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Cardiovascular > Cardiovascular Treatment > Flashcards

Cardiovascular Treatment Flashcards

1
Q

What are some modifiable risk factors of CVD

A

Smoking
Diet
Exercise
Weight
Alcohol

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2
Q

Non modifiable risks of CVD

A

Age
Ethnicity
Genetics
Males

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3
Q

Who gets statins regardless of their QRISK score

A

High risk patients

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4
Q

Whats the QRISK tool

A

A tool used to assess 10 year CVD risk. If they get 10% or more theyre at risk hence need primary prevention (20mg atorvastatin)

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5
Q

Primary prevention of CVD includes

A

20mg atorvastatin and lifestyle changes

Anti hypertensives if bp >140/80

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6
Q

What ages are at higher risk of CVD

A

50+yrs

85+yrs are at higher risk

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7
Q

What comorbidities of CVD are modifiable

A

Depression/anxiety
Abnormal lipids
Hypertension
T2DM
Social isolation

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8
Q

Whats the definition of cardiovascular disease

A

Group of disorders of the heart caused by atherosclerosis and thrombosis

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9
Q

Cardiovascular diseases include

A

MI
stroke
Angina

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10
Q

QRISK2 estimates….

A

10 year CVD risk

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11
Q

Qrisk 3 estimates

A

10 year CVD risk

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12
Q

JBS3 estimates

A

The lifetime risk of CVD events and 10 year

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13
Q

ASSIGN estimates

A

10 year risk of CVD

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14
Q

Which CVD risk tool is used in scotland

A

ASSIGN

The rest are used in england and wales

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15
Q

Who are the high risk patients of CVD who require statins regardless of the risk assessments

A

T1DM
established CVD
CKD
familial hypercholesterolaemia
80 yrs or over especially if they smoke or have hypertension
10% or more 10 yr CVD risk

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16
Q

Which drugs are used in primary prevention of CVD

A

Lipid regulating drugs

Antihypertensives (only high risk patients with BP >140/90mmHg)

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17
Q

Are antiplatelets used in primary prevention of CVD

A

No

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18
Q

Whens antihypertensives given in CVD primary prevention

A

If theyre high risk with a BP of >140/90mmHg

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19
Q

What drugs are used in CVD secondary prevention

A

Lipid regulating drugs such as high dose (atorvastatin 80mg)
Antihypertensives (bp >140/90mmHg)
Antiplatelets

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20
Q

A patient requires primary prevention as they achieved 14% on the QRISK tool. They also have anxiety and depression. What primary prevention would you give?

A

Lifestyle measures
If ineffective give a low dose statin

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21
Q

A patient requires primary prevention as they achieved 11% on the QRISK tool. They also have a history of familial hypercholestraemia. And they present with a blood pressure of 164/93mmHg. What primary prevention would you give?

A

Atorvastatin 20mg or ezetimibe
Antihypertensive because theyre high risk and have BP >140/90mmHg

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22
Q

In primary prevention what would be the first line?

A

Lifestyle if theyre not high risk

If ineffective give a low dose statin

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23
Q

In primary prevention we aim to reduce non HDL cholesterol by……

A

> 40%

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24
Q

What is hyperlipidaemia?

A

High cholesterol, triglycerides or both

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25
Q

What are the main causes of hyperlipidaemia?

A

Hypothyroidism
Drugs — antipsychotics especially 1st gen, immunosuppressants, antiretrovirals and corticosteroids)

Liver/ kidney disease
Family history
Diabetes
Lifestyle- smoking, obesity

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26
Q

Which drugs can cause hyperlipidaemia

A

Antipsychotics especially 1st gen

Antiretrovirals

Corticosteroids

Immunosuppressants

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27
Q

How do thyroid levels affect cholesterol

A

Low thyroid levels (hypothyroidism) causes high cholesterol levels

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28
Q

Patients at high risk of developing hyperlipidaemia include….

