Cardio Exam 4

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palliative care

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217 Terms

1

palliative care

whole-person care for people with serious illness

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2

whole-person care

holistic care that addresses well-being as defined by individuals, their families, and communities

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3

serious illness

health condition that carries a high risk of mortality and either negatively impacts a person’s daily functioning or quality of life or excessively strains their caregivers

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4

no

should you wait until heart failure stage D for palliative care?

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5

mortality and rehospitalizations

what does palliative care NOT change?

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6

treat underlying cause, palliate

symptom management approach in serious illness

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7

drug side effect

any symptom in an older adult should be considered a ______ until proved otherwise

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8

NSAIDs

what is the most common cause of uncontrolled (and reversible) dyspnea in heart failure

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9

decompensation, death, increase in systolic blood pressure and MAP

what do systemic NSAIDs increase risk of?

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10

NSAIDs cause vasoconstriction of the afferent arteriole, which increases sodium and fluid retention

how do systemic NSAIDs worsen dyspnea in heart failure?

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11

NSAIDs constrict the afferent arteriole, which leads to reduced glomerular pressure, which causes an acute kidney injury

how do systemic NSAIDs cause acute kidney injury?

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12

NSAIDs prevent aspirin from binding to COX-1, making aspirin ineffective

how do NSAIDs affect antiplatelets when administered together?

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13

increase risk of GI bleeding

what risk does NSAIDs and anticoagulants have when administered together?

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14

life expectancy, values, preferences

what three things should someone think about when deprescribing medications?

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15

mortality, hospitalizations, high risk medications, and polypharmacy

benefits of deprescribing

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16

collect history

c in CEASE

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17

evaluate risk

first e in CEASE

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18

5

number of medications that is a predictor for drug induced harm

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19

assess each drug

a in CEASE

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20

sort (ranking drugs from high to low harm)

s in CEASE

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21

eliminate

second e in CEASE

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22

aspirin, amiodarone, statins, anticoagulants, HF meds (keep as long as tolerated)

potentially inappropriate cardiovascular medications in serious illness, frailty, or older adults

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23

indication, time to benefit, adverse effects, half-life

key factors for deprescribing decisions in serious CVD

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24

yes

end of lockman material

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25

group 1

who classification for pulmonary hypertension (PAH)

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26

group 2

who classification for PH with left heart disease

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27

group 3

who classification for PH with lung diseases or hypoxemia

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28

group 4

who classification for PH due to chronic thrombotic or other obstructions

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29

idiopathic PAH; connective tissue disorders

two most common reasons for PAH

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30

1

who functional class for no limitation of usual physical activity

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31

2

who functional class for mild limitation of physical activity with no discomfort at rest

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32

3

who functional class for marked limitation of physical activity with no discomfort at rest

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33

4

who functional class where PH symptoms are present at rest and have visible signs of right ventricular heart failure

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34

who functional class, 6 minute walk distance, BNP

three best indicators of survival rates in pulmonary hypertension

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35

clinical suspicion (ex: high BNP), echocardiogram, confirm with right heart catheterization

three steps in the PH diagnosis algorithm

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36

right heart catheterization

what is the diagnostic test needed in order to diagnose PH?

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37

greater than 20mmHg at rest

what is the mPAP minimum to be diagnosed with PH?

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38

CCBs

a patient that has a positive vasodilator test (idiopathic responder) can be put on what medication?

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39

idiopathic, hereditary, drug induced PH

what three groups of PH can you perform a vasodilator test on?

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40

who functional class 4

which group of patients does not need to go through a vasodilator test because CCBs are not an option to begin with?

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41

nifedipine, amlodipine, diltiazem, felodipine

what are the four options for beta blockers for PH?

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42

tadalafil

which PDE-5 inhibitor can’t be used in a patient with poor renal function?

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43

nitrates

what drug class is contraindicated in PDE-5 inhibitors?

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44

riociguat

what is the singular SGC inhibitor?

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45

who functional class 1 and 4

which patients are riociguat approved in?

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46

PDE-5 inhibitors and nitrates

what drug classes are contraindicated in SGC inhibitors?

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47

macitentan

what is the only endothelin receptor antagonist to decrease mortality and morbidity rate?

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48

ambrisentan

what is the only endothelin receptor antagonist to be selective for ETa?

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49

endothelin receptor antagonists

which PH drug class can cause fetal toxicity and requires monthly pregnancy tests?

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50

bosentan, macitentan, ambrisentan

what are the three endothelin receptor antagonists?

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51

epoprostenol

which prostacyclin has the best survival rates in PH?

