2016 AHA Statin Drug Interactions Q2

2016 AHA Statin Drug Interactions

According to the 2016 AHA Scientific Statement:
“Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease” p e477

” … the combination of ________ with lovastatin, pravastatin, and simvastatin is potentially harmful and should be avoided …”

a) amiodarone
b) amlodipine
c) fenofibrate/fenofibric acid
d) gemfibrozil

click here for answer

(D)

” … the combination
of gemfibrozil with lovastatin, pravastatin, and
simvastatin is potentially harmful and should be avoided.
Although gemfibrozil interacts with atorvastatin,
pitavastatin, and rosuvastatin, the result is only a minor
increase in statin concentrations, and the combination
may be considered if clinically indicated. Fluvastatin may
be used in combination with gemfibrozil without any specific
dose limitations, …”

2016 AHA Statin Drug Interactions Q1

2016 AHA Statin Drug Interactions

According to the 2016 AHA Scientific Statement:
“Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease” p e469

“DDIs involving the CYP450 enzyme system are generally classified as inhibition or induction interactions … Regardless of the underlying mechanism, enzyme inhibition produces _______ serum concentrations of 1 or both medications. In the case of statin DDIs, the result is most often an _______ in statin serum concentrations.”

a) decreased ; decrease
b) decreased ; increase
c) increased ; increase
d) increased ; decrease

click here for answer

(C)

“DDIs involving the CYP450 enzyme system are generally classified as inhibition or induction interactions. Enzyme inhibition may occur as a result of direct competition by substrates for available binding sites, reduced enzymatic activity, or both. The onset of enzyme inhibition usually occurs rapidly after the introduction of an interacting drug. Direct competition is the most common mechanism resulting in DDIs and often occurs when 1 drug has a higher binding affinity for the enzyme or is present in significantly greater concentrations than its competing substrate. In contrast, some drugs may bind irreversibly to the enzyme and prevent its participation in subsequent metabolic reactions. Regardless of the underlying mechanism, enzyme inhibition produces increased serum concentrations of 1 or both medications. In the case of statin DDIs, the result is most often an increase in statin serum concentrations.”

2016 ACC AHA Dual Antplatelet Therapy in CAD Q5

2016 ACC AHA Dual Antplatelet Therapy in CAD
http://circ.ahajournals.org/content/134/10/e123

According to the “2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease,” p e133

“In patients with ACS (NSTE-ACS or STEMI) treated with DAPT after BMS or DES implantation, P2Y12 inhibitor therapy (clopidogrel, prasugrel, or ticagrelor) should be given for at least
_________.”

a) 6 months
b) 9 months
c) 12 months
d) 24 months

click here for answer

(C)

“In patients with ACS (NSTE-ACS or STEMI) treated
with DAPT after BMS or DES implantation, P2Y12
inhibitor therapy (clopidogrel, prasugrel, or ticagrelor)
should be given for at least 12 months.1”

2016 ACC AHA Dual Antplatelet Therapy in CAD Q4

2016 ACC AHA Dual Antplatelet Therapy in CAD
http://circ.ahajournals.org/content/134/10/e123

According to the “2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease,” p e133

“In patients with SIHD treated with DAPT after DES implantation, P2Y12 inhibitor
therapy (clopidogrel) should be given for at least _______.”

SIHD = stable ischemic heart disease
DAPT = dual antiplatelet therapy
DES = drug-eluting stents

a) 3 months
b) 6 months
c) 9 months
d) 12 months

click here for answer

(B)

“In patients with SIHD treated with DAPT
after DES implantation, P2Y12 inhibitor
therapy (clopidogrel) should be given for at
least 6 months.”

2016 ACC AHA Dual Antplatelet Therapy in CAD Q3

2016 ACC AHA Dual Antplatelet Therapy in CAD
http://circ.ahajournals.org/content/134/10/e123

According to the “2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease,” p e133

“In patients with SIHD treated with DAPT after BMS implantation, P2Y12 inhibitor therapy
(clopidogrel) should be given for a minimum of _______.”

a) 1 month
b) 3 months
c) 6 months
d) 12 months

click here for answer

(A)  

“In patients with SIHD treated with DAPT after BMS implantation, P2Y12 inhibitor therapy (clopidogrel) should be given for a minimum of 1 month.”

