5. Cardiovascular drugs 2 Flashcards

Question

BP threshold

Answer 1

when you start treatment

Answer 2

what you aim to treat to

Answer 3

use clinic BP measurements to monitor response to treatment and aim for target BP beneath 140/90 for under 80s and 150/90 for over 80s

Answer 4

``` White coat effect is when people already have hypertension but get stressed out in clinic and their bp changes Need to use ABPM or HBPM to monitor target: below 135-85 mmHg in under 80s below 145/85 in over 80s ```

Answer 5

Proteinuria low: ACR<70 or PCR<100 - Target blood pressure <140/90 Proteinuria high: ACR>70 or PCR>100 - Target blood pressure <130/80

Answer 6

should be included in: Patients with urinary ACR>30 or PCR>50 Diabetic patients with microalbuminuria

Answer 7

Pseudo-resistant Hypertension (Non adherence; white coat effect) Secondary Hypertension Resistant Hypertension

Answer 8

Confirm BPs with ABPM and HBPM Low dose spirolactone if potassium under 4.5mmol/l Alpha blocker/beta blocker if potassium over 4.5mmol/l

Answer 9

Check for postural hypotension Treat to below NICE targets in >80 year old patients ie CBP<150/90 or ABPM/HBPM <145/85 Use clinical judgement

Answer 10

Severe “hypertension” (BP≥ 180/120 mmHg) with acute damage to the target organs Lower BP in minutes to hours!!

Answer 11

Severe “hypertension” without acute damage to the target organs Lower BP after a review within 7 days

Answer 12

``` Asymptomatic Headache Epistaxis Presyncope Palpitations ``` Chest pain Dyspnoea Neurological deficit

Answer 13

Eyes (papilloedema) Brain (encephalopathy, stroke) Heart (pulmonary oedema, MI) Kidneys (AKI) Aortic dissection

Answer 14

Same day specialist review IV Therapy – Labetalol, GTN, Sodium nitroprusside, Esmolol Reduce BP/MAP (20–25% in the 1-2 hours) Target of 160/100 in 6 hours

Answer 15

ABPM/HBPM GP follow up within 7 days Oral treatment

Answer 16

Under 84 year olds should have CV risk estimated Lifestyle modification Offer atorvastatin for a 10% or greater 10‑year risk of developing CVD For people 85 years or older also consider atorvastatin (no need for CV Risk calculation) Offer statins in Type 1 diabetes (>40 and long standing) and CKD (no need for CV Risk calculation)

Answer 17

Start statin treatment in people with CVD Do not delay statin treatment to manage modifiable risk factors

Answer 18

Adults with chronic kidney disease (CKD 3) should be offered atorvastatin Do not use a risk assessment tool to assess CVD risk in people with an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 and/or albuminuria

Answer 19

Lipid measurement Liver function tests – 3x upper limit of normal Renal function HbA1C Thyroid stimulating hormone Creatine kinase (CK) - 5x upper limit of normal. No need to do CK unless symptoms

Answer 20

Lipid measurement (3 months after) - 40% reduction in non- HDL Cholesterol Liver function tests (3 months after) Creatine kinase (CK) - if symptoms Annual medication review

Answer 21

Ezetimibe monotherapy is recommended as an option for treating primary (heterozygous‑familial or non‑familial) hypercholesterolaemia in adults in whom initial statin therapy is contraindicated or not tolerated Ezetimibe co‑administered with statin might be appropriate

Answer 22

Stop, reduce dose or switch statin Specialist input Ezetimibe Not fibrates!!

Answer 23

Exclude excess alcohol and poor glycaemic control Triglyceride >20 mmol/l – Refer to specialist Triglyceride 10–20 mmol/l – repeat as fasting sample within 2 weeks. If still >10 mmol/l then refer to specialist. Triglyceride 4.5–9.9 mmol/l – check CVD risk and correlate with cholesterol

Answer 24

``` Age Gender LDL cholesterol HDL cholesterol Blood pressure Diabetes Smoking Obesity ```

Answer 25

QRISK®2 and 3 – 10 year Cardiovascular risk | JBS3 - Lifetime CV risk