CVS medication

Question 1

Primary prevention of CVS disease

QRISK 3 Score

Answer 1

percentage risk of the patient having a stroke or MI in next 10 years

if >10% risk then start on atorvostatin 20mg

if CKD or T1DM start irrespective of %

check lipid aat 3 month - aim for reduction of 40% in non HDL cholestrol

check LFT 3 months and 12 months after starting a statin

Question 2

Secondary prevention of CVS disease (4 A’s)

Answer 2

Aspirin (plus second antiplatelt e.g. clopidogrel for 12M)
Atorvostatin 80mg
Atenolol (beta blocker titrated to max)
ACE inhibitor (Ramipril)

Question 3

stable angina medical management

Answer 3

Immediate symptoms releief
GTN spray when required (5 min, repeat, ambulance)

Long term
beta-blocker (bisoprolol 5mg OD)
ca2+ channel blocker (amlodipine 5mg OD)
other options- isosorbide mononitrate, ivabradine, nicorandil, ranolazine

Question 4

Stable angina secondary prevention (4 A’s)

Answer 4

Aspirin 75mg OD
Atorvostatin 80mg OD
ACEi
Atenolol (beta-blocker)

*procedures/surgical
Percutaneous Coronary Intervention (PCI)
Coronary Artery Bypass (CABG)

Question 5

Management of acute STEMI

Answer 5

within 12 hours
PCI if available within 2 hours
Thrombolysis if PCI not available - inject fibrinolytic medication e.g. streptokinase, alteplase, tenecteplase

Question 6

Management of NSTEMI (BATMAN)

Answer 6

Beta blockers
Aspirin 300mg
Ticagrelor 180mg (clopdiogrel 300mg alternative)
Morphine
Anticoagulant (LMWH- enoxaparin 1mg/kg/twice daily for 2-3 days)
Nitrates (GTN)
oxygen if sats dropping <95%

Question 7

Complications of MI (DREAD)

Answer 7

Death
Rupture of heart septum / papillary muscles
Edema
Arrhythmias, aneurysm
Dressler’s syndrome (Post myocardial infarction syndrome)

Question 8

Secondary prevention of an MI (6 A’s)

Answer 8

ACEi rampiril
Atenolol
Aldosterone antagonist if clinical HF - eplerone
Aspirin 75mg
Another antiplatelt - clopidogrel, ticagrelor 12M
Atorvostatin 80mg

dual antiplatelts*

Question 9

Management of acute LVF (Pour SOD)

Answer 9

Pour- stop IV fluids
Sit up
Oxygen (<95%)
Diuretics (IV furosemide 40mg)

IV opiates
NIV / CPAP
Inotropes noradrenaline to force heart contractions.

Question 10

Management of chronic heart failure (ABAL)

Answer 10

ACEi ramipril
Beta blocker (bisoprolol)
Aldosterone antagonsit
Loop diuretics furosemide

• ARB if ACEi is not tolerated/avoid ACEi in valvular heart disease
• aldosterone antagonist if b-blocker not controlling symptoms

Question 11

HTN management

Answer 11

ABCD

ACEi
Beta blocker
Ca2+ blocker
D thiazide like diuretic (indapamide 2.5mg OD)
ARB angiotensin II repceptor blocker (candersartan)

if <55 y/o and not black use A
if >55 y/o or black use C

A+ C (ARB + C)
A + C + D
A + C + D + D