CVS Flashcards
LDL goal for secondary prevention
- <1.4 mmol/L for those with h/o ACS
- <1.8 mmol/L for others
LDL goal for DM
- <2.6 mmol/L for DM not complicated with CKD, end-organ damage and <10 years
- <1.8 mmol/L for DM >10 years or with CKD or end-organ damage
LDL goal for CKD
- In general, <2.6 mmol/L
- ESC holds more stringent targets for CrCl < 30 mL/min to be <1.4 mmol/L
- KDIGO recommends NOT treat to target, but fire and forget
Threshold for initiating fibrate
- Initiate when TG > 4.5 mmol/L
- Start with PO Fenofibrate 160 mg OD with food
- Target <2.3 mmol/L (ESC 2019)
Statin that needs bedtime dosing
Fluvastatin
Lovastatin
Simvastatin
Statin that needs to be taken with food
Lovastatin
Lipophilic statins or those affected by grapefruit
Atorvastatin
Lovastatin
Simvastatin
Statins not significant affected by CYPs
Rosuvastatin
Pravastatin
Statin that requires renal adjustment
Lovastatin
Rosuvastatin (<30)
BP goals
Usually <130/80 mmHg for most
<150/90 for elderly with multiple comorbidities
<120 SBP (KDIGO)
Doses of ACE inhibitors in HF
Enalapril: 2.5 mg BD -> 10-20 mg BD
Lisinopril: 2.5-5 mg OD -> 20-40 mg OD
Doses of Entresto in HF
Start: 50 mg BD
Target: 200 mg BD
Doses of beta blockers in HF
Bisoprolol: 1.25 mg OD -> 10 mg OD
Carvedilol: 3.125 mg BD -> 25-50 mg BD
Metoprolol succinate XL: 12.5-25 mg OD -> 200 mg OD
Dose of spironolactone in HF
Start: 12.5-25 mg OD
Target: 25-50 mg OD
Doses of SGLT2 inhibitors in HF
Start: 10 mg OD
Target: 10 mg OD
Doses of furosemide
Usual: 20-40 mg OD-BD
Max dose: 600 mg/day
Doses of Metolazone in HF
Usual: 2.5 mg OD
Max 20 mg/day
Lipophilic beta blockers
Carvedilol
Nebivolol
Low: Atenolol
Beta blockers that undergo renal excretion
Atenolol
Bisoprolol (50%)
Labetalol (50%)
Nebivolol (>50%)
Concerns with flecainide
- -ve inotropic effect (ADHF, IHD, valvular disease)
- 1:1 conduction with AV node and rapid ventricular contraction in absence of BB
DDI: Digoxin, amiodarone
Concerns with amiodarone
- Optic neuritis, corneal deposits
- Severe GI upset
- Photosensitivity, blue-grey skin
- Thyroiditis (hypo usually)
- Pulmonary toxicity
- LFT derangement
- Peripheral neuropathy
Medications to be avoided in HF
NSAID
Thiazolindinediones
Saxagliptin
Fleicainide, disopyramide, sotalol, dronedarone
Doxazosin
Diltiazem, verapamil
Nifedipine
Dosing for Apixaban
AF: 5 mg BD
2.5 mg BD if any two: SCr >133, age >80, weight <60
VTE: 10 mg BD x 7 days > 5 mg BD x 6 months > 2.5 mg BD
Dosing for Rivaroxaban
AF: 20 mg OD
CrCl <50: 15 mg OD
VTE: 15 mg BD x 7 days > 20 mg OD x 6 months > 10 mg OD
Electrolyte effects of thiazides
Reduce K, Na, Mg
Increase Ca, UA, BUN
Electrolyte effects of loops
Reduce K, Na, Ca, Mg
Increase BUN
Dosing range for HCTZ
25-50 mg/day
CrCl <10: Lack of efficacy
Loop diuretic dosing
Furosemide 40 mg
Torsemide 20 mg
Bumetanide 1 mg
Spironolactone dosing
Max 50 mg/day
eGFR <30: Stop
Dosing for ACEi
Enalapril/lisinopril: up to 40 mg/day
Reduce dose when CrCl <30
Dosing for ARB
Losartan: up to 100 mg/day
Valsartan: up to 320 mg/day
Washout period between nitrates and PED5 inhibitors
24 hours: Sildenafil, vardenafil
48 hours: Tadalafil
Maximum dose of hydralazine
100 mg TDS
Doses of nitrates
ISMN: Usually up to 120 mg/day
ISDN: Target 40 mg TDS in HF
