HTN + Hyperlipidaemia Flashcards
what is the 1st line in T2DM (caucasian, all ages)?
ACEi
what’s the 1st line in T2DM in Affro-Carribean (all ages)?
ARB
what are the options in stage 4 of the HTN pathway?
if potassium <4.5mmol/l = low dose spiro
if potassium >4.5mmol/l = alpha blocker or beta blocker
what are the side effects of ACEi? CHHAReD
Cough - give ARB
Hyperkalaemia
Hepatic failure
Angioedma
Renal impairment
Dizziness and headaches
do ARBS have the same side effects as ACEi?
yes except no cough or angioedema
what 4 types in interactions do you need to look out for with ACEi?
- increased risk of renal failure (avoid other nephrotoxic drugs, ARBs, K+ sparing diuretics, NSAIDs)
- increase hyperkalameia (avoid other drugs ‘tequila always makes nurses smile’
- increase risk of volume depletion - consider diuretics
- increase plasma of lithium
name the carioselective beta blockers. What’s the benefit of these? BAtMAN
Bisoprolol
Atenolol
Metoprolol
Acebutolol
Nebivolol
less likely to cause bronchospasam as selective to the receptors in the heart - give to asthmatics
name the water soluble beta blockers.
What are the benefits if these? water CANS
Celiprolol
Atenolol
Nadolol
Sotalol
less likely to cross BBB = less nightmares
name the intrinsic sympathomimetic beta blockers. What are the benefits of these? Ice PACO
Pindolol
Acebutolol
Celiprolol
Oxprenolol
less likely to cause cold extremeties
what are the side effects beta blockers?
- bradycarida, or heart failure
- blunt the effects of hypoglycaemia
- can cause hyperglycaemia
- bronchospasams (contraindicated in asthmatics)
what are the main interactions with beta blockers?
- digoxin - can cause heart block
- other hypotensives
what are the 2 rate limiting CBB?
diltaizem, verapamil
what are the 4 main side efects of CBB?
- dizziness
- gingival hyperplasia (enlarged gums)
- vasodilatory effects (flushing, headaches, ankle swelling)
- complete atrioventricular block (more in rate limitng)
why don’t you give rate liming CBB in QT prolongation?
due to risk of atrioventricular block
what would increase someones risk of pre-eclampsia in pregancy?
What is given to reduce the risk?
risk factors = HTN, diabetes, kindey disease, autoimmune disease
give aspirin from week 12 of pregnancy until birth
what are the 1st and 2nd line antihypertensives in pregnancy and what is the BP aim?
1st = labetolol
2nd = nifedipine or methyldopa
135/85
whats the clinic BP target if someone is less than 80?
140/90
whats the clinic and home BP target if someone is over 80?
clininc = 150/90
home = 145/85
whats the BP target in renal disease?
140/90
whats the BP target in T1DM?
135/85
what are the tatgers for good and bad cholesterol?
HDL 1 or above
LDL less than 3
what 5 patient groups should lipid lowering medication be given to?
- under 85yrs with 10-year risk of CVD >10%
- patients with T2DM with 10yr risk <10%
- all type 1 diabetics if over 40yrs, had diabetes for 10yrs, have established nephtopathy
- CKD
- familial hypercholesterolaemia
what statins can be given any time of day?
atorvastatin and rosuvastatin
what statins need to be taken at night?
simvastatin, pravastatin, fluvastatin
whats the strongest statin avaialble?
atorva 80mg
can someone with hypothyroidism immediately start a statin?
hypothyroidism should be managed before starting statin
can patients at high risk of diabetes start statin straight away if high cholesterol?
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
what baseline monitoring is needed for statins?
LFTs
thyroid function
renal function
creatinine kinase
when do LFTS need to be monitored?
baseline, 3 months, 12 months
when do you stop a statin due to changes in serum transaminases?
if raised by 3x the upper limit
is creatinine kinase measured in all patients on statins?
only those with persistent muscle aches
what would prevent a patient being started on a statin in relation to creatinine kinase? How do you manage this?
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
what are the 3 main SEs of statins?
- rhabdomyolysis and myopathy
- interstitial lung disease
- teratogenic
how long should statins be discontinued in someone planning to conceive?
3 months
what are the 3 main types of interactions to look out for with statins?
- CYP450 inducers = reduce the conc of inducers
- CYP450 inhibitors = increase statin = increased rhabdomyolysis (avoid concurrent use of macrolides and grapefuit juice)
- fusidic acid (oral) - stop statin and restart 7 days after last dose
when is the maximum dose of simvastatin 20mg?
when prescribed alongside amlodipine, amiodarone, rate limiting CBB
when is the maximum dose of simvastatin 40mg?
when given with ticagrelor
when is the maximum dose of atorvastatin 10mg?
when given with ciclosporin or tipranavir
what lipid lowering agent can’t be used in patients with renal impairement?
fibrates - due to myotoxicity
