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IOS 9 Exam 4
Macrovascular Disease
| Question | Answer |
|---|---|
| Microvascular disease is primarly associated with | TYpe 1 although Macrovascular does affect Type 1 |
| Macrovascular complication are primarly associated with | Type II DM |
| Atherosclerosis is associated with | CHV, CVA, PAD |
| Microvascular is associated with | Nephropathy, retinopathy, neuropathy |
| Should try HTN in Type II Dm because | Early death (men 11.6, women14.3) & people sicker |
| Glycemic control and CVD | there is an association that has a low level of evidence in TYPE II but not in Type I |
| HTn Primary goal is to | Reduce morbidity and mortality |
| Modifiable risk factors for CVD | HTN, dyslipidemai, obesity, smoking, sendetary lifestyle/poor diet |
| JNC7 Lifestyle modifications Level A to reduce BP | Weight reduction (5-20), DASH (8-14), Sodim restriction 2.4g/d or 6mgNaCl (2-8), Physical activity 30 min (4-9), ETOH (2-4) |
| Smoking cessation is recommended but | Is level E it does not reduce BP but CVD |
| JNC-7 compelling indication medications for DM | ACE, ARB, Diuretic, B-Blocker, CCB |
| BP Goals from the ADA | Systolic <130 Level c, and diastolic <80 levels B, if necessary use multiple drugs Level b |
| ADA CVD recommendations | Intital drug should lower BP, ACE, ARB, B-Blocker, Diuretic, CCB- All patient should be on and ACE or ARB unless not tolerated, the thiazide |
| Type I any level of proteinuria should use | ACE |
| Type II with microalbuminuria should use | ACE or ARB |
| Type 2 with macroalbuminaria should use | ARB |
| ALLHAT study results | ACE or CCB NOT superior to chlorthothalidone |
| HOPE trial results level of evidence A | ACE shown to improve CVD outcomes in high CVD risk patients |
| ARB level A | Type 2, HTN, microalbuminuria and superior in macroalbumuria, benefit proven in diabetic neuropathy |
| B-Blockers | Mask hypoglycemia (do not feel hypoglycemia) |
| CCB level of evidence A | Not the first line drug but they are 3rd line |
| Diabetic dyslipidemia patho | Insulin resistance cases increase in TG and LDL while decreaseing HDL=mixed lipidemia, DM have LDL mutation small and sticky |
| NCEP ATP III | LDL goals <100 or <70 secondary Non-HDL 130 or 100 tertiary Increased HDL <40men and <50women |
| NCEP ATPIII chose a drug that has | 30-40% reduction of LDL if in Very high, high, moderatley high class |
| Poor glycemic control causes an increase in | Triglycerides and decreases HDL |
| Diabetes without overt CV disease | LDL goal <100 (level A), >40,statin therapy 30-40% reduction reguardless of baseline (Level A) , If <40 + CVD risk factors (obesity, hyperlipid, smoking, microalbuminuria, and glycemia control)-Level C |
| Diabetes with Overt CVD | LDL Goal <70- (Level B), Statin reduction of 30-40%-Level A |
| Lifestyle modifications | Reduced saturated fat, cholesterol intake, weight loss and increased phycial activity improve lipid profile Level A, TC >150 & HDL increases Level C, Lowering TG and increaseing HDL with fibrate associated with reduced CV Level A |
| Heart Protection study results | DM w.out AVD given Simvastatin or placebo for 5 years-Decreased CVD even if baseline was low-mutant <40 stating therapy with 30-40% reduction reguarless of LDL |
| Cards -Collaborative Atorvastatin diabetes study-Level of evidence A | Primary Prevention of DM patients benefited ,the lower your LDL the less CVD risk |
| Target to Treat Level B | Those with CVD given low and high dose statin result is LDL <70 = less AVD |
| Myopathy definition | Muscle aches and elevation of the creatin kinase 10x the upper limit of normal |
| Rhabdomyolysis | CK>10,000 or CK>10 then ULN Plus and elevation of Scr or medication intervention iwth IV hydration |
| Fenofibrates | Lower TG and raise HDL- CHoose ginofibrate no dose limitations |
| Niacin can be used in | controlled DM patients, but it does increase glucose , Niaspan less SE |
| Bile acid sequestratants | Lower LDL but used in combination....They do increase TG |
| Cholersterol absorption inhibitors- Ezetimide | Reduce LDL 18% must be used in combination |
| Mixed dyslipidemia | Require combination therapy to decrease LDL, TG, increase HDL-Statin, fenobribrate needed |
| ADA standrds for Type II ASA therapy w/o AVD | Type 2 >40 + risks (FHx of CVD, HTN, smoking, dyslip, albumin) Level A |
| ADA standard for Type I ASA therapy w/o AVD | Increase CVD risk and those > 40 with additional risk factors (FHx of CVD, HTN, Dyslip, Smoking, albuminuria) Level C |
| Consider ASA therapy in | those 30-40yo, if presence of risk factors (FHx of CVD, HTN, dyslipidemia, smoking, albuminuria) Level E |
| Secondary prevention of patients with AVS and ASA therapy | Both Type1 and II - ASA recommended Level A |
| High risk patients CVD risk who cannot take ASA | Plavix is reasonable alternative if ASA allergy, bleeding tendancy, anticoagulant therapy, recent GI bleed, and clinically active liver disease who cannot take ASA |
| National Lipid association Recommendation to continue stain use | Rule out other etiologies of CK or muscle symptoms, obtain pretreatment, baseline CK may be considered if high risk, Not necessary to measure CK levels in asymptomatic patients, council patients about risk of myalgia (report), CK in symptomatic, |
| National lipid association Recommendation when to stop and or restart statin therapy | Develop intolerable symptoms stop and rechallenge, Tolerable pain or asymptomatic with CK>10 the ULN continue or stop if symptoms intolerable, Rhabdomyolyssis =CK>10,000 IU or CK>10ULN with elevated Scr or require IV NS -stop statin. Risk/benefit therapy |
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liza001
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