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Cardiology > 2.5.1 Treatment of Cardiovascular Disorders > Flashcards

2.5.1 Treatment of Cardiovascular Disorders Flashcards

1
Q

Other than statins, what is a promising therapy to reduce LDL levels?

A

PCSK9 Inhibitors

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2
Q

What are the two epidemics of the US addressed in this lecture?

A

Obesity and HF

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3
Q

Are statins created equal?

A

No, statins have different levels of efficacy.

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4
Q

Which aldosterone blockade has an estrogenic effect that can lead to gynecomastia?

A

Spironolactone

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5
Q

Two examples of PCSK9 inhibitors. Why aren’t these as commonly used?

A

Alirocumab and evolocumab

Still awaiting results of outcome trials

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6
Q

What is the one well studied method to reduce relative risk for coronary heart disease?

A

Lipid lowering therapy

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7
Q

What are some of the causes of HF?

A

CAD

HTN

Valve dysfunction

Idopathic

Infection (Chagas disease)

Toxins (alcohol or cytotoxic drugs)

Valvular disease

Prolonged dysrhythmias

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8
Q

What are the primary effects of PCSK9 inhibitors?

A

LDL lowering

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9
Q

What is angina pectoris? What triggers it? Location? When is it considered stable?

A

Discomfort (not pain) in chest and related areas

Typically retrosternal in location brought on by exertion or emotional stress

Can orginate/radiate to jaw, neck, throat, shoulders, back, or arms

“Stable” when no change in frequency, duration, precipitating, or relieving factors in past 60 days

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10
Q

What is ischemia?

A

Supply/demand mismatch, most often due to severe CAD

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11
Q

What is used to treat bradydysrhythmias (SA node dysfunction, AV node dysfunction, complete AV block)?

A

Pacemakers

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12
Q

List the statins in order of relative potency (low to high).

A

Lovastatin, Pravastatin, Simvastatin, Fluvastatin, Atorvastatin, Rosuvastatin

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13
Q

What are the primary effects of statins?

A

LDL lowering, modest HDL raising and triglyceride lowering

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14
Q

In what patient population does CABG have an especially better mortality reduction in than PCI?

A

Diabetes mellitus

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15
Q

What are medical therapies are known to reduce mortality in HF?

A

Beta blockers (carvedilol, metoprolol succinate, and bisoprolol)

ACE Inhibitors/ ARBs (Lisinopril)

Neprilysin inhibitor/ ARB (sacubitril/valsartan)

Vasodilators (Hydralazine/isosorbide dinitrate combo)

Diuretics - Aldosterone antagonists (spironolactone, eplerenone)

Loop diuretic - furosemide

Sinus node inhibitor (ivabradine)

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16
Q

What is the normal function of PCSK9?

A

PCSK9 binds LDLRs and facilitates their degradation, which ultimately results in lower LDLRs and increased blood cholesterol

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17
Q

What is commonly used to in CABG of the LAD?

A

Left internal mammary artery

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18
Q
A
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19
Q

What do statins inhibit?

A

HMG-CoA Reductase

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20
Q

In patients with STEMI w/o contraindications (asthma, COPD, bradycardia, advanced heart block), what should be administered?

Hint: Common side effect = fatigue

A

Beta blocker

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21
Q

When are nitrates indicated? Effect on CAD mortality? Common side effect?

A

Patients with refractory symptoms despite beta blockers (or intolerant to beta blockers)

Effect on CAD mortality: no mortality benefit

Common side effect: headache

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22
Q

What treatments are used for symptom management in HF?

THESE DO NOT REDUCE MORTALITY.

A

Vasodilators

Loop diuretics (furosemide)

Nitrates

Digoxin

Inotropes/infusion therapy (refractory HF)

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23
Q

What is the lifetime risk of developing symptomatic CAD after age 40 in men and women?

A

Men: 49%

Women: 32%

24
Q

What are some other terms for coronary artery disease (CAD)?

A

Ischemic heart disease (IHD)

Atherosclerotic heart disease (ASHD)

Arteriosclerosis

Atherosclerotic cardiovascular disease (ASCVD)

25
Q

What anticoagulant can be used as ancillary therapy to fibrinolytic therapy?

A

Heparin (UFH)

Can be used in both STEMI and NSTEMI

26
Q

ACE Inhibitors are especially good for what type of post-MI patients?

What is the most common side effect? A severe side effect?

A

MI-patients with LV systolic dysfunction (EF < or = 40%)

Most common side effect is cough, angioedema is uncommon but serious

27
Q

What does PCI stand for?

A

Percutaneous coronary intervention (PCI)

28
Q

What is the most common side effect of statins?

