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Y3 GP > CKD, Hypertension And Hyperlipidaemia + HF > Flashcards

CKD, Hypertension And Hyperlipidaemia + HF Flashcards

1
Q

What is CKD ?

A

The progressive loss of nephrons resulting in permanent compromise of renal function.

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2
Q

What are the classifications of CKD ?

A

Stage 1 - normal GFR with other evidence of kidney damage
Stage 2 - mild impairment 60-89 GFR
Stage 3 - moderate impairment 30-59 GFR
Stage 4 - severe impairment 15 - 29 GFR
Stage 5 - east allied renal failure less than 15 GFR

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3
Q

Other than GFR what are some other ways in which kidney damage can be shown ?

A

Persistent microalbuminuria
Persistent Proteinuria
Persistent haematuria
Abnormalities seen on USS
Biopsy showing glomerulonephritis

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4
Q

What are some causes of CKD ?

A

Glomerulonephritis
Multisystem - DM or Alport’s
Pyelonephritis
HTN
Polycystic kidney disease
Idiopathic

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5
Q

What is common in the PMH if someone has CKD ?

A

Recurrent UTI’s
HTN
( May have had pre-eclampsia )

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6
Q

What medications should be asked about if someone is suspected to have CKD ?

A

Analgesics
Anti-rheumatic meds
Antibiotics - gentamycin, aminoglycosides and cephalosporins

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7
Q

What conditions are important to ask about in the family history when someone is suspected of having CKD ?

A

Adult polycystic kidney disease
Alports disease

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8
Q

What are some clinical features of CKD ?

A

Nausea and vomiting
Diarrhoea
Uraemic pericarditis
HTN
HF
Confusion
Seizures
Anaemia
Itchy skin

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9
Q

What conditions should be screened for CKD ?

A

DM
HTN
CVD
Renal tract disease or calculi

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10
Q

What investigations should be performed when suspecting CKD ?

A

FBC
ESR
U&E
EGFR
Bone profile
MSU
Creatinine clearance
USS
Renal biopsy
Albumin : creatinine ratio

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11
Q

What is the management of CKD in primary care ?

A

Regular measurements of kidney function using serum creatinine
Advice on smoking cessation
Weight loss advice
Encourage regular aerobic activity
Limit alcohol
Oral anti platelets and anticoagulants

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12
Q

What are some complications of CKD ?

A

HTN
Anaemia
Renal osteodystrophy
Atherosclerosis
Renal cysts

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13
Q

What is heart failure ?

A

A clinical syndrome with typical symptoms and signs caused by a structural and/or functional abnormality that produces raised intracardiac pressure and inadequate Canadian output at rest and/or exercising.

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14
Q

What is the NYHA score for HF ?

A

A functional classification of HF based on severity of symptoms and limitation of physical activity.

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15
Q

What are some causes of HF ?

A

Coronary artery disease
Hypertension
Valvular disease
Congenital heart disease
Arrhythmias
Volume overload

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16
Q

What are some complications of HF ?

A

AF
Ventricular arrhythmias
Cachexia
Anaemia
Depression
CKD
AKI
Sudden cardiac death

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17
Q

What signs can be examined for in patients with suspected HF ?

A

Tachycardia
Displaced heart beat or murmurs
Raised JVP
Obesity
Peripheral oedema

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18
Q

What investigations should be performed when suspecting HF ?

A

Measure NT-pro-BNP ( if less than 400 HF less likely )
Arrange a 12 lead ECG
CXR
Blood tests - U&E, eGFR, FBC, iron levels, TFT and LFT
Urine dipstick

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19
Q

What increases levels of BNP ?

A

Age over 70
Left ventricular hypertrophy
MI
Right ventricular overload
Hypoxia
CKD
Sepsis
COPD
DM
Liver cirrhosis

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20
Q

What conditions cause breathlessness over than HF ?

A

COPD
Asthma
PE
Lung cancer
Anxiety

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21
Q

What conditions cause peripheral oedema over than HF ?

A

Nephrotic syndrome
Drugs such as amlodipine
Hypoalbuminaemia

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22
Q

What is the management for HF ?

