Cardiovascular epidemiology and drugs Flashcards
Irreversible risk factors for CVD
age
sex
family history
Reversible (by behaviour change) risk factors for CVD
smoking
obesity
diet
exercise
Reversible (by pharmacological intervention) risk factors for CVD
hypertension
hyperlipidaemia
diabetes
stress
What has to occur in a patients mind for them to have a behavioural change?
know the info,
believe the info,
and have a personal motivation to change
What is primary prevention
having measures in place to prevent getting a health issue in the first place
What is secondary prevention
After presenting with e.g. CVD putting measures in place to not get it again
Why is primary prevention difficult
People don't think they'll get it. Opportunistic approach - family history - diet - smoking - test cholesterol - test bp - test for type 2 diabetes
Why is secondary prevention easier than primary
personal motivation to fix risk factors is much higher
What are the main approaches to preventing CVD
- lifestyle changes
- control total cholesterol
- statin treatment
- reduce cholesterol <5.0mmol/L or 25% - control hypertension
- moderate hypertension
- mild hypertension with evidence of CVD
- reduce blood pressure to target of <140/85 - Anti platelet drugs - Asprin
- when identified CVD
- When high risk with no identified disease
How can drugs be used in the CVS
prevent further disease
reduce symptoms of current disease
What drugs are used to prevent further disease
- anti platelet drugs
- lipid lowering drugs
- anti-arrhythmics
- anticoagulants
What drugs are used to reduce symptoms of current disease
- diuretics
- anti-arrhythmics
- nitrates
- Ca channel blockers
- Ace inhibitors
What do anti-platelet drugs do
interfere with platelet aggregation by reversibly or irreversibly inhibiting various steps in the platelet activation required for primary haemastasis
What do anticoagulant drugs do
inhibit the production or activity of the factors that are required for the coagulation cascade
What does aspirin do
anti-platelet drug
inhibits platelet aggregation
- after the balance between throboxane A2 and Prostacyclin
- irreversible for the life of the platelet (but need to take regularly cause newly produced platelets will be unaffected if you don’t)
What does clopidogrel do
anti- platelet drug
inhibits ADP induced platelet aggregat
What does dipyridamole do
anti-platelet drug
inhibits platelet phosphodiesterase
What are the features of anti-platelet drugs
- used in combination to increase affect
- significantly reduce chance of a heart attach or stroke
- prolong the bleeding time following dental extraction
Two new antiplatelet drugs?
prasugrel
ticagrelor
- only prescribed in conjunction with aspririn
- only licenced for ACS
- poor evidence of bleeding risk in dentistry
What is it that clots can form over in the arteries leading to CVD
atheroma
athrolosclerosis
What does warfarin do
- inhibits synthesis of Vit K dependent clotting factors (2,7,9,10 slow-2 days, Protein C and S quick)
- initial hypercoagulation. Anticoagulation takes 2-3 days so often heparin used concurrently initially
How is warfarin monitored
must be monitored regularly
INR test
- ratio of patients blood clotting to a control sample
- a treated person should take 2-4 times as long at clotting
- under 2 - risk of clot
- 2-4 fine
- over 4 risk of bleed
drug and food interaction also important
What is it important to consider when treating a patient on warfarin
assume all drugs interact with warfarin
- get INR tested day after prescribing
- LA safe
- local haemostatic measures always
new oral anticoagulants? (NOAC)
rivaroxiban
apixaban
dabigatran