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52

treprostinil

which prostacyclin has a long half life, is easiest to titrate, and works the fastest?

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53

iloprost

which prostacyclin must be inhaled 6-9 times a day?

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54

flolan

epoprostenol formulation that is unstable at physiological pH and temperatures

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55

veletri

epoprostenol formulation that is thermostable

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56

treprostinil

epoprostenol formulation that is an IV formulation associated with higher risk of gram-negative blood infections than epoprostenol

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57

selexipag

selective ip receptor agonist

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58

better as combination therapy

are tadalafil and ambrisentan better as a combination therapy or monotherapies?

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59

better as macitentan and tadalafil only

are macitentan and tadalafil and selexipag better as a combination therapy or monotherapies?

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60

yes

end of wessel material

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61

diet, drugs, diseases, disorders of metabolism

four secondary causes of hyperlipidemia

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62

retinoic acid and anabolic steroids

which drugs caused significantly elevated triglycerides?

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63

pancreatitis

biggest concern of significantly elevated triglycerides

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64

statins

1st line cholesterol medications in all patients without contraindications

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65

myalgias and rhabdomyolysis

two most common adverse effects for statins

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66

active liver disease, pregnancy

statin contraindications

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67

myalgia

muscle pain and weakness without CK elevation from statins

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68

myopathy

myalgias with CK that has 10 times the upper normal limit

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69

rhabdomyolysis

myopathy or weakness or CK that has 10,000 times the upper normal limit

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70

elderly, women

risk factors for muscle pain

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71

CK over 10 times the upper normal limit

what level of creatinine clearance is the minimum to stop statin

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72

Co-Q10

OTC medication that improves statin-associated muscle symptoms

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73

azole antifungals, macrolide, gemfibrozil, cyclosporine (diltiazem and verapamil over 10mg)

drugs that are contraindicated with simvastatin

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74

gemfibrizol

which fibrate is contraindicated in statins?

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75

40-80mg

high intensity dose range of atorvastatin

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76

20-40mg

high intensity dose range of rosuvastatin

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77

clinical ASCVD and secondary prevention patients

which patients should get high intensity statins?

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78

PSCK9 inhibitors

what drug class is preferred in very high risk patients if statins/ezetimibe do not lower LDL enough?

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79

high intensity statin

recommendations for primary prevention patient with LDL>190

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80

moderate intensity statin (high intensity if other risk factors)

recommendations for primary prevention patient with LDL<190 and diabetes and 40-75 years old

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81

lifestyle modifications

recommendations for primary prevention patient who is 0-19 years old

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82

lifestyle modifications

recommendations for primary prevention patient who is 20-39 years

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83

risk and benefits discussion

recommendations for primary prevention patient who is over 75 years old

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84

dependent on 10-year ASCVD risk (same recommendations as in Jacobsen lecture)

recommendations for primary prevention patient who is 40-75 years old with elevated LDL (still below 190) and no diabetes

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85

coronary artery calcium (CAC)

non-invasive CT scan of the heart to measure calcified plaque in coronary arteries

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86

LDL greater than 190

what is the LDL range for severe primary hypercholestrolemia?

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87

moderate intensity statin/high intensity statin with risk factors, no other non-statins recommended

primary prevention in those with diabetes

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88

GI issues

what are bile acid sequestrants more likely to be used for instead of hypercholesterolemia?

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89

statins, levothyroxine, warfarin, digoxin, vitamins

bile acid sequestrant drug interactions

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90

constipation

most common side effect with bile acid sequestrants

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91

250

bile acid sequestrants can’t be used if triglycerides are over what value?

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92

fibric acid

drug of choice when triglycerides are over 500mg and LDL is normal

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93

gemfibrozil

which specific fibrin cannot be used with statins?

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94

fenofibrate

which specific fibrin cannot be used with cyclosporine?

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95

ezetimibe

which cholesterol drug should not be used as a monotherapy due to not being effective in low HDL or high triglyceride patients?

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96

inhibits ATP citrate lyase (higher up in statin pathway)

mechanism of action for bempedoic acid (nexletol)

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97

reduces hepatic production of VLDL and reduces clearance of HDL

niacin mechanism of action

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98

flushing, liver disease

niacin side effects

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99

inhibitor of lipoprotein and endothelial lipase (lower levels of ANGPTL3 have lowered LDL and triglycerides)

example drug: evinacumab

mechanism of action for angiopoietin-like 3 drugs

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100

50%

LDL reduces by how much when a PCSK9 inhibitor is used with a max dose statin

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