clw 3 Flashcards
HTN, HLD, DM, CKD
how to calculate BMI
weight / height^2
EF of HFrEF
≤40%
what to monitor when on statins
Creatinine kinase, statin associated muscle symptoms
when to start fibrates
when TG >5.8
if CK >4xULN, can start statin?
no
if lft more than 3xULN, stop statin?
yes
high risk for future ASCVD events
ACS (within 12m)
MI /stroke
FH
DM
CKD
target LDL for ASCVD, DM more than 10 years or DM with complications (neuropathy, retinopathy, microalbuminuria), familial history
1.8
DM with no complications or less than 10 years
2.6
doubling dose of statin gives reduction of how much
6-7% of LDL
main benefit of statin
reduce risk of mortality, especially for those with underlying ascvd
statin induced AE
dark urine, lethargy, anorexia, stomach pain, light coloured stools, jaundice
monitoring statin: labs?
lipids: 8+-4 weeks when adjusting, else annually
ALT: 8+-4 weeks, routine repeat not recc
CK: not necessary unless got myalgia
hba1c: high dose statin only
sglt2i AE
diabetic ketoacidosis, lightheadedness, fournier gangrene (practise good personal hygiene), UTI, increased urination
GOT of anemia
correct blood loss
remove drug causes
correct iron/folate/b12 deficiency
MOA of ESAs in CKD
Stimulate differentiation of erythroid progenitor stem cells and
induce release of reticulocytes from bone marrow
how often to monitor hgb after esa administration
every 1-2 weeks, then 3 months
AE of ESA
hypertension, flu-like syndrome, vascular access thrombosis (increases thickness of blood and chances of clotting)
common side effects of ESA tx and what to co-administer
iron deficiency due to stimulation of erythropoiesis
iron
oral iron administration
best taken without food, but can cause gastric discomfort
take apart from calcium salts, quinolones, H2RA, PPI
ADHERENCE!
SE of PO iron intake
constipation, dark stools, NV
try to increase dibre intake to reduce constipation
IV iron intake SE
allergy, hypotension, dizziness, dyspnea, headache, lower back pain, arthritis
what to monitor in CKD
eGFR, corrected Ca, P, PTH, ALP, Vit D
what is in the DASH diet for HTN
Eat this: vegetables, fruits, whole grains, fat-free or low-fat dairy, fish, poultry, beans, nuts and seeds, vegetable oils.
Limit this: fatty meats, full-fat dairy, sugar sweetened beverages, sweets, sodium intake
when to stop metformin an why
egfr<30 due to lactic acidosis risk
why SU and BB not preferred together
mask sx of hypofly
when to start anemia tx and goal of hgb
hgb <10
goal: 10-11
how to reduce dose of DM drugs when starting insulin
TZD discon
SU discon/reduce by 50%
dpp discon if got glp1
non pharm MBD
avoid high phosphate foods (800-1000mg a day) such as red meat, choc, dairy
if patient is having worsening ckd, why cannot increase dose of statin
may increase risk of rhabdo/SAMS
when switching from acei to arni, washout period?
36h
why do patients get tachycardia when they have HF?
in response to filling problem, to try and increase the filling
hence do not start BB yet until stable
if adherence is an issue for night statin doses, what to do
change to morning dosing is fine
high intensity statin
ator 40mg
why is hypercalcemia dangerous
can lead to high risk of calcification, formation of deposits and cvs mortality
when assessing Ca, P, PTH, can you look at the numbers one off?
no, review over time
calcium salt se for phosphate binding
hypercalcemia, constipation, loss of appetite, NV
phosphate binder administration
- compliance!
- take binders with meals/snacks to be effective
- space apart from quinolones, antiepileptics, digoxin, warfarin
vitamin d deficiency (Serum 25(OH)D) level
<15
side effect of vit d drugs
increase GI absorption of Ca and P, causing hypercalcemia, hyperphosphatemia
effect of calcimimetics
- increase sensitivity of calcium receptor on PTH gland
- inhibit PTH synthesis, secretion
- decrease ca and phosphate
side effects of calcimimetics
NVD, hypocalcemia
