Secondary prevention drugs

Question 1

Post MI

Answer 1

ACEi (or ARB)

Beta blocker

Statin (high intensity 80mg)

Antiplatelet dual therapy - aspirin and clopidogrel, stop the clopidogrel after 12m

Lifestyle- smoking, cardio diet, exercise, wt loss, limit alcohol

Question 2

If Qrisk2 >10%

Answer 2

Lifestyle

Statin (atorvostatin 20mg OD for primary prevention, or 80mg OD if have diagnosed CVD)

Aspirin 75mg OD

Question 3

Angina

Answer 3

GTN (PRN)

1st line- beta blocker or CCB

2nd line- long acting nitrate e.g. isosorbide mononitrate

Consider antiplatelet (aspirin 75mg OD) and if they have CKD, HTN, HF, LVD, DM, prev MI- ACEi

Question 4

Heart failure reduced ejection fraction

Answer 4

Loop diuretic (furosemide 20-40mg)

ACEi (or ARB)

Beta blocker (don’t start at same time as ACEi)

Consider: antiplatelet if atherosclerosis, statin, reducing other drugs that may worsen it.

Question 5

Heart failure preserved ejection fraction

Answer 5

Loop diuretic

Question 6

AF

Answer 6

Rate control- Beta blocker or CCB depending on co-morbs

Do CHADVASC to determine stroke risk-

1= consider anticoag, 2= defo give

This would be warfarin or NOAC. Use HAS-BLED to check bleeding risk.

Consider referral for rhythm control

Question 7

Stroke secondary prevention

Answer 7

Antiplatelet (clopidogrel 75mg OD)

Statin (80mg OD)

Antihypertensive (normal pathway)

If AF or atrial flutter- anticoag (warfarin or NOAC) and would probably stop the antiplatelet if so