2016 ACC AHA Dual Antplatelet Therapy in CAD Q2

2016 ACC AHA Dual Antplatelet Therapy in CAD
http://circ.ahajournals.org/content/134/10/e123

According to the “2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease,”p e132

“In patients treated with DAPT, a daily aspirin dose of ______________ is
recommended.”

a) 81 mg (range, 75 mg to 100 mg)
b) 162 mg
c) 325 mg (range, from 300 mg to 500 mg)
d) 500 mg

click here for answer

(A)  

“In patients treated with DAPT, a daily aspirin
dose of 81 mg (range, 75 mg to 100 mg) is
recommended.”

2016 ACC AHA Dual Antplatelet Therapy in CAD Q1

2016 ACC AHA Dual Antplatelet Therapy in CAD
http://circ.ahajournals.org/content/134/10/e123

According to the “2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease,” p e131, 3.3,

“____________ should not be administered to patients with a prior history of stroke or TIA.”

a) Clopidogrel
b) Ticagrelor
c) Prasugrel
d) Dual antiplatelet therapy

click here for answer

(C)

 

“Prasugrel should not be administered to patients
with a prior history of stroke or TIA.”

Heart Failure: 2017 ACC/AHA Update Q5

Heart Failure: 2017 ACC/AHA Update

According to the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure” p 18

“Ivabradine can be beneficial to reduce HF hospitalization for patients with symptomatic (NYHA class II-III) stable chronic HFrEF (______) who are receiving GDEM*, including a beta blocker at maximum tolerated dose, and who are in sinus rhythm with a heart rate of _________ at rest”

[Class (Strength) of Recommendation = IIa = Moderate]

*(GDEM = GDMT = guideline-directed management and therapy)

a) LVEF </=35% ; 70 bpm or less
b) LVEF </=35% ; 70 bpm or greater
c) LVEF >/=35% ; 70 bpm or less
d) LVEF >/=35% ; 70 bpm or greater

click here for answer

(B)

http://www.onlinejacc.org/content/early/2017/04/20/j.jacc.2017.04.025?_ga=2.134278641.1865466118.1504974232-2120518496.1502210448
p 18
“Ivabradine can be beneficial to reduce HF hospitalization for patients with symptomatic (NYHA class II-III) stable chronic HFrEF (LVEF ≤35%) who are receiving GDEM*, including a beta blocker at maximum tolerated
dose, and who are in sinus rhythm with a heart rate of 70 bpm or greater at rest (154-157).”

Heart Failure: 2017 ACC/AHA Update Q4

Heart Failure: 2017 ACC/AHA Update

According to the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure” p 22:

“In appropriately selected patients with HFpEF ( ________, elevated BNP levels or HF admission within 1 year, estimated glomerular filtration rate >30 mL/min, creatinine <2.5 mg/dL, potassium <5.0 mEq/L), aldosterone receptor antagonists might be considered to decrease hospitalizations …”

Class of Recommendation (COR) = IIb = “WEAK”

“HFpEF = heart failure with preserved ejection fraction”

a) with EF >/=35%
b) with EF >/=45%
c) with EF >/=55%
d) but declining EF

click here for answer

(B)

Source:
http://www.onlinejacc.org/content/early/2017/04/20/j.jacc.2017.04.025?_ga=2.134278641.1865466118.1504974232-2120518496.1502210448

“In appropriately selected patients with HFpEF (with EF ≥45%, elevated BNP levels or HF admission within 1 year, estimated glomerular filtration rate >30 mL/min, creatinine <2.5 mg/dL, potassium <5.0 mEq/L), aldosterone receptor antagonists might be considered to decrease hospitalizations …”

 

Heart Failure: 2017 ACC/AHA Update Q3

Heart Failure: 2017 ACC/AHA Update

According to the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure” p17

“ARNI = angiotensin receptor–neprilysin inhibitor”

a) “ARNI may be administered concomitantly with ACE inhibitors”
b) “ARNI should not be administered concomitantly with ACE inhibitors or within 6 hours of the last dose of an ACE inhibitor”
c) “ARNI should not be administered concomitantly with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor”
d) “ARNI should not be administered concomitantly with ACE inhibitors or within 7 days of the last dose of an ACE inhibitor”

click here for answer

(C)

source:

http://www.onlinejacc.org/content/early/2017/04/20/j.jacc.2017.04.025?_ga=2.134278641.1865466118.1504974232-2120518496.1502210448
“ARNI should not be administered concomitantly
with ACE inhibitors or within 36 hours of the last
dose of an ACE inhibitor (148, 149).”