630 Final Exam Questions With Well Elaborated Answers Solutions Guaranteed

Who needs a statin (4 groups) and what intensity - correct answers LDL 190 = high clinical ASCVD (stroke, MI, TIA, CVA, ischemic, Angina, stint, bypass, CABG, stenosis)= 75 high 40 with ASCVD 7.5= moderate Type II diabetes = 7.5=high What labs to test before statin therapy - correct answers AST/ALT Renal function lipid panel optional- CK for myopathy What are the high intensity statins? - correct answers Atorvastatin 40-80 mg Rosuvastatin 20-40 mg Atorvastatin vs. Rosuvastatin preferred in CKD CYP3a4 metabolized taken in morning lower dose in Asian Americans majority of trials - correct answers preferred in CKD- Ator CYP3a4 metabolized- Ator taken in morning- both lower dose in Asian Americans- Rosuva majority of trials- Ator When to return to clinic after statin initiation, what to monitor - correct answers 4-12 weeks initial is usually 6-8 weeks monitor lipid panel for % reduction AST/ALT every 6-12 months What percent reduction is moderate statin? high? - correct answers Moderate: 30 -50 % High 50% Describe statin myopathy - correct answers bilateral weakness large muscles all day long how many statins should you try before switching to non statin - correct answers at least 3 a lot of drs want more what increases myopathy risk in statin therapy - correct answers older age renl function history of myopathy drugs that are cyp3a4 hepatic dysfunction low vit D hypothyroidism When to treat triglycerides? Why treat? What agent? - correct answers 500 Treat for acute pancreatitis fenofibrate - safer with statins then gemfibrozil who is not a candidate for statin therapy - correct answers 3 X normal AST/ALT 10 x normal CK pregnant Improve- IT trial and Ezitimibe - correct answers trial not ideal patients were not on high intensity statin reduced CV events 15-20 % Fourier and PCSK9 when are they warranted - correct answers reduced CV events lowered LDL 50% reductions only warranted in clinical ASCVD and LDL190 Niacin - correct answers raises HDL and lowers LDL, Tri no ASCVD risk reduction long time to titrate flushing Dietary recommendations for high TG - correct answers decrease alcohol low sugar-sugary drinks, fruit low fat veggiens , lean meat Heart Catheter LHC vs RHC - correct answers LHC- see perfusion, see blockages, radial RHC- can be done at bedside, acute HF Normal RR tachpnia - correct answers 12-16 16= tachypnia= fluid in lungs etiology of HF - correct answers ischemia from CAD Uncontrolled HTN HfPef is usually HTN starting or uptitrating Beta blocker - correct answers has negative ionotropic effect at beginning Pt feels like crud, flu like, fatigue, for 2 weeks Left side Heart dysfunction vs right side - correct answers Left- dyspnea, tachypnea, low O2, rales, *L=Lungs* Right- back up in peripheral, fluid build up, pants too tights, edema, ascites, hepatomegaly, JVD, mental status, low BP, low CO, extra heart sound HF classification HFrEF HfpEF HFpEF borderline HFpEF improved - correct answers HFrEF = 40 HfpEF= 50 HFpEF borderline= 41-49 HFpEF improved 40 Heart failure stage and class - correct answers Stage cannot move back Stage: A-high risk with no damage B-structural damage with no symptoms C-damage with symptoms D- refractory, maximized all medications Class I- no limitation of physical activity II- slight limitation of physical activity III- less than normal activity causes symptoms, no symptoms at rest IV- symptoms at rest non pharm therapy of HF when to contact dr about weight - correct answers smoking cessation obesity- hard to change limit Na to 2 g no isometric or intense exercise Dynamic exercise weigh your self daily if 2-3 lb in a day or 5 lbs in a week call limit fluids Max lasix dose what to add if still fluid retention - correct answers 160 mg BID HCTZ metolazone side effects of too much diuretics - correct answers low potassium, Na, Mg hypotension alternatives to lasix - correct answers bumetanide 1mg=40 mg torsemide= once daily higher cost higher bioavailbility Meds to be cautioned with a patient who has HF - correct answers NSAIDS- limit Asthma control- limit albuterol use