A

T1DM, T2DM if their CVD risk is 10% or more

CKD

family history

Age

CVD risk 10% or more

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29
Q

Which patients do you give statins regardless of serum cholesterol levels

A

Patients at high risk
- T1DM, T2DM if their CVD risk >10%
- CKD
- family history
- over 80
- CVD risk 10% or more

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30
Q

If you cant use statins in primary prevention of CVD, what is the second line?

A

First line is a low dose statin
2nd line is ezetimibe

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31
Q

What is a high intensity statin?

A

A statin which reduces LDL/ bad cholesterol by more than 40%

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32
Q

What are examples of high intensity statins?

A

Atorvastatin

Rosuvastatin

Simvastatin

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33
Q

For primary prevention of CVD what statins would you use and why

A

High intensity (Rosuvastatin, atorvastatin, simvastatin) or ezetimibe

Because they reduce LDLs by more than 40%

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34
Q

Why are statins beneficial in 85yrs ans over in CVD disease risk

A

They reduce risk of non fatal MI

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35
Q

Can we use fibrates in primary and secondary prevention of CVD

A

No

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36
Q

What lowering lipid drugs cant we use in primary and secondary prevention of CVD

Give examples

A

Fibrates

Clofibrate

Fenofibrate

Gemfribrozil

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37
Q

What lowering lipid drugs aren’t recommended in primary and secondary prevention of CVD

A

Nicotinic acid, bile acid sequestrants and omega 3 fatty acid compounds

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38
Q

Healthy Range for HDL

A

> 1

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39
Q

Range for triglycerides

A

< 1.8

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40
Q

LDL range in high risk patients

A

2 or less

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41
Q

LDL range in a healthy adult

A

3 or lower

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42
Q

TC range in high risk adults

A

4 or less

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43
Q

TC range in healthy adults

A

5 or less

44
Q

Hyperlipidaemia diagnosis lipid range

A

6 or more

45
Q

Hypercholesterolaemia drug of choice

Why

A

Statins to reduce LDL by 50% or more

46
Q

Hypercholesterolaemia first line, 2nd line and 3rd line

A
  1. Statins
    • Ezetimibe
  3. Refer to specialist for nicotinic acid, bile acid or a fibrate
47
Q

If triglyceride levels are high (>1.8mmol) what can be added to a statin and why

A

Fenofibrate

Because theyre effective at lowering triglycerides than statins

48
Q

Whats used to lower triglycerides and LDL cholesterol

A

Nicotinic acid

49
Q

Statins interact with fibrates because

A

They increase the risk of rhabdomyolysis

50
Q

Whats rhabdomyolysis

A

Muscle wastage

51
Q

Statin monitoring

A

Liver function and creatinine kinase

52
Q

How frequently would you monitor liver function in statin use

A

liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity

53
Q

How frequently would you monitor creatinine kinase in statin use

A

Before treatment and in patients who have had persistent, generalised, unexplained muscle pain

54
Q

When would you discontinue statins when monitoring liver function

A

If they have more than 3x the upper limit of the reference range

55
Q

Measure hbA1c in those at high risk of diabetes who are using statins, how frequently

A

Before and after 3 months

56
Q

Statin is contraindicated with ____ because of increased risk of rhabdomyolysis

A

Gemfibrozil

57
Q

Which fibrate is contraindicated with statins

A

Gemfibrozil

58
Q

Statins MOA

A

Inhibit HMG CoA reductase

An enzyme involved in cholesterol synthesis in the liver

59
Q

Can statins be given in pregnancy

A

No

60
Q

Can statins be given in breastfeeding

A

Avoid

61
Q

How prior would you stop statins before pregnancy

A

Stop statins 3 months before trying to conceive

62
Q

Statins patient and carer advice, look out for_____

A

Rhabdomyolysis—> unexplained muscle pain, tenderness or weakness

63
Q

Can statins be used in hepatic impairment

A

Use with caution
But avoid in active liver disease or when there are unexplained persistent elevations in serum transminases (3x the upper limit)

64
Q

Can statins be used in renal impairment

A

Discontinue if elevated creatinine kinase because of sign of myopathy

65
Q

A patient is on simvastatin, he went in for his monitoring at 3 months and his creatinine kinase was elevated. What would you do and why?

