CVD- HEART FAILURE + HYPERLIPIDAEMIA Flashcards
1
Q
What is Heart failure?
A
Clinical syndrome that is characterised by reduced cardiac output.
2
Q
What is ejection fraction in HF?
A
Less than 40%
3
Q
What are the 4 symptoms of HF?
A
Dyspnoea
Swollen ankles + legs
Cough - frothy + pink-tinged
Fatigue , low exercise tolerance
4
Q
What is treatment for HF + fluid overload?
A
Loop OR thiazide diuretic.
5
Q
When is thiazide diuretics be ineffective in HF?
A
If eGFR is less than 30
6
Q
What thiazide diuretic is still effective in HF in severe RI?
A
Metolazone
7
Q
What is 1st line treatment for HF?
A
ACEi + Beta blocker
8
Q
What to give if ACEi intolerant in HF?
A
Give ARB- candesartan, valsartan or Losartan
9
Q
What to give if ACEi + ARB intolerant in treating HF?
A
Hydralazine + Nitrate
10
Q
What BB is recommended for HF treatment?
A
Bisoprolol, Carvedilol
11
Q
What beta-blocker is given to treat HF patient if they are 70+ with mild-mod HF?
A
Nebivolol
12
Q
What to give if HF symptoms continue even after 1st line tx?
A
Add aldosterone antagonist.
13
Q
What to give if HF symptoms continue even after giving aldosterone antangonist?
A
Specialist advice+ consider sacubritril, valsartan, ivabradine, hydralazine + nitrate
14
Q
What is cardiovascular disease?
A
Condition affecting heart or blood vessels
15
Q
What are the 4 types of CVD?
A
Coronary artery disease - angina/ Heart attack
Cerebrovascular disease
Peripheral arterial disease
Aortic disease
16
Q
What are 2 examples of coronary artery disease?
A
Angina
Heart attack
17
Q
What are 2 examples of cerebrovascular disease?
A
Stroke
transient ischaemic attack
18
Q
Describe the 3 steps that can cause a blood clot to form?
A
- healthy artery
- Atherosclerosis - plaque buildup
- Thrombosis - blood clot forms + can break, go to heart or brain.
19
Q
What are 4 unmodifiable risk factors of CVD?
A
Men
50+ years
Family Hx
South asian, afro- Carribbean
20
Q
What are 9 modifiable risk factors of CVD?
A
HTN
Dyslipidaemia
DM
Obesity
Poor diet
Inactivity
smoking
Excess alcohol
Psychosocial factors- depression
21
Q
What things make up a cardioprotective diet?
A
Increased fibre,
Fruit + Veg
Oily fish
Less salt- less than 6g
Alcohol <14 units
22
Q
What amount of exercise is cardioprotective?
A
2.5 hr moderate
1hr 15- high intensity
23
Q
What 2 things make up the cardiovascular risk assessment?
A
being over 40 years.
estimated 10 year risk > 10%
24
Q
What is used to calculate CVD risk?
A
QRISK - >10% bad
25
What are some risk factors of established CVD?
85+ years
DM - age 40+
Target organ damage
Chronic kidney disease- eGFR <60, albuminuria.
Familial hypercholesterolemia
26
What is primary prevention of CVD?
low dose of high intensity statin- atorvastatin
27
What are 3 high intensity statins?
atorvastatin
Rosuvastatin
simvastatin
28
What is order of intensity of statins based on 20mg dose?
Rosuvastatin
Atorvastatin
Simvastatin
pravastatin
fluvastatin
29
What dose of high intensity statin given?
atorvastatin 80MG OD.
30
When is 80mg atorvastatin given?
Secondary prevention of CVD
31
What antiplatelet dose is given for secondary prevention of CVD if atherosclerosis?
75mg aspirin Daily
32
What else is given for secondary prevention of CVD if stroke/TIA + sinus rhythm?
Clopidogrel OR dipyridamole + Aspirin
33
What CCB is safe for HF?
Amlodipine
34
Why should other CCBs (rate limiting and short-acting dihydropyridines) NOT be used in HF treatment?
they reduce cardiac contractility
35
What are 2 examples of short-acting dihydropyridines?
Nifedipine
nicardipine
36
Why are diuretics good in HF?
