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82 Cards in this Set
- Front
- Back
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Describe the relationshiop of alcohol drinking to cardiovascular disease
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U shaped, with moderate drinking being least risk
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Which is better for assessing risk, triglycerides or total cholesterol
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Total cholesterol
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Highest risk factor for cardiovascular disease?
What is the second highest? |
Highest = LVH, second highest = Sedentary lifestyle. Third highest = DM
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Starting at what age should fasting lipoprotein profiles be obtained?
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Starting at 20 yrs, and then every 5 years
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Goal for LDL therapy in pt with CHD?
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<100
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Goal for LDL therapy in pt with 2+ risk factors?
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<130
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Goal for LDL therapy in pt with 0-1 risk factors
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<160
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What is the primary target of monitoring for cardiovascular risk in a patient with metabolic syndrome?
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LDL
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Patient is on corticosteroids, progesterone, or anabolic steroids. What does this imply for their cholesterol?
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Will be elevated
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Person with CHD or equivelant who has LDL > 130
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Aggressive lifestyle Rx, + drug.
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If a patient has CHD and LDL <130 but greater than 100, do you immediately start pt on lipid lowering drug?
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No
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If pt has 0-1 risk factors, at what point do you consider adding drugs for cholesterol?
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If LDL > 190, and lifestyle changes are initiated and fail to reduce LDL
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Drug that lowers LDL the most:
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LDL
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Drug that raises HDL the most:
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Nicotinic acid
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Absolute contraindication of fibric acid use:
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Severe renal disease.
Also causes gallstones |
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Best drug for lowering triglycerides (2):
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Nicotinic acid or fibric acids
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In a patient who is hospitalized with CHD, at what LDL should drugs be considered?
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If LDL > 130
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What is the first line of therapy in all lipid and non-lipid risk factors associated with metabilic syndrome:
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Lifestyle reduction – especially weight reduction
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At what LDL do you start thinking familial hypercholesterolemia?
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LDL > 190
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Level for borderline high and high triglycerides:
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Borderline: 150-199. High = 200-500
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Sweating episodes + tachycardia. What do you look for?
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Pheochromocytoma.
Check urine or serum for vanillylmandelic acid or metanephrines |
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Pt is on clonidine and doesn't respond. What disease must you consider?
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Pheochromocytoma.
Check urine or serum for vanillylmandelic acid or metanephrines |
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Treatment for pheochromocytoma:
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Surgical resection.
Enure adequate beta-blockage, alpha blockade, and volume expansion |
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Pt has BP >160/100. What should be considered for all patients?
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Therapy with 2 agents
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HTN + CAD. What do you treat with?
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Beta blocker
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Pt has HTN, truncal obesity and osteoporosis. What should you look for?
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Cortisol in the urine. This is cushings disease
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Pt with HTN with hypokalemia.
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Conn's syndrome
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BP treatment of choice for pt with depressed LV function
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Diuretics, ACE and beta-blockers
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Pt is on statin in combo with niacin, fibrates or cyclospirine. What is pt at risk for?
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Rhabdomyolysis or myositis
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How to calculate LDL from total cholesterol
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Total C – (HDL +1/5TG)
Only valid if TG<400 |
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Pt has proteinuria + Hematuria. What to look for:
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Suspect nephritic syndrome
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What is the next diagnostic step in pt with elevated createnine?
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Urine microscopy
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How ominous is papilledema?
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Very!
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Order of tests to determine organ damage in HTN:
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Urinalysis then Chemistry panel then Fasting glucose
then Lipids then ECG |
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What should you do before starting antihypertensive meds in a woman who is reproductive age?
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Pregnancy test
Thiazides, ACEi, CCB and ARBs are contra-indicated |
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Follow up for pt with White Coat Syndrome
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24 hr monitoring or home blood pressure monitoring at the very least
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What is the first line treatment in African American pt with diabetes?
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ACE inhibitor
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Minimum target for BP in pt with diabetes?
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<135/85.
Note: JNC 7 says <130/80 |
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Can a pt who is mildly hypertensive and on antihypertensives get off their medications if BP improves?
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Yes! But with constant monitoring
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Which BP med can lead to acute renal failure?
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ACE inhibitor
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Pt is hypokalemic. Which BP med should you ask about?
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Thiazides
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Pt presents with hyperuricemia, and elevation of cholesterol, and metabolic alkalosis. What BP med are they on?
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Thiazides
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Pt is being treated for HTN and found to have elevated lipids. Which meds must you consider?
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Thiazides and Beta Blocker usage
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Pt has yellow plaques on eyelids and yellow masses found on tendons. What should you test for?
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Severe hyperlipidemia
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Pt has 3 risk factors for CHD and LDL = 145. Treatment?