A

Discontinue statins because its a sign of myopathy

66
Q

Whats myopathy

A

Muscle weakness

67
Q

Do the SE of statins increase with dose increase

A

Yes

68
Q

Whats a common side effect of statins

A

Muscle toxicity

69
Q

Which statins can you give anytime of the day and why

A

Atorvastatin and Rosuvastatin due to their long half life

70
Q

Which statins do you need to give at night

A

Simvastatin

Pravastatin

Fluvastatin

71
Q

Atorvastatin 80mg OD dose for

A

Secondary prevention if CVD

72
Q

Simvastatin 80mg MHRA warning

A

Causes rhabdomyolysis

73
Q

Whats the max strength of simvastatin with amlodipine

Why

A

20mg simvastatin

Because amlodipine increases statin exposure

74
Q

Whats the max strength of atorvastatin with ciclosporin

A

10mg atorvastatin

75
Q

Whats the max strength of Rosuvastatin with clopidogrel

A

20mg Rosuvastatin

76
Q

Maximum strength of simvastatin with a fibrate

A

Simvastatin 10mg

77
Q

Max strength of simvastatin with amlodipine

A

Simvastatin 20mg

78
Q

Max strength of simvastatin with Amiodarone

A

20mg

79
Q

Max strength of simvastatin with diltiazem

A

20mg

80
Q

Max strength of simvastatin with verapamil

A

20mg

81
Q

A patient presents to you with muscle pain and cramps in their legs, their on statins, what do you do?

A

Check creatinine kinase levels

If 5x above upper limit repeat in 7 days

Withhold statin until less than 5x the upper limit of the normal range then start at a lower dose

82
Q

A patient on a statin needs their LFTs monitored how frequently

A

Before
3Months
12 months

83
Q

Whats monitored before starting statins

A

LFTs
U&Es
Creatinine kinase
HbA1c or fasting blood glucose
Hypothyroidism
Renal function

84
Q

Whats monitored after starting statins

A

LFTs at 3 months and 12 months

HbA1c in those at high risk of diabetes at 3 months

85
Q

Important statin interactions

A

Nicotinic acid, fibrates, Amiodarone, colchicine

Carbamazepine

Clarithromycin/ erythromycin

Grapefruit juice

Ketoconazole/ miconazole

Amlodipine

86
Q

Statins and amlodipine interaction

A

Increases exposure of statin and increased risk of rhabdomyolysis

87
Q

Statin interaction with ketoconazole/ miconazole

A

Increased exposure to statins

88
Q

Grapefruit interaction with statins

A

Increases exposure to statin

89
Q

Clarithromycin/ erythromycin snd statin interaction

A

Increases exposure to statin

90
Q

Carbamazepine and statin interaction

A

Increased risk if Hepatotoxicity

91
Q

Amiodarone interaction with statin

A

Increased risk of rhabdomyolysis

92
Q

Colchicine interaction with statin

A

Increased risk of rhabdomyolysis

93
Q

Nicotinic acid and statin interaction

A

Increased risk of rhabdomyolysis

94
Q

Fibrates and statin interaction

A

Increased risk of rhabdomyolysis

statins CI with Gemfibrozil

95
Q

Max strength of simvastatin with Ronalazine

A

20mg

96
Q

Simvastatin at high intensity strength is

A

80mg

97
Q

Simvastatin strength at medium intensity is

A

40, 20mg

98
Q

Simvastatin strength at low intensity

A

10mg

99
Q

Simvastatin 20mg is what intensity

A

Medium

100
Q

Atorvastatin high intensity strengths

A

20,40,80mg

101
Q

Atorvastatin medium intensity strengths

A

10mg

102
Q

Fluvastatin medium intensity strength

A

80mg

103
Q

Fluvastatin low intensity strength

A

20,40mg

104
Q

Pravastatin low intensity strengths

A

10,20,40mg

105
Q

Rosuvastatin high intensity strengths

A

10,20,40mg

106
Q

Rosuvastatin medium intensity strength

A

5mg

Cardiovascular (9 decks)

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