A

Loop diuretic if volume overload is present - titrate dose to relieve symptoms
Prescribe an ACEi and beta blocker
Aldosterone antagonist and SGLT2i
Consider Antiplatelet drug and statin therapy
Reduce risk factors

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23
Q

What information and advice should be given to someone with HF ?

A

Reduce salt consumption
Restrict fluid intake
Smoking cessation
Reduce alcohol consumption
Regular low intensity physical activity

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24
Q

When should a HF patient be referred ?

A

Severe HF
HF that doesn’t respond to treatment
Ejection fraction lower than 35%
Pro- BNP higher than 2000
Other co-morbidities - CKD or COPD

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25
Q

Who should a HF patient be followed up ?

A

Regular follow ups and monitoring
Monitor symptoms and signs
Review meds
Monitor U&E’s and eGFR every 6 months
Review every 6 months

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26
Q

What safety netting advice should be given ?

A

Advice the patient about reporting worsening symptoms - increasing breathlessness, fatigue, ankle swelling, rapid weight gain

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27
Q

What are some symptoms of HF ?

A

Breathlessness
PND
Orthopnoea
Fatigue
Exercise intolerance
Nocturia

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28
Q

What are some signs of HF ?

A

Tachycardia
Displaced apex beat
Third heart sound
Gallop rhythm
Reduced pulse volume
Raised JVP
Oedema
Basal crepitations
Ascites

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29
Q

What is hypertension ?

A

A high systemic arterial blood pressure
Defined as persistent raised blood pressure 140 /90 or higher

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30
Q

What are the stages of HTN ?

A

Stage 1 hypertension - 140/90 mmHg to 159/99 mmHg

Stage 2 Hypertension - 160/100 mmHg or higher but less than 180/120 mmHg

Stage 3 hypertension - clinic systolic blood pressure of 180 mmHg or higher or clinic diastolic blood pressure of 120 mmHg or higher.

31
Q

What is the difference between primary and secondary HTN ?

A

Primary - no identifiable cause
Secondary - has an underlying cause - renal, endocrine or vascular cause

32
Q

What are some risk factors for HTN ?

A

Age
Gender ( under 65 women have lower, over 65 women have higher )
Ethnicity
Genetic factors
Social deprivation
CKD or DM
Smoking
Obesity
Excessive alcohol consumption
Anxiety o stress

33
Q

What are some secondary causes of HTN ?

A

CKD
Chronic pyelonephritis
PCKD
Renal artery stenosis
Primary hyperaldosteronism
Cushing’s syndrome
Thyroid disfunction
Drugs
Pregnancy

34
Q

What are some complications of HTN ?

A

HF
Coronary artery disease
Stroke
CKD
Peripheral artery disease
MI

35
Q

What investigations should be performed when suspecting HTN ?

A

Measure BP in a relaxed, calm setting
Ambulatory BP reading
Home BP reading
Test for kidney function
Test for DM ( HbA1c )
ECG
HDL cholesterol

36
Q

What lifestyle advice should be given for someone with HTN ?

A

Healthy diet - low sodium
Regular exercise
Reduce caffeine
Stop smoking
Low alcohol intake

37
Q

What is the first step in treating HTN ?

A

ACEi or ARB ( CCB if over 55 or black African or Caribbean ethnicity )

38
Q

What is the second step in treating HTN ?

A

ACEi or ARB + CCB or thiazide like diuretic

CCB + ACEiorARB or thiazide I like diuretic if over 55 or black African or Caribbean ethnicity

39
Q

What is the third step in the management of HTN ?

A

ACEi or ARB + CCB + thiazide like diuretic

40
Q

What are the BP targets in people over 80 ?

A

Less than 150/90

41
Q

How often should someone with HTN be reviewed ?

A

Annually

42
Q

What should be done at the reviews of HTN ?

A

Assess adherence to medication
Lifestyle advice
Check BP
Check renal function ( serum creatinine, electrolytes and eGFR and urine to check ACR
Perform a QRISK

43
Q

What is hyperlipidaemia ?

A

Conditions that cause an increase in the levels of lipids in the blood.

44
Q

What does an increase in chylomicrons and very low density lipoproteins lead to ?

A

An increase in triglycerides

45
Q

What does an increase in low density and intermediate lipoproteins lead to ?

