thera 3 test 2 CHD/ACS

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  1. treating myopathy and the pt has severe muscle symptoms or fatigue
    D/C statin get CK, urinalysis for myoglobinuria, creatine
  2. treating myopathy and the pt has mild/moderate symptoms
    D/C statin, look for other risk factors (hypothyroidism, reduced renal/hepatic fxn, rheum disorders, vitamin D deficiency, primary muscle dx)
  3. when would you check FLP after stain initiation
    4-12 wks, if LDL reduction less than expected, asses adherence & secondary causes of hyperlipidemia
  4. when would you consider reducing the dose of a statin in regards to LDL level
    < 40 mg/dL
  5. what advantages does aspirin have in primary prevention of cardiovascular events in men and women
    • men - MI
    • women - stroke
  6. risk factors for CHD
    • smoking
    • HTN
    • albuminuria
    • dyslipidemia
    • family history of CHD
  7. if a pt is having an ACS event which marker is the most accurate for early onset
  8. a pt is in the ER with suspected ACS event, what is appropriate to start while acutely working up the pt
    • MONAB
    • morphine - optional, only if they are having refractory pain
    • oxygen - optional, if they are < 90%
    • nitroglycerin - sublingual, total of 3 doses in 5 minute intervals (NOT if HoTN)
    • aspirin - full dose, chew it up
    • beta blocker - w/I the first 24 hrs. if they are tachycardia and hypertensive. oral if they are HoTN (metoprolol)

    antiplatelet - UFH, full Tx dose at least until you get a plan. enoxaparin 1mg/kg/day
  9. what are the contraindications of fibrinolytic therapy
    • active bleeding
    • history of ICH
    • pregnancy
    • oral anticoagulant use
    • high risk for bleeding
    •   recent trauma
    •   recent major surgery
    •   severe uncontrolled hypertension 185/105
  10. post MI CI for beta blockers
    • low baseline HR
    • severe bradycardia
    • preexisting high-degree AV block
    • sick sinus syndrome (w/no pacemaker)
    • refractory heart failure
  11. recommended levels of activity for management of IHD
    • 30-60 minutes of moderate intensity at least 5 days/wk + increase in lifestyle activity
    • resistance training 2 days/week
    • cardiac rehab
  12. 6 lifestyle elements that could influence prognosis of IHD
    • maintain BMI of 18.5-24.9
    • waist circumference M < 40, F <35
    • lipid management
    • BP control
    • smoking cessation
    • individualized diabetes mgmt. plan
  13. diet considerations for the mgmt. of IHD
    • saturated fats < 7% of total calories
    • trans fats < 1% of total calories
    • cholesterol < 200 mg/day

    high in fruits/vegetables, whole grains and reduced sodium intake
  14. when do we initiate aspirin as primary prevention of CHD
    • M = 45-79 yo if benefit of MI > GI bleed
    • F = 55-79 yo if benefit of stroke > GI bleed
  15. when do we initiate statins for the primary prevention of CHD
    • LDL > 190 mg/dL
    • 40-75 yo + DM
    • 10 year ASCVD risk of > 7.5%
  16. symptoms of ACS
    squeezing, tightness, pressure that comes on gradually and intensity will wax and wane over several minutes. discomfort that doesn't change with breathing or position
  17. symptoms other than chest pain that are considered "angina equivalent"
    • dyspnea
    • N/V
    • diaphoresis
    • unexplained fatigue
  18. what could cause troponin levels to be falsely elevated
    it is renally cleared, CKD
  19. invasive strategy
    • cath lab for coronary angiography
    • assess need for PCI or CABG
  20. conservative strategy
    • observe
    • follow symptoms and cardiac biomarkers
    •   cath lab only if these worsen
    • consider stress testing
  21. Tx guidelines for anticoagulants in a pt whose has a stint placed
  22. Tx guidelines for unfractionated heparin if a pt is medically managed
    continue for 48 hours
  23. Tx guidelines for enoxaparin and fondapainux if a pt is medically managed
    continue for the duration of the hospitalization
  24. if a pt goes in for a CABG what do you do with the enoxaparin, fondaparinux, clopidogrel and UFH
    • enoxaparin - discontinue 12-24 hrs prior
    • fondaparinux - discontinue 24 hrs prior
    • clopidogrel - discontinue 5 days prior
    • UFH - hold 2 hrs prior
  25. 3 P2Y12 ADP receptor antagonists
    • clopidogrel - plavix
    • Prasurgrel - effient
    • ticagrelor - brilinta
  26. which P2Y12 ADP receptor antagonist is reversible
    ticagrelor - brilinta
  27. which P2Y12 ADP receptor antagonist can be used upstream of catheterization
    clopidogrel - plavix
  28. compare antiplatelet therapy of clopidogrel vs prasurgrel
    • TRITON-TIMI 38 trial
    • equal mortality difference secondary to cardiovascular
    • prasurgrel has increased mortality secondary to bleeding
  29. compare antiplatelet therapy of clopidogrel vs ticagrelor
    • PLATO study
    • decreased risk of mortality w/ ticagrelor but CI if there is a history of hemorrhagic stroke
  30. 3 GP IIb/IIIa inhibitors
    • eptifibatide - integrilin
    • tirofiban - aggrastat
    • abciximab - reopro
  31. which anticoagulant is preferred during PCI in cath lab if the pt has a high bleeding risk
    bivalrudin - angiomax
  32. stent restenosis
    • renarrowing of coronary artery at the site of stent placement due to tissue growth
    • occurs 3-6 months later
  33. stent thrombosis
    • acute thrombosis at the site of the stent that can cause a rapid and complete occlusion of the coronary artery
    • occurs 0-30 days later
  34. which stents have a higher likelihood of restenosis
    bare-metal stent
  35. which stents have a higher likelihood of thrombosis
  36. when are BP IIb/IIIa inhibitors used
    typically only for pts undergoing PCI with UFH and up to 18 hours after PCI
  37. absolute CI's to fibrinolysis
    • any previous ICH
    • known structural cerebrovascular lesion
    • known malignant intracranial neoplasm
    • ischemic stroke w/I 3 mo
    • suspected aortic dissection
    • active bleeding
    • severe closed-head or facial trauma w/I 3 mo
  38. CI to nitrates as home meds
    • systolic BP < 90 or 30+ below baseline
    • bradycardia (<50bpm) or tachycardia >100bpm
    • phosphodiesterase inhibitor w/I last 24-48 hrs
    • severe anemai
  39. CI to beta blockers as home meds
    • systolic BP < 90 or 30+ below baseline
    • bradycardia (<50bpm) or tachycardia >100bpm
    • phosphodiesterase inhibitor w/I last 24-48 hrs
  40. CI to ACEI as home meds
  41. CI to CCBs as home meds
    • left ventricular dysfunction
    • sick sinus syndrome
    • hypotension

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thera 3 test 2 CHD/ACS
2014-03-29 01:17:07
thera test CHD ACS
thera 3 test 2 CHD/ACS
thera 3 test 2 CHD/ACS
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