Relief of breathlessness and oedema in patients with fluid retention.
37
What is the first line diuretic used in HF?
Loop diuretic - e.g. furosemide
38
What is problem with thiazide diuretics in HF patients?
Only effective in patients with eGFR > 30 + mild fluid retention.
39
What other drug is added for worsening/severe HF if patient in sinus rhythm as add-on?
Digoxin
40
What is monitoring req for ACEi/ARB?
Start baseline bloods: K+ and Na+, renal function, + BP should be checked.
Monitor bloods 2 weeks after starting + after dose changes
41
What is MHRA warning (Jan 2023) regarding Metolazone?
Caution when switching patients between metolazone preparations - differences in bioavailability + dosing instructions
42
What is hyperlipidaemia?
High blood lipid levels e.g. cholesterol, triglycerides.
43
What is the total cholesterol target?
<5mmol/L
44
What is the LDL cholesterol target?
<3mmol/L
45
What is the HDL cholesterol target?
>1mmol/L
46
What is the target non-HDL cholesterol level?
<4mmol/L
47
What is target triglycerides?
<2.3mmol/L
48
What are some lifestyle factors that affect cholesterol?
Fatty diet
Smoking
Excess alcohol
Obesity
49
What 4 conditions can influence hyperlipidaemia?
DM
Kidney/ liver disease
Hypothyroidism
Family Hx
50
What 4 drugs can cause high cholesterol?
Antipsychotics
Immunosuppressants
Corticosteroids
HIV
51
What is 1st line tx for high cholesterol?
Statins
52
What drug is used in severe hyperlipidaemia?
Statin + add Exetimibe
53
What drug to add if triglycerides are still high?
Fenofibrate
54
What drug to give in familial hyperlipidaemia?
High intensity statin OR
ezetimibe
55
List 5 lipid- lowering drugs?
1.Statins
2.Ezetimibe - alternative
3. fibrate
4. bile acide sequestrant
5. nicotinic acid group
56
List 5 statins
Atorvastatin
Fluvastatin
Pravastatin
Rosuvastatin
Simvastatin
57
What is the most intense statin?
Atorvastatin
58
What is the least intense statin?
Fluvastatin
59
List 4 fibrates?
Bezafibrate
Ciprofibrate
Fenofibrate
Gemfibrozil
60
List 3 bile acid sequestrant?
Colesevelam
Colestipol
Colestyramine
61
What lipid lowering drug class interferes with absorption of fat-soluble vits?
Bile acid sequestrants
62
What are fat-soluble vitamins
vit A, D, E, K
63
What counselling advice to give patients who take vits and bile acid sequestrants?
Take vitamins 1 hr BEFORE or 4 hrs after
64
How long should vitamins be taken before coleveselam?
4 hours before
65
List 2 drugs in nicotinic acid group?
Acipimox
Nicotinic acid
66
What other drugs help reduce cholesterol?
Omega 3 fatty acids
Lomitapide
Evolocumab
Alirocumab
67
What is moa of Statin?
Competitively blocks the HMG-CoA reductase involved in cholesterol synthesis in liver.
Most effective in lowering LDL.
68
What is the indication of statin?
Hyperlipidaemia - CVD prevention
69
What 2 statins are usually taken at night?
Simvastatin
Fluvastatin
70
What is MHRA advice/warning for statins?
Risk of myopathy + myasthenia gravis
71
What dose of statin is used for secondary CVD prevention?
80mg
72
What is 1 common SE of Statin?
Myalgia - muscle pain
73
What are 3 more uncommon SE of statin?
Myopathy
Myositis
rhabdomyoloysis
74
What is counselling given to pt regarding statin SE?
report muscle pain, weakness or tenderness.
75
What is monitored in statins?
LFT + lipids @ 3 months and 12 months
Creatine kinase - if 5x upper limit - do NOT give.
76
What are 4 cautions to consider when a patient uses statin?
Family hx of muscle disorder/toxicity.
High alcohol intake
Renal impairment
Hypothyroidism
77
What are 3 Rare SE of statins?
Interstitial lung disease
DM
Hepatotoxicity
78
What counselling to give to prevent lung disease from statin?
Report cough, dyspnoea , weight loss
79
What is monitored for patients on statin with DM?