A

Increase in cholesterol

46
Q

What are some conditions that cause hyperlipidaemia ?

A

Nephrotic syndrome
Hypothyroidism
Biliary obstruction
Pregnancy
Steroids
DM
Renal failure
Excessive alcohol intake

47
Q

What are the associated clinical disorder of type 1 hyperlipidaemia ?

A

Lipoprotein lipase deficiency
Apolipoprotein C-II deficiency

48
Q

What are the associated clinical disorder of type 2a hyperlipidaemia ?

A

Familial hypercholesterolaemia
Hypothyroidism

49
Q

What are the associated clinical disorder of type 4 hyperlipidaemia ?

A

DM

50
Q

What are the elevated particles in type 1 hyperlipidaemia ?

A

Chylomicrons

51
Q

What are the elevated particles in type 2a hyperlipidaemia ?

A

LDL

52
Q

What are the elevated particles in type 2b hyperlipidaemia ?

A

LDL
VLDL

53
Q

What are the elevated particles in type 3 hyperlipidaemia ?

A

IDL

54
Q

What are the elevated particles in type 4 hyperlipidaemia ?

A

VLDL

55
Q

What are some clinical features of hyperlipidaemia ?

A

Xanthelasmas
Corneal arcus
Xanthomas

56
Q

What are some investigations of hyperlipidaemia ?

A

Fasting cholesterol
Triglyceride levels
FBC
ESR
LFT
TFT

57
Q

What indications are there for testing for suspected hyperlipidaemia ?

A

Family history
Family history of individual history of CHD before 60 years old
Xanthelasma or xanthomas
Corneal arcus
HTN or DM

58
Q

What is included in a lipid lowering diet ?

A

Low fat diet
Reduce saturated fat from animal sources
Choose wholegrain foods
Increase fruit and veg
Increase fibre

59
Q

What should be assessed before starting statin therapy ?

A

Smoking status
Alcohol consumption
BP
BMI
Total cholesterol, HDL and triglycerides
HbA1c
Renal function and eGFR
ALT and AST levels
TSH levels

60
Q

What should total cholesterol levels be ?

A

5 or below

61
Q

What is atherosclerosis ?

A

A condition where there is a build up of fatty deposits inside the artery that cause the artery to harden and narrow restricting blood flow.

62
Q

What are extreme levels of triglycerides ( over 20 mmol/L ) associated with ?

A

Pancreatitis
Morbidity and mortality

63
Q

What are some lifestyle modifications that should be advised when suspecting hyperlipidaemia ?

A

Less fatty food
More oily fish
Wholegrain
Smoking cessation
Limit alcohol

64
Q

What are the pharmacological treatment options for hyperlipidaemia ?

A

Statins are first line
Ezetimibe and fibrates

65
Q

How do statins work ?

A

Competitively inhibit HMG - CoA reductase - an enzyme involved in cholesterol synthesis ( especially in the liver ).

66
Q

What are some common side effects of statins ?

A

Athralgia
Constipation or diarrhoea
Dizziness
Flatulence
Headaches
Muscle aches
Nausea

67
Q

What are some examples of statins ?

A

Atorvastatin
Simvastatin
Fluvastatin
Rosuvastatin

68
Q

What is the drug action of Ezetimibe ?

A

Inhibits the intestinal absorption of cholesterol
If used alone has a modest effect on lowering LDL - cholesterol with little effect on other lipoprotein

69
Q

What are some side effects of Ezetimibe ?

A

Diarrhoea
GI discomfort

70
Q

What is the mechanism of action of fibrates ?

A

Activates PPAR alpha increasing lipolysis activating lipoprotein lipase and reducing Apoprotein CIII.

71
Q

What are the contraindications for fibrates ?

A

Gall bladder disease
Pancreatitis
eGFR lower than 30

72
Q

What are some side effects of fibrates ?

A

Abdominal pain
Diarrhoea
Flatulence
Nausea
Vomiting
Cholelithiasis

73
Q

What follow up should be organised in someone with hyperlipidaemia ?

A

Follow up after 3 months of starting treatment
Recheck LFTs
Review statin treatment annually

74
Q

What are serious adverse effects of statins ?

A

Myopathy
Rhabdomyolysis

Y3 GP (12 decks)

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