A

Muscles pains (myalgias). It can cause patients to stop taking the medications

Statins have been indicated to possibly raise blood sugar resulting in memory impairment

29
Q

What did the Framingham Heart Study establish as a relationship between BMI and HF risk?

A

For every unit increase in BMI, risk of HF increased by 5% in males and 7% in females

30
Q

What are some possible medical therapies for CAD?

A

Aspirin (ASA)

Thienopyridines (clopidogrel, prasugrel)

P2Y12 inhibitor (ticagrelor)

Beta blockers

ACEI/Angiotensin Receptor Blockers (ARB)

Nitrates (NTG, isosorbide)

Aldosterone antagonists

Lipid lowering agents

Fibrinolytics (for STEMI)

31
Q

What is important about the stages, phenotypes, and treatment of HF?

A

HF is a progressive disease. Everyone starts in stage A. This is where we can best try to prevent progression into the other stages of HF. By the time patients get to stage D, there aren’t many proven beneficial therapies. Treatment may shift over to palliative comfort care.

32
Q

Why must platelet counts be monitored daily for a patient on heparin?

A

HIT, heparin-induced thrombocytopenia

33
Q

How does the half-life of LMW heparins (enoxaparin, dalteparin, tinzaparin) compare to heparin?

A

Longer half-life, less commonly used

34
Q

What is the failure rate of fibrinolytics in the treatment of STEMIs?

A

~20-40%

35
Q

When are implantable cardioverter defibrillators (ICDs) preferred over pacemakers?

A

Patients with persistently low EF (< or = 35%) despite optimal HF medical therapy

36
Q

What is CABG?

A

Coronary artery bypass grafting

37
Q

What is used to treat angina?

A

Nitroglycerin (NTG)

38
Q

What are the 4 “statin benefit groups”?

A

Known ASCVD

LDL > or = 190

Diabetics

Adults w/ 10-yr ASCVD risk of >/= 7.5%

39
Q

What is the most common antiplatelet therapy given for CAD (post-MI and maintenance therapy indefinitely)?

A

Aspirin (ASA)

40
Q

What are the two types of left ventricular dysfunction in HF?

A

Systolic: impaired contractility

Diastolic: impaired filling, relaxation, or compliance

41
Q

Fibrinolytics are indicated in what type of MI? Examples?

A

STEMI only

Atleplase, reteplase, tenecteplase, streptokinase

42
Q

When a patient is allergic to ASA, what are some alternatives?

A

Clopidogrel, Prasugrel, Ticagrelor

43
Q

What symptom is associated with acute ischemic syndromes/acute coronary syndromes? What are the two possible types of MI

A

Unstable angina

Non-ST segment elevation MI (NSTEMI) or ST segment elevation MI (STEMI)

44
Q

CAD is commonly asymptomatic. When it is symptomatic, what are the main symptoms?

A

Chronic stable angina or unstable angina

45
Q

What are the primary effects of niacin? What side effect causes patients to discontinue taking it?

A

LDL lowering, good HDL and trig effects

Flushing

46
Q

What are two conditions (other than DM) that indicate CABG over PCI?

A

3 vessel disease and L ventricular dysfunction

47
Q

What are fibrates and what are they used for?

A

These have an effect on raising HDL, triglyceride loweing and modest LDL lowering

48
Q

What are common side effects of fibrates?

A

myopathy - especially in individuals with decreased creatinine clearance

49
Q

What are bile acid resins?

A

These have modest LDL lowering ability

50
Q

What are the current guidelines for prevention of CHD?

A

Focus on primary prevention. Less focus on achievement of a specific goal and use of non statin. Put them on a drug that will lower their risk

51
Q

When would you use fibrinolytics?

A

Use in acute ST elevation MI - these convert plasminogen to plasmin to break up a clot

52
Q

When would you not want to use an aldosterone blockade?

A

Because of its potassium raising effects, avoid using in patient with advanced renal disease or elevated serum potassium

53
Q

Hydralazine/isosorbide combo can have what side effect at high doses?

A

Lupus-like symptoms

54
Q

What are your survival promoting drugs therapies in heart failure patients?

A

Beta blockers

ACE inhibitors or ARBs

Aldosterone antagonists

Hydralazine/isosorbide dinitrate combo

55
Q

When would a patient need biventricular pacing (CRT)?

A

This is beneficial to patients with symptomatic HF and bundle branch block. This is intended to restor synchronous right and left ventricular conduction.

Low ejection fraction, significant HF symptoms despite optimal medical therapy, delayed intraventricular conduction

56
Q

When would you prescribe ICDs?

A

Low ejection fraction patients, or have hypertrophic cardiomyopathy

Use for resuscitated sudden cardiac arrest not associated with acute MI

Cardiology (46 decks)

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