CVD

Question 1

Risk factors of CVD

Answer 1

Smoking
Genetics - FH
Age
Gender
obesity
diet 
excersise

Question 2

Primary prevention for CVD

Answer 2

modify diet, excersise, stop smoking,

Question 3

Secondary prevention for CVD

Answer 3

Medications for
Angina
Heart Attack
Stroke
Claudication

Question 4

Prevention regime

Answer 4

Lifestyle changes
2.Control Total Cholesterol
Statin Treatment
Reduce cholesterol <5.0mmol/L or 25%
3.Control Hypertension
Moderate hypertension
mild hypertension with evidence of CV disease
Reduce blood pressure to target of <140/85
4.Anti Platelet drugs - Aspirin
When identified Cardiovascular disease
When HIGH RISK with no identified disease

Question 5

Cardiovascular drug categories
Prevent disease
Reduce current symptoms

Answer 5

Prevent further disease
Anti platelet drugs
Lipid lowering drugs
Anti-arrhythmics
Anticoagulants
Reduce symptoms of current disease
Diuretics
Anti-arrhythmics
Nitrates
Calcium channel blockers
Ace inhibitors

Question 6

Antiplatelet drugs and actions

Why are they prescribed

Answer 6

Aspirin - inhibits PLT aggregation
Clopidegrel - inhibit ADP and PLT aggregation
Dipyrimadole - inhibit PLT phosphodiesterase

Given to reduce chance of heart attack or stroke

Question 7

Issues with antiplatelets

Answer 7

On own not a significant bleeding risk but if used in combination

Question 8

Anticoagulants and their action

Answer 8

Warfarin

NOACS - rivaroxiban/apixiban/dabigatran

Question 9

Wat is the action of warfarin

Answer 9

Coumarin based anitcoagulant
Inhibits synthesis of Vitamin K dependent clotting factors
2, 7, 9,10 (slow – 2 days)
Protein C, Protein S (quick)
Initial Hypercoagulation
Anticoagulation takes 2-3 days, then after 2-3d to clear
Often HEPARIN used concurrently initially

Question 10

Therapeutic range of INR

Answer 10

2.0-4.0

Question 11

NOAC drugs and their usually routine

Answer 11

Rivaroxiban -x1 daily – (aXi)
Apixaban -x2 daily – (aXi)
Dabigatran -x2 daily – (dTi)

Question 12

NOAC interactions

Answer 12

Safe with ‘Dental’ Antibiotics except Macrolides
Erythromycin and Clarithromycin
Safe with Antifungals – topical and fluconazole
Safe with Local Anaesthetics
Safe with Antivirals
NSAID will prolong action and inhibit platelets – avoid

Question 13

What are statins and their action

Answer 13

HMG coA Reductase inhibitors (“Statins”)
Simvastatin – (a ‘prodrug’)
Atorvastatin
Inhibit cholesterol synthesis in the liver
Reduce total cholesterol and LDL-cholesterol
Side effects – possible myositis with some drug interactions – includes antifungals
HMG coA Reductase inhibitors (-statin)
Simvastatin – (a ‘prodrug’)
Atorvastatin
Rosuvastatin
Inhibit cholesterol synthesis in the liver
Reduce total cholesterol and LDL-cholesterol
Side effects – possible myositis with some drug interactions – includes some dental antifungals
FLUCONAZOLE interaction
Omit statin during antifungal treatment

Question 14

What are beta blockers - names and action

Answer 14

Beta-adrenergic blockers (β-blockers)
Atenolol – selective - β1 only
Propranolol – non-selective – β1 and β2
Many others (-olol)
Stop arrhythmias leading to cardiac arrest (Ventricular fibrillation – VF)
Reduces heart muscle excitability

Question 15

How do beta blockers work

Answer 15

Beta-adrenergic blockers (β-blockers
Prevent increase in heart rate
Cause postural hypotension
Prevent unusual heart rhythms which can lead to heart attacks
Reduce heart efficiency
Make heart failure worse
Block beta receptors in the lungs
Make asthma worse or difficult to treat

Question 16

What are diuretics

Answer 16

Antihypertensive and for Heart Failure
Thiazide diuretics (bendroflumethiazide)
Loop diuretics (frusemide)
Increase salt and water LOSS
Reduce plasma volume
Reduce cardiac workload
Side effects – can lead to Na+/K+ imbalance if not monitored carefully
Can lead to dry mouth in the elderly

Question 17

What are nitrates

Answer 17

Short acting – Glyceryl Trinitrate (GTN)
Emergency management of angina pectoris
Long acting – Isosorbide Mononitrate
Prevention of angina pectoris

Dilate VEINS
Reduce preload to the heart
Dilate resistance arteries
Reduce cardiac workload (afterload)
Reduce cardiac oxygen consumption
Dilate colateral coronary artery supply
Reduce anginal pain

Question 18

What are Ca channel blockers

Answer 18

Hypertension
Block Calcium channels in smooth muscle
Some more active on peripheral blood vessels
Relaxation and vasodilation
Nifedipine, amlodipine (-pine)
Some more active on the heart muscle
Slow conduction of pacing impulses
Verapamil

Question 19

What are ACE inhibitors

Answer 19

Angiotensin Converting Enzyme (ACE) inhibitors
Many on the market (-pril)
Enalapril
Ramapril
Lisinopril
Inhibit conversion of angiotensin I to angiotensin II
Prevents aldosterone dependent reabsorbtion of salt and water.

Question 20

How do ACE inhibitors work

Answer 20

Reduce blood pressure
Reduce excess salt and water retention
 - side effects – cough, hypotension
Angiotensin II blockers
Losartan and others (-artan)
Inhibit same system but by a different mechanism