CVS

Question 1

LDL goal for secondary prevention

Answer 1

• <1.4 mmol/L for those with h/o ACS
• <1.8 mmol/L for others

Question 2

LDL goal for DM

Answer 2

• <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

Question 3

LDL goal for CKD

Answer 3

• 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

Question 4

Threshold for initiating fibrate

Answer 4

• Initiate when TG > 4.5 mmol/L
• Start with PO Fenofibrate 160 mg OD with food
• Target <2.3 mmol/L (ESC 2019)

Question 5

Statin that needs bedtime dosing

Answer 5

Fluvastatin
Lovastatin
Simvastatin

Question 6

Statin that needs to be taken with food

Answer 6

Lovastatin

Question 7

Lipophilic statins or those affected by grapefruit

Answer 7

Atorvastatin
Lovastatin
Simvastatin

Question 8

Statins not significant affected by CYPs

Answer 8

Rosuvastatin
Pravastatin

Question 9

Statin that requires renal adjustment

Answer 9

Lovastatin
Rosuvastatin (<30)

Question 10

BP goals

Answer 10

Usually <130/80 mmHg for most
<150/90 for elderly with multiple comorbidities

<120 SBP (KDIGO)

Question 11

Doses of ACE inhibitors in HF

Answer 11

Enalapril: 2.5 mg BD -> 10-20 mg BD
Lisinopril: 2.5-5 mg OD -> 20-40 mg OD

Question 12

Doses of Entresto in HF

Answer 12

Start: 50 mg BD
Target: 200 mg BD

Question 13

Doses of beta blockers in HF

Answer 13

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

Question 14

Dose of spironolactone in HF

Answer 14

Start: 12.5-25 mg OD
Target: 25-50 mg OD

Question 15

Doses of SGLT2 inhibitors in HF

Answer 15

Start: 10 mg OD
Target: 10 mg OD

Question 16

Doses of furosemide

Answer 16

Usual: 20-40 mg OD-BD
Max dose: 600 mg/day

Question 17

Doses of Metolazone in HF

Answer 17

Usual: 2.5 mg OD
Max 20 mg/day

Question 18

Lipophilic beta blockers

Answer 18

Carvedilol
Nebivolol

Low: Atenolol

Question 19

Beta blockers that undergo renal excretion

Answer 19

Atenolol
Bisoprolol (50%)
Labetalol (50%)
Nebivolol (>50%)

Question 20

Concerns with flecainide

Answer 20

• -ve inotropic effect (ADHF, IHD, valvular disease)
• 1:1 conduction with AV node and rapid ventricular contraction in absence of BB

DDI: Digoxin, amiodarone

Question 21

Concerns with amiodarone

Answer 21

• Optic neuritis, corneal deposits
• Severe GI upset
• Photosensitivity, blue-grey skin
• Thyroiditis (hypo usually)
• Pulmonary toxicity
• LFT derangement
• Peripheral neuropathy

Question 22

Medications to be avoided in HF

Answer 22

NSAID
Thiazolindinediones
Saxagliptin
Fleicainide, disopyramide, sotalol, dronedarone
Doxazosin
Diltiazem, verapamil
Nifedipine

Question 23

Dosing for Apixaban

Answer 23

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

Question 24

Dosing for Rivaroxaban

Answer 24

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

Question 25

Electrolyte effects of thiazides

Answer 25

Reduce K, Na, Mg Increase Ca, UA, BUN

Question 26

Electrolyte effects of loops

Answer 26

Reduce K, Na, Ca, Mg Increase BUN

Question 27

Dosing range for HCTZ

Answer 27

25-50 mg/day CrCl <10: Lack of efficacy

Question 28

Loop diuretic dosing

Answer 28

Furosemide 40 mg Torsemide 20 mg Bumetanide 1 mg

Question 29

Spironolactone dosing

Answer 29

Max 50 mg/day eGFR <30: Stop

Question 30

Dosing for ACEi

Answer 30

Enalapril/lisinopril: up to 40 mg/day Reduce dose when CrCl <30

Question 31

Dosing for ARB

Answer 31

Losartan: up to 100 mg/day Valsartan: up to 320 mg/day

Question 32

Washout period between nitrates and PED5 inhibitors

Answer 32

24 hours: Sildenafil, vardenafil 48 hours: Tadalafil

Question 33

Maximum dose of hydralazine

Answer 33

100 mg TDS

Question 34

Doses of nitrates

Answer 34

ISMN: Usually up to 120 mg/day ISDN: Target 40 mg TDS in HF