Cardiovascular Medicine 1 Flashcards
what are the risk factors for cardiovascular disease
> irreversible
- age
- sex
- family history
> reversible
- smoking
- obesity
- diet
- exercise
- hypertension
- hyperlipidaemia
- diabetes
- stress
what does the patient need to do to change their risk modification
- need to have information on why they should change
- need to believe they can change
- need to have motivation to change
- need to have a behavioural change
what is primary prevention
stop the risk that is going to give you the disease before you actually have the disease
this is often more difficult as if the patient doesnt believe they will get the disease they have no motivation to make the changes - its not real to them
what is secondary prevention
once you have the disease, this is to stop it getting worse
this is easier as the patient wont want the disease to get any worse, they now have motivation as it is real to them
what can be done in primary prevention
> exercise > diet > not smoking > assess total risk - medical treatment if risk is high
what can be done in secondary prevention
> diet
exercise
not smoking
medical treatment to reduce risk
what type of approach should be taken with primary prevention
opportunistic approach > family history > diet > smoking > test cholesterol > test blood pressure > test for type 2 diabetes
what problems are likely to arise after presenting with CV disease
> angina
heart attack
stroke
claudication
what is included in the approach to prevention?
> lifestyle changes
> control total cholesterol
- statin treatment
- reduce cholesterol (<5.0mmol/L or 25%)
> control hypertension
- moderate hypertension
- mild hypertension with evidence of CV disease
- reduce blood pressure to target <140/85
> antiplatelet drugs - aspirin
- when identified CV disease
- when high risk with no identified disease
why are drugs used in CV system
> to prevent further disease
> to reduce symptoms of current disease
what drugs can be used to prevent further disease in the CV system
- anti-platelet drugs
- lipid lowering drugs
- anti-arrhythmics
- anticoagulants
what drugs can be used to reduce symptoms of current disease in CV system
- diuretics
- anti-arrhythmics
- nitrates
- calcium channel blockers
- ace inhibitors
what does aspirin do
inhibits platelet aggregation (dont want to stick to blood vessel walls)
alters the balance between thromboxane A2 and prostacyclin
irreversible for the life of the platelet (platelets last a week)
taking a aspirin every day means it will act on every new platelet being made in the body
how much aspirin should be taken to prevent platelet function
75mg
how much aspirin should be taken for painkiller function
300mg
what does clopidogrel do
inhibits ADP induced platelet aggregation
what does dipyridamole do
inhibits platelet phosphodiesterase
name new antiplatelet drugs
prasugrel and ticagrelor
when are new antiplatelet used
only prescribed in conjunction with aspirin
only licensed for acute coronary syndromes
poor evidence of bleeding risk in dentistry
what is atherosclerosis
> happens in arteries
more common as you get older
depends on biochemical factors in blood vessel walls and how you metabolise things
affected by diet and lifestyle
platelets stick to walls which narrows the artery and limits the blood flow
what do antiplatelets do
stop platelets sticking to walls and to each other
platelet helps to initiate clot formation but clot happens due to clot factors
name oral anticoagulants
> warfarin
(cheapest and most common, needs to be monitored and each patient has a tailored dose)
> rivaroxiban
apixaban
dabigatran
(these 3 drugs dependent on size of patients, these are preferred now but still more expensive but may work out that the cost of care is less overall as a result)
explain warfarin and its actions
- coumarin based anticoagulant
- inhibits synthesis of vitamin K dependent clotting factors (2,7,9,10 [slow] and protein C and S [quick])
- initial hypercoagulation
> anticoagulation takes 2-3 days
> often heparin used concurrently initially
> need to go into hospital and receive injectable anticoagulant to allow the oral warfarin time to actually work in the body - once stabilised it will take 2-3 days to los effect if drug stopped
> very easily upset
why must warfarin be monitored regularly
> drug and food interaction
- plasma protein binding
- liver metabolism
- need to have a predictable level of medicines and types of food
> monitored with INR test
- standardised prothrobin time (PT)
> usually therapeutic range is 2-4
- within range = no alteration needed for dental care
- out of range = refer for medical range
- less than 2 = risk of clot
- over 4 = risk of bleed
> local haemostatic measures always
> ID Block - avoid if possible but not contraindicated
