CV Risk Flashcards
What are the non-modifiable CV risk factors?
Age Family history Gender Ethnicity Co-morbidities
What are the modifiable CV risk factors?
HTN Smoking Abnormal blood lipids Physical inactivity Obesity Unhealth diet Stress Alcohol use
What are the 3 main components of cigarette smoke?
Tar
Carbon monoxide
Nicotine
What is the half life of nicotine in the blood?
90-120 minutes
What does ‘AAA’ stand for?
Ask Advise Act
What are the 3 licensed medications for smoking cessation?
NRT
Bupropion
Varenicline
What was Bupropion originally developed as?
An antidepressant
When should Bupropion be started?
1 week before the quit date
What is the dosing regime for Bupropion?
1 x 150mg OD first week
2x 150mg OD from quit date for 7-11 weeks
How does Vaernicline work?
Reduces cravings and withdrawal symptoms
Which has fewer side effects- Bupropion or Varenicline?
Varenicline
One unit of alcohol is equal to what?
1/2 pint of beer, lager or cider
50ml of fortified wine e.g. sherry or port
What are the BMI classes?
<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
What should waist circumference be?
Men < 94cm
Women<80cm
What ages should QRISK2 be used for?
(25)40-85 years
Specialist assessment should be arranged if total cholesterol or non-HDL is over what?
TC: 9.0mmol/L
non-HDL: 7.5mmol/L
TGs: 20mmol/L
What should be done in people with TG concentration between 10 and 20 mmol/L?
Repeat with fasting test (5- 14 days later)
Review potential secondary cause
What are statins?
HMG CoA reductase inhibitors
What do NICE recommend for CV secondary prevention?
Atorvastatin 80mg
What do NICE recommend for CV primary prevention?
Atorvastatin 20mg
Statins should be offered to people with a CV risk of what?
> 10%
For people on high intensity statins, what is the aim for reduction in non-HDL cholesterol?
> 40%
What are the potential SEs for statins?
Myopathy
Rhabdomyolysis
Which statin does amlodipine interact with?
Simvastatin
dose>20mg
How often should TC, HDL and non-HDL be monitored after initiation of a statin?
3 months
and annually thereafter
Atorvastatin does not have a license for primary prevention- true or false?
True
-some local formularies remain with simvastatin 40mg
5Kg weight loss equates with what BP reduction?
5mmHg
What are the low intensity statins?
Fluvastatin 20, 40
Pravstatin 10,20 40
Simvastatin 10
What are the medium intensity statins?
Fluvastatin 80
Simvastatin 20, 40
Atorvastatin 5
What are the high intensity statins?
Simvastatin 80
Atorvastatin 20, 40, 80
Rosivastatin 10,20, 40
What statin does amlodipine and diltiazem interact with?
Simvastatin
What is first line statin for people with >10% CV risk (primary prevention)?
Atorvastatin 20mg
Statins should be discontinued if creatine kinase is what?
> 5 times upper limit of normal
What % reduction do a) low intensity b)medium intensity c) high intensity statins cause?
a) 20-30%
b) 31-40%
c) >40%
What statin treatment should people with CVD have?
Atorvastatin 80mg
QRISK will underestimate risk in who?
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
Antiplatelet treatment should be prescribed for secondary prevention of CV events in people with what?
Angina Previous MI Previous stroke or TIA Peripheral arterial disease AF
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) 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
What should be prescribed alongside clopidogrel if person has high risk of GI adverse effects?
Lansoprazole 15mg OD
What are appropriate first line PPIS?
Lansoprazole, omperazole, pantoprazole
If a smoker’s attempt to quit is unsuccessful, do not offer a repeat prescription within how many months?
6 months
When should Ezetimibe be an option for reducing CV risk?
High risk patients who are intolerant to 3 statins
What should be done if LFTs are raised when wanting to initiate a statin?
Do not exclude people who have liver transaminase levels which are raised but are less than 3 x the upper limit of normal
What should be done if creatine kinase is raised when wanting to initiate a statin?
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.
QRISK2 risk assessment tool should be used to assess who?
For primary prevention of CVD in people 84 or under
In people with type 2 diabetes
QRISK2 should not be used to assess who?
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
QRISK will underestimate risk in people with what?
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
What are the possible secondary causes of dyslipidaemia?
Excess alcohol Uncontrolled diabetes Hypothyroidism Liver disease Nephrotic syndrome
When should statins be stopped in pregnancy?
Advise women planning pregnancy to stop taking statins 3 months before they attempt to conceive and not to restart them until breastfeeding is finished
