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MS4 - GP > CVS > Flashcards

CVS Flashcards

1
Q

How to estimate CVS risk

A

QRISK2 score (online)

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2
Q

At what QRISK score are statins started

A

10yr risk of 10%

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3
Q

Medical mx of smoking cessation

A

Nicotine replacement therapy NRT
Bupropion
Varenicline
E-cigarettes

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4
Q

Different forms of NRT

A 
patch
gum
inhalors
lozenges
sprays
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5
Q

Bupropion mech of action

A

affects addictive behaviour in brain

antidepressant

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6
Q

Advise on Bupropion use

A

8 week course
stop smoking in 1-2 wks through the course
doubles the chance of quitting after 3 mo

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7
Q

CI to bupropion

A

epilepsy
bipolar
eating disorder
breast feeding

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8
Q

CI to NRT

A

None

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9
Q

Varenicline mech of action

A

partial agonist of nicotine receptor

reduces cravings and rewarding effect of smoking

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10
Q

Varenicline vs bupropion

A

v= more effective, but more SEs so prescribed less often

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11
Q

E-cigs mech of action

A

deliver vaporised nicotine

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12
Q

BP and age

A

BP increases with age

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13
Q

How many times to measure BP in clinic if high first time

A

If HTN at 1st, repeat, if significantly lower, repeat again

BP= lowest of the last 2 measurements

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14
Q

What to do if someone is hypertensive in clinic

A

Ambulatory BP monitoring (ABPM) 24HRS
or
Home BP monitoring (HBPM) over 7 days

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15
Q

Whats involved in HBPM

A

7 days, twice daily measurements

BP= average of all readings

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16
Q

Stages of HTN

A

Stage 1 : >140/90 or A/H BPM >135/85
Stage 2: >160/100 or A/H BPM > 150/95
Severe: clinic >180/110

17
Q

Lifestyle advice for HTN

A

stop smoking
increase exercise
reduce salt intake
moderate alcohol consumption

18
Q

When to medically rx HTN

A 
If severe (even before A/H BPM) or stage 2 HTN
Stage1 HTN with high QRISK (>20%)
19
Q

HTN meds

A

CADB or ACDB (if <55)

1) If <55, ACEi or ARB. CCB if >55 or black
2) ACEi/ARB + CCB
3) ACEi/ARB + CCB + diuretic (Thiazides)
4) (resistant hypertension) Another diuretic (spironolactone) or β or α blockers

20
Q

example of thiazides used for HTN

A

Indapamide

21
Q

Which 2 drugs should be avoided together if poss in HTN?

A

B blockers and thiazides

impairs glucose tolerance and induces DM

22
Q

When to consider specialist advice on chol/TG levels

A 
Tot chol
> 7.5 + FH premature CHD (<50yo) 
> 9 
TG 
> 10 
> 4.5 + tot chol>7.5
23
Q

Starting dose of statins for primary prevention of CVD

A

atorvastatin 20 mg

24
Q

SEs of statins

A
  • GI upset (consider milder simvastatin)
  • Myalgia, myopathy, rhabdomyolysis
  • Liver function
  • DM
25
Q

Which bloods need to be tested for statins and when

A

at start, 3 and 12 mo
liver transaminases
if >3 times normal, stop

26
Q

Diet advice for CVS risk

A
  1. reduce sat fats and cholesterol
  2. increase mono-unsat fat intake (eg olive oil)
  3. use wholegrain varieties of starch
  4. reduce sugar intake
  5. eat 5 fruit/veg a day
  6. eat 2 portions of fish, 1 oily fish /wk
  7. eat 4 portions of unsalted nuts, seeds /wk
  8. limit alcohol to 14 units/wk
27
Q

Exercise advice for CVS risk

A

Per wk:

  • 150min moderate aerobic or 75min high intensity
  • 2 days of muscle strengthening (all muscles each time)
28
Q

Secondary prevention post MI

A
  • ACEi or ARB
  • 75 mg Aspirin + 12mo of clopidogrel (or anticoagulation + aspirin for AF)
  • BB 12mo (for life if L ventricular problem)
  • 80 mg atorvastatin
29
Q

Driving restriction post MI

A

4 wks or 6 (for bus/lorry drivers)

30
Q

BP measurement different devices

A

Aneroid (tends to under-read)
Mercury (most accurate, but safety issues)
Electronic

31
Q

How to select the correct cuff for bp

A

in adults:

  • a cuff’s bladder length should be >2/3 of circumference of the arm
  • a cuff’s bladder height should be >1/2 of circumference of the arm
32
Q

How does too big of a cuff affect readings

A

gives BP lower than it is

33
Q

How does too small of a cuff affect readings

A

gives BP higher than it is

34
Q

Which arm normally gives a higher BP

A

right (always use right to record BP)

35
Q

Normal variation in BP between 2 arms

A

10 mmHg

36
Q

Pulsus paradoxus

A

BP goes down on inspiration

37
Q

How much BP difference is normal between inspiration and expiration

A

5 mmHg

more than 10 pathological

38
Q

Causes of pathological pulsus paradoxus

A

cardiac tamponade
constrictive pericarditis
severe asthma
emphysema

MS4 - GP (12 decks)

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