD and vasospastic angina?

Beta blockers

Which two drugs are used in vasospastic angina?

CCBs and nitrates

How frequently should SL nitroglycerin be refilled?

Every 6 months

This mechanism of action is for which drug?

• Decrease O2 demand

• Does NOT decrease HR or BP

• Contraindicated with strong 3A4 inhibitors

  • When used with non-DHPs, max does of 500 mg BID

Ranolazine

This mechanism of action is for which drug?

• Inhibits phosphodiesterase

• Inhibits platelet aggregation

• Increases vasodilation

• Contraindicated in congestive HF

• Improves claudication symptoms, but doesn’t change in CV deaths

Cilostazole

Claudication definition

Fatigue, cramping or pain of vascular origin in the lower extremities induced by exercise and relieved by rest

CCD

Angina

PAD

Claudication

After how long is it considered chronic limb ischemia?

2 weeks or longer

T/F: rivaroxaban 2.5 mg BID plus aspirin is approved for both CAD and PAD

True

T/F: in PAD patients, dual antiplatelet therapy (aspirin and clopidagrel) is not necessary long term but is beneficial after revascularization

True