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PA40256 > CV Risk > Flashcards

CV Risk Flashcards

1
Q

What are the non-modifiable CV risk factors?

A 
Age
Family history
Gender
Ethnicity
Co-morbidities
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2
Q

What are the modifiable CV risk factors?

A 
HTN
Smoking
Abnormal blood lipids
Physical inactivity
Obesity
Unhealth diet
Stress
Alcohol use
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3
Q

What are the 3 main components of cigarette smoke?

A

Tar
Carbon monoxide
Nicotine

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4
Q

What is the half life of nicotine in the blood?

A

90-120 minutes

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5
Q

What does ‘AAA’ stand for?

A

Ask Advise Act

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6
Q

What are the 3 licensed medications for smoking cessation?

A

NRT
Bupropion
Varenicline

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7
Q

What was Bupropion originally developed as?

A

An antidepressant

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8
Q

When should Bupropion be started?

A

1 week before the quit date

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9
Q

What is the dosing regime for Bupropion?

A

1 x 150mg OD first week

2x 150mg OD from quit date for 7-11 weeks

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10
Q

How does Vaernicline work?

A

Reduces cravings and withdrawal symptoms

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11
Q

Which has fewer side effects- Bupropion or Varenicline?

A

Varenicline

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12
Q

One unit of alcohol is equal to what?

A

1/2 pint of beer, lager or cider

50ml of fortified wine e.g. sherry or port

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13
Q

What are the BMI classes?

A 
<18.5 underweight
18.5-25 Desirable
25-30 Overweight
>30 Obese
30-35 Class 1 obese
35-40 Class 11 obese
>40 Morbidly obese
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14
Q

What should waist circumference be?

A

Men < 94cm

Women<80cm

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15
Q

What ages should QRISK2 be used for?

A

(25)40-85 years

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16
Q

Specialist assessment should be arranged if total cholesterol or non-HDL is over what?

A

TC: 9.0mmol/L
non-HDL: 7.5mmol/L
TGs: 20mmol/L

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17
Q

What should be done in people with TG concentration between 10 and 20 mmol/L?

A

Repeat with fasting test (5- 14 days later)

Review potential secondary cause

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18
Q

What are statins?

A

HMG CoA reductase inhibitors

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19
Q

What do NICE recommend for CV secondary prevention?

A

Atorvastatin 80mg

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20
Q

What do NICE recommend for CV primary prevention?

A

Atorvastatin 20mg

21
Q

Statins should be offered to people with a CV risk of what?

A

> 10%

22
Q

For people on high intensity statins, what is the aim for reduction in non-HDL cholesterol?

A

> 40%

23
Q

What are the potential SEs for statins?

A

Myopathy

Rhabdomyolysis

24
Q

Which statin does amlodipine interact with?

A

Simvastatin

dose>20mg

25
Q

How often should TC, HDL and non-HDL be monitored after initiation of a statin?

A

3 months

and annually thereafter

26
Q

Atorvastatin does not have a license for primary prevention- true or false?

A

True

-some local formularies remain with simvastatin 40mg

27
Q

5Kg weight loss equates with what BP reduction?

A

5mmHg

28
Q

What are the low intensity statins?

A

Fluvastatin 20, 40
Pravstatin 10,20 40
Simvastatin 10

29
Q

What are the medium intensity statins?

A

Fluvastatin 80
Simvastatin 20, 40
Atorvastatin 5

30
Q

What are the high intensity statins?

A

Simvastatin 80
Atorvastatin 20, 40, 80
Rosivastatin 10,20, 40

31
Q

What statin does amlodipine and diltiazem interact with?

A

Simvastatin

32
Q

What is first line statin for people with >10% CV risk (primary prevention)?

A

Atorvastatin 20mg

33
Q

Statins should be discontinued if creatine kinase is what?

A

> 5 times upper limit of normal

34
Q 
What % reduction do
a) low intensity
b)medium intensity
c) high intensity
statins cause?
A

a) 20-30%
b) 31-40%
c) >40%

35
Q

What statin treatment should people with CVD have?

A

Atorvastatin 80mg

36
Q

QRISK will underestimate risk in who?

A

People treated for HIV
People with serious mental health problems
People taking meds that can cause dyslipidaemia, such as antipsychotics, corticosteroids, or immunosuppressants.
People with autoimmune disorders

37
Q

Antiplatelet treatment should be prescribed for secondary prevention of CV events in people with what?

A 
Angina
Previous MI
Previous stroke or TIA
Peripheral arterial disease
AF
38
Q

Which antiplatelet is indicated for the following:

a) MI
b) Coronary or carotid interventions such as stenting
c) Ischaemic stroke and TIA
d) Peripheral artery disease
e) Multivascular disease

A

a) Aspirin 75mg (Clopidogrel 75mg alternative)
b) Aspirin 75mg with Clop 75, prasugel 10 or ticagrelor 90 bd
c) Clop 75
d) Clop 75
e) Clop 75

39
Q

What should be prescribed alongside clopidogrel if person has high risk of GI adverse effects?

A

Lansoprazole 15mg OD

40
Q

What are appropriate first line PPIS?

A

Lansoprazole, omperazole, pantoprazole

41
Q

If a smoker’s attempt to quit is unsuccessful, do not offer a repeat prescription within how many months?

A

6 months

42
Q

When should Ezetimibe be an option for reducing CV risk?

A

High risk patients who are intolerant to 3 statins

43
Q

What should be done if LFTs are raised when wanting to initiate a statin?

A

Do not exclude people who have liver transaminase levels which are raised but are less than 3 x the upper limit of normal

44
Q

What should be done if creatine kinase is raised when wanting to initiate a statin?

A

If more than 5 x the upper limit of normal, re-measure after 7 days. If still high, do not start statin treatment.

If high but less than 5 x upper limit of normal, start or reduce to a lower dose of statin once symptoms have resolved.

45
Q

QRISK2 risk assessment tool should be used to assess who?

A

For primary prevention of CVD in people 84 or under

In people with type 2 diabetes

46
Q

QRISK2 should not be used to assess who?

A

People with type 1 diabetes
With an eGFR < 60ml/min and/or albuminuria
Pre existing CVD
At high risk of developing CVD because of familial hypercholesterolaemia

47
Q

QRISK will underestimate risk in people with what?

A

HIV infection
Serious mental health problems
Taking meds that can cause dyslipidaemia e.g. antipsychotics, corticosteroids or immunosuppressant drugs
Autoimmune disorders e.g. systemic lupus erythematosus and other systemic inflammatory disorders

48
Q

What are the possible secondary causes of dyslipidaemia?

A 
Excess alcohol
Uncontrolled diabetes
Hypothyroidism
Liver disease 
Nephrotic syndrome
49
Q

When should statins be stopped in pregnancy?

A

Advise women planning pregnancy to stop taking statins 3 months before they attempt to conceive and not to restart them until breastfeeding is finished

PA40256 (10 decks)

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