Daily Learning Flashcards
Don't forget what you've learnt
Statins and which common medication can cause myopathy?
Clarithromycin/erythromycin (macrolides)
Important adverse reactions from statins:
Myopathy (myalgia, myositis, rhabdomyolysis or just an asymptomatic raised CK)
Hepatic impairment
Maybe increasing the risk of haemorrhagic stroke, only in the context of previous haemorrhagic stroke.
What do you look for in the LFTs of someone taking a statin?
Check at baseline, at 3 months and then 12 months.
If serum transaminase rise to 3 times upper limit of normal and remain there, discontinue.
What are contraindications to statin use?
Erythromycin/clarithromycin treatment. Stop statins until course is complete.
Pregnancy
Who should be given a statin?
All with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral vascular disease)
Anyone with a 10 year cardiovascular risk of >10% (QRISK)
Patients with type 1 diabetes mellitus for >10 years, are aged >40 or have established neuropathy.
When should a statin be taken and why?
At night, because that’s when the majority of cholesterol synthesis occurs
What are the prescriptions of choice for primary and secondary prevention of cardiovascular disease?
1°: 20mg atorvastatin ON
2°: 80mg atorvastatin ON (i.e. if previous history of CVD)
What are the 3 main layers of a blood vessel wall called?
Tunica intima
Tunica media
Tunica adventitia
What are the properties of the tunica intima?
Comprises of endothelial monolayer and connective tissue
Endothelial cells sealed by tight junctions
What are the properties of the tunica media?
Separated from tunica intima by internal elastic lamina (a fenestrated sheath)
Contains smooth muscle cells in an extracellular matrix of collagen, proteoglycans and elastin.
Between smooth muscle cells are gap junctions, which allow depolarisation of cells in groups called Syncytia.
What are the properties of the tunica adventitia?
Separated from tunica media by the external elastic lamina.
Contains collagenous tissue supporting fibroblasts and nerves.
In large arteries and veins also contains the Vasa Vasorum, small blood vessels penetrating the outer portion of the media supplying the vascular wall with oxygen and nutrients.
