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Pre-reg > HTN + Hyperlipidaemia > Flashcards

HTN + Hyperlipidaemia Flashcards

1
Q

what is the 1st line in T2DM (caucasian, all ages)?

A

ACEi

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2
Q

what’s the 1st line in T2DM in Affro-Carribean (all ages)?

A

ARB

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3
Q

what are the options in stage 4 of the HTN pathway?

A

if potassium <4.5mmol/l = low dose spiro
if potassium >4.5mmol/l = alpha blocker or beta blocker

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4
Q

what are the side effects of ACEi? CHHAReD

A

Cough - give ARB
Hyperkalaemia
Hepatic failure
Angioedma
Renal impairment
Dizziness and headaches

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5
Q

do ARBS have the same side effects as ACEi?

A

yes except no cough or angioedema

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6
Q

what 4 types in interactions do you need to look out for with ACEi?

A
  1. increased risk of renal failure (avoid other nephrotoxic drugs, ARBs, K+ sparing diuretics, NSAIDs)
  2. increase hyperkalameia (avoid other drugs ‘tequila always makes nurses smile’
  3. increase risk of volume depletion - consider diuretics
  4. increase plasma of lithium
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7
Q

name the carioselective beta blockers. What’s the benefit of these? BAtMAN

A

Bisoprolol
Atenolol
Metoprolol
Acebutolol
Nebivolol

less likely to cause bronchospasam as selective to the receptors in the heart - give to asthmatics

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8
Q

name the water soluble beta blockers.
What are the benefits if these? water CANS

A

Celiprolol
Atenolol
Nadolol
Sotalol

less likely to cross BBB = less nightmares

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9
Q

name the intrinsic sympathomimetic beta blockers. What are the benefits of these? Ice PACO

A

Pindolol
Acebutolol
Celiprolol
Oxprenolol

less likely to cause cold extremeties

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10
Q

what are the side effects beta blockers?

A
  • bradycarida, or heart failure
  • blunt the effects of hypoglycaemia
  • can cause hyperglycaemia
  • bronchospasams (contraindicated in asthmatics)
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11
Q

what are the main interactions with beta blockers?

A
  1. digoxin - can cause heart block
  2. other hypotensives
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12
Q

what are the 2 rate limiting CBB?

A

diltaizem, verapamil

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13
Q

what are the 4 main side efects of CBB?

A
  1. dizziness
  2. gingival hyperplasia (enlarged gums)
  3. vasodilatory effects (flushing, headaches, ankle swelling)
  4. complete atrioventricular block (more in rate limitng)
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14
Q

why don’t you give rate liming CBB in QT prolongation?

A

due to risk of atrioventricular block

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15
Q

what would increase someones risk of pre-eclampsia in pregancy?
What is given to reduce the risk?

A

risk factors = HTN, diabetes, kindey disease, autoimmune disease

give aspirin from week 12 of pregnancy until birth

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16
Q

what are the 1st and 2nd line antihypertensives in pregnancy and what is the BP aim?

A

1st = labetolol
2nd = nifedipine or methyldopa

135/85

17
Q

whats the clinic BP target if someone is less than 80?

A

140/90

18
Q

whats the clinic and home BP target if someone is over 80?

A

clininc = 150/90
home = 145/85

19
Q

whats the BP target in renal disease?

A

140/90

20
Q

whats the BP target in T1DM?

A

135/85

21
Q

what are the tatgers for good and bad cholesterol?

A

HDL 1 or above
LDL less than 3

22
Q

what 5 patient groups should lipid lowering medication be given to?

A
  1. under 85yrs with 10-year risk of CVD >10%
  2. patients with T2DM with 10yr risk <10%
  3. all type 1 diabetics if over 40yrs, had diabetes for 10yrs, have established nephtopathy
  4. CKD
  5. familial hypercholesterolaemia
23
Q

what statins can be given any time of day?

A

atorvastatin and rosuvastatin

24
Q

what statins need to be taken at night?

A

simvastatin, pravastatin, fluvastatin

25
Q

whats the strongest statin avaialble?

A

atorva 80mg

26
Q

can someone with hypothyroidism immediately start a statin?

A

hypothyroidism should be managed before starting statin

27
Q

can patients at high risk of diabetes start statin straight away if high cholesterol?

A

they should have their HbA1c checked before starting statin due to relationship between hyperlipidaemia and diabetes - 1st line would be diet and exercise then repeat HbA1c in 3 months

28
Q

what baseline monitoring is needed for statins?

A

LFTs
thyroid function
renal function
creatinine kinase

29
Q

when do LFTS need to be monitored?

A

baseline, 3 months, 12 months

30
Q

when do you stop a statin due to changes in serum transaminases?

A

if raised by 3x the upper limit

31
Q

is creatinine kinase measured in all patients on statins?

A

only those with persistent muscle aches

32
Q

what would prevent a patient being started on a statin in relation to creatinine kinase? How do you manage this?

A

if measurements 5x higher than upper limit don’t start, remeasure in 7 days

if still higher do not start statin

if levels under 5 times upper limit then start at lower dose

33
Q

what are the 3 main SEs of statins?

A
  1. rhabdomyolysis and myopathy
  2. interstitial lung disease
  3. teratogenic
34
Q

how long should statins be discontinued in someone planning to conceive?

A

3 months

35
Q

what are the 3 main types of interactions to look out for with statins?

A
  1. CYP450 inducers = reduce the conc of inducers
  2. CYP450 inhibitors = increase statin = increased rhabdomyolysis (avoid concurrent use of macrolides and grapefuit juice)
  3. fusidic acid (oral) - stop statin and restart 7 days after last dose
36
Q

when is the maximum dose of simvastatin 20mg?

A

when prescribed alongside amlodipine, amiodarone, rate limiting CBB

37
Q

when is the maximum dose of simvastatin 40mg?

A

when given with ticagrelor

38
Q

when is the maximum dose of atorvastatin 10mg?

A

when given with ciclosporin or tipranavir

39
Q

what lipid lowering agent can’t be used in patients with renal impairement?

A

fibrates - due to myotoxicity

Pre-reg (47 decks)

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