17 - HTN, CKD, Hyperlipidaemia Flashcards

Question

Apart from antihypertensive pharmacology, how are primary care involved in the management of hypertension?

Answer 1

**- Lifestyle advice** e.g diet and exercise, caffeine, dietary sodium, smoking, alcohol, stress reduction **- Patient leaflets** e.g British Heart Foundation **- Review anually** if being controlled, if not at more regular intervals

Answer 2

- Take their b.p, multiple times if high - Encourage adherance to treatment - Check eGFR, U+Es, serum creatinine - Check urine for proteinuria - Assess Qrisk score - If well controlled consider deprescribing but check them every 4 weeks for 6 months to check for recurrence then 2 to 3 times a year

Answer 3

Blood pressure and a dipstick for proteinuria is done at every antenatal visit Eclampsia is the occurence of one or more seizures in women with pre-eclampsia If at **high risk of pre-eclamsia women should take 75-150mg aspirin daily from 12 weeks gestation**

Answer 4

Referral to a specialist and **stop ACEi, ARBs and thiazides** all need to be stopped due to the risk of congenital abnormalities Any hypertension in pregnancy should be treated with **labetolol first line** or **nifedipine** If **\>160/110** mother will need to be **admitted to hospital** for ongoing monitoring and IV drugs **Review antihypertensives 2 weeks after birth** and monitor babies for signs of hypotension if breast fed

Answer 5

Autosomal dominant **Suspect when total cholesterol \>7.5mmol/L** and/or **Personal/family history of premature CHD** (before the age of 60 in first degree relative

Answer 6

**^{- If homozygous or child managed in secondary care by specialist}** - Consider baseline ECG **- Addressing other modifiable CVD risk factors** e.g smoking, blood pressure **- Offer individualised advice from dietician** - Address any causes of secondary hyperlipidaemia e.g uncontrolled diabetes, excess alcohol **- Baseline bloods** before lipid-modifying treatment **- High intensity statin** (e.g atorvastatin 20mg or rosuvastatin 10mg) **- Info and support groups** e.g HEART UK **- Genetic counselling** **- REVIEW ANUALLY** FOR ANY STATIN SIDE EFFECTS AND TO CHECK HBA1C, BP, LIFETSTYLE ADVICE ETC

Answer 7

- If suspected **take 2 LDL measurements.** If \>13 suspect homozygous, if \>11 suspect heterozygous **- Look for clinical signs** but absence does not rule out diagnosis e.g tendon xanthomas, premature corneal arcus, xanthelasma - **Exclude any secondary causes** e.g look at drug history and history - Use **Simon Broome** or **DLCN criteria**

Answer 8

**Atorvastatin 20 mg** or **Rosuvastatin 10 mg** after baseline bloods Not rosuvastatin if predisposing factors for rhabdomyolysis e.g Asian, stage 3 CKD **- If statins contraindicated ezetimibe 10 mg** once daily (provided CK and LFTs are fine). Coprescribe with statin if statins not working

Answer 9

**- CK** if have generalised muscle pains (if five times over limit retest in 7 days and if still raised don't give, if raised but below five times can give) **- LFTs** (can give if blow three times normal limit but need to find cause of raised test) **- Renal function** (helps work out dosage) **- HbA1c** **- TFTs** (hypothyroidism can cause dyslipidaemia and statin-induced myopathy)

Answer 10

- Measure lipid levels after 3 months, want a 50% reduction in LDL. - If not appropriate reduction, **check adherance and timing** and **titrate dose up to max**. If already max consider **coprescription of ezetimibe 10mg** or switch to **80mg simvastatin** - If still not reducing refer to secondary care for PCSK9i **- Recheck LFTs after 3 months then 12 months** then again only if clinically indicated. **- Annually review patient** e.g lifestyle, side effects

Answer 11

- Beta Blockers - Prednisone - Amiodarone - Cyclosporin and other immunosuppressants - Anabolic Steroids - Protease Inhibitors (Antiretroviral drugs) - Diuretics - Oral oestrogen - Antidepressants

Answer 12

- Type 2 DM (high LDL+TGs, low HDL) - Pregnancy - Hypothyroidism - Menopause - Nephrotic syndrome - Anorexia nervosa

Answer 13

- Atorvastatin 10mg is medium intensity - Atorvastatin 20mg, 40mg, 80mg is high intensity

Answer 14

- hypertension - diabetes mellitus - CKD - dyslipidaemia - RA - influenza - serious mental health problems - periodontitis

Answer 15

**- Everyone aged 40–74 years**, who has not already been diagnosed with CVD, diabetes, or chronic kidney disease, is invited **every 5 years** for a free health check. - Includes a CVD risk assessment, assessment of alcohol consumption, physical activity, cholesterol level, body mass index (BMI), an assessment for dementia in those aged 65-74 years, and screening for diabetes mellitus and chronic kidney disease - Qrisk score should be calculated every 5 years!!!!!!!!

Answer 16

**Atorvastatin 20mg** After an informed discussion about benefits and harms, after having been provided with lifestyle advice, and if there are no contraindication (e.g grapefruit juice)

Answer 17

- \<84 if QRISK\>10% and lifestyle modifications not worked - All type 1 diabetics - CKD - Familial hypercholesterolaemia - \>85 especially if smoker or HTN. Take into account life expectancy, polypharmacy, risks and benefits etc

Answer 18

- Once any established CVD start **atorvastatin 80mg,** do not wait to see if modification of risk factors helps. Low dose if DDIs like fenofibrate and clarithromycin - If already on simvastatin try to encourage to switch to atorvastatin. If already on rosuvastatin leave them on this - Want a reduction of 40% LDL in 3 months!!!!!!!

Answer 19

- Beta blocker - Alpha blocker

Answer 20

Metformin metallic taste!!!!!