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Since >130 consider medical treatment.
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Pt has 2 risk factors for CHD and LDL = 125. Treatment?
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Pt is below goal of <130 but less than 160 which is cutoff for treatment. Consider lifestyle changes
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Pt has no CHD risk factors and LDL = 145. Treatment?
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Pt is above goal of <130 and less than 190 which is cutoff for treatment. Consider lifestyle changes
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First line drug for elevated Tgs?
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Niacin, then Gemfibrozil
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Pt has elevated Tgs and is diabetic. Treatment?
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Gemfibrozil
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Pt is female, postmenopausal and has no cardiovascular risk factors. Do you start estrogen replacement therapy?
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Controversial
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Med with the best track record during pregnancy
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Methyldopa
Beta blockers and hydralazine are safe |
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Pt has renal artery stenosis. What is the BP medicine of choice?
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ACE inhibitor
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Diagnostic test of choice for renal artery stenosis:
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MRA
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First step in measuring coarctation of aorta
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Check blood pressure in lower extremities
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Pt has volume mediated hypertension, but no signs of hypokalemia.
What cause of secondary HTN should you consider? |
NSAID mediated HTN
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Pt is on a medication that ends in -sin. What should you be thinking about doing?
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Alpha blockers (-Sin) have NOT been shown to reduce morbidity and mortality.
Switch to a different class |
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Pt has high blood pressure and asthma. What class of drugs should you avoid?
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Beta blockers
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What is a good medicine to use in hypertensive emergency?
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Nitroprusside
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According to Harrisons, what do you do for a pt who is high risk for CAD and LDL >100
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Diet PLUS Drugs
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Pt with moderate risk (>2 factors) who has 20% 10-y risk and LDL>130
Treatment? |
Diet + Drugs
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Pt has 2 risk factors for CHD although 10-y risk <10% and LDL > 130. Treatment?
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Diet + Drugs
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Pt has no established CHD, and no risk factors. What is target LDL?
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<160
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Pt has TG = 340. Pt has dieted and exercised and still not ideal. Which agent do you begin with?
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Niacin
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Pt has Tgs = 562. Treatment?
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Meds
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Pt has high LDL and wants to know which foods have the biggest impact on his cholesterol.
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Reducing fats (especiallysaturated fats) is more important than cholesterol.
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Teenager with cardiovascular Sx. What MUST you check for?
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Cocaine use!!
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You have a pt who is a smoker. What should you discuss at every appointment.
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1. If they still smoke
2. If they are willing to quit 3. Advise cessation |
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Does evidence suggest that smoking cessation reduces risk of AMI?
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Yes!
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Criteria for metabolic syndrome:
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Need 3 of the five factors:
Abdominal obesity TG>150 Low HDL (<50 m, <40 w) BP > 130/85 Glucose >110 High LDL is not a criteria! |
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Pt has gout and high blood pressure. Which med should you avoid?
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Diuretics
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Which antihypertensive med is absolutely the worst for a pregnant woman?
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ACE inhibitor
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Pt is a smoker who wants to quit and has a history of seizures. What must you avoid?
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Bupoprion
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In ALL pts who want to quit smoking. What should you advice about lifestyle.
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Avoid weight gain by careful diet and exercise
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Pt has been trying to quit smoking for 3 weeks but is still going through withdrawal. What do you tell them?
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"Hang in there"
Withdrawal is worst in first month |
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Pt has osteoporosis and HTN. Which drug should you go with
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Thiazides
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Pt has arrhythmia and HTN. Which drug should you go with?
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Beta blocker
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Pt has chronic kidney failure and starts on an ACE and notices small increase in Cr. Do you discontinue ACE?
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No
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Pt has Type IIb dyslipidemia (Incr LDL + VLDL)
Which med would you avoid? Why? |
Avoid Cholestyramine (Bile acid binding resin... can raise triglycerides
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Pt has Type III hyperlipidemia (dysbetalipoproteinemia)
Which med do you go with? |
Gemfibrozil or Niacin
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Which lipid is associated with Type IV dyslipidemia?
What med would you use? |
VLDL (related to triglycerides)
Use Niacin, Gemfibrozil and statins |
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You are seeing a young female pt in her early twenties. Fasting lipids show elevated VLDL and chylomicrons. What's your diagnosis? Be specific!
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Familial hypertriglyceridemia.
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My “Made up” approach to diagnosing and treating pts with familial dyslipidemia.
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If LDL is elevated think type II or II-b (combined). Go with statins
If triglycerides are elevated (or VLDL/Chylo) go with niacin or gemfibrozil. If it specifically says only chylomicrons are elevated, go with diet (type I) |