Fasting glucose/Hb1ac done pre tx and 3 months in
still continue it.
80
What is monitored to prevent statin hepatotoxicity?
LFT- stop if 3x ULN
81
What is myopathy?
Diseases of muscles
82
What is myositis?
Muscle inflammationq
83
What is rhabdomyolysis?
life- threatening condition where damaged muscle releases proteins into blood.
This damages kidney + heart.
84
What to monitor in uncontrolled DM?
HBA1C , fasting blood glucose
85
What to do if patient has hypothyroidism?
Hypothyroidism should be managed adequately BEFORE starting treatment with a statin.
86
Monitoring requirement in statins if patient has hypothyroidism?
TSH
87
Can statins be used in pregnancy?
Teratogenic -NO
88
After stopping statins, how long to continue contraception?
Continue 1 month after stopping statin
89
What to do if planning to conceive and taking statins?
Discontinue statin 3 months before attempting to conceive
90
What is max statin dose?
80mg OD
91
What dose adjustment if taking statin with ciclosporin?
If need to use both together,
max statin dose CANNOT exceed 10 mg daily.
92
What dose adjustment if taking statin with elbasvir with grazoprevir?
max 20mg daily of statin
93
What is MHRA advice regarding statins?
infrequent reports of myasthenia gravis
94
What is myasthenia gravis?
rare condition causing weak muscles
95
What steps should pharmacist do if a patient gets myasthenia gravis from statin use?
Refer patient with symptoms to neurologist.
96
What counselling to give to pt with myasthenia gravis?
Continue taking their statin unless they are advised to stop.
If swallowing issues, breathless - seek immediate help
Inform GP if muscle weakness in arms/ legs worsening after activity, double vision, droopy eyelids
97
What drug class increases statin toxicity?
Macrolide abx - Clarithromycin + erythromycin
98
What counselling to give patient on statin if they starting antibiotics?
Stop statin until abx course completed
99
What drink item cannot be given with statins?
Grapefruit juice- increases toxicity.
100
What 3 drug classes increase statin toxicity?
Amiodarone
Fungals - fluconazole
CCB (e.g. verapamil)
101
What drug class increases rhabdomyolysis with statin use?
Fibrates
102
What fibrate drug rhabdomyolysis with statin use?
AVOID gemfibrozil
103
What antibiotics increase hepatotoxicity with statins?
Flucozacillin + tetracyclines
104
What 4 drug classes increase hepatotoxicity with statins?
MTX, isoniazid, sulfasalazine, carbamazepine, valproate.
105
Should statins be stopped if pt has diabetes?
NO- statin has more benefits than risk
106
What dose of simvastatin is given if patient also takes amiodarone, amlodipine, diltiazem and verapamil? (VADAR)
20mg
107
What is the dose adjustment of rosuvastatin when taking with clopidogrel?
5mg initially, max 20mg
108
What is the dose adjustment of rosuvastatin when taking with bezafibrate, ciprofibrate, fenofibrate?
5mg
109
Interaction between statin and gemfibrozil
Rhabdomyolysis
110
List 3 loop diuretics?
Furosemide
bumetanide
torasemide
111
List 3 BB licensed for HF?
Bisoprolol
carvedilol
nebivolol
112
List 3 Thiazide like diuretics?
metolazone, indapamide, and chlorthalidone
113
What condition is ACEI contra-indicated in?
Angiodema
114
Patients on ACEI, starting sacubritirl , what should we do?
Stop ACEI 36 hours before for washout period
115
What is ramipril dose if CrCL 30-60ml/min?
Max. daily dose 5 mg if creatinine clearance 30–60 mL/minute
116
What ramipril dose if CrCL less than 30 mL/min?
Max. initial dose 1.25 mg OD (do not exceed 5 mg daily)
117
What is simvastatin max dose if given with amlodipine, amiodarone, ranolazine?
20mg
118
What is max simvastatin dose with bezafibrate or ciprofibrate?
10mg daily
119
Interaction between statin + oral fusidic acid?
Rhabdomyolosis- AVOID
120
Rosuvastatin must be taken in caution with what ethnicity ---?
Asian
121
If creatine kinase more than 5 times for statin what to do?
Repeat after 7 days
If the repeat concentration remains above 5 times the ULN, statin treatment should not be started.
