Hyperlipidaemia, stable angina, ACS and oedema Flashcards
What is QRISK2 used to calculate?
The 10-year risk of cardiac events.
What is JBS3 used to calculate?
Lifetime risk of cardiac events.
What percentage QRISK2 score is used to determine treatment?
10%+.
What compounds/drugs are not recommended for primary or secondary prevention of cardiovascular disease?
Fibrates, nicotinic acid, bile acid sequestrants, omega-3 fatty acid compounds.
Which individuals are at a high risk of developing cardiovascular disease?
Those with diabetes, hypertension, smokers, CKD, familial hypercholesterolaemia, age over 85.
What lifestyle changes should all people at a high risk of cardiovascular disease make?
Modifications to diet, exercise, weight-management, alcohol consumption, smoking cessation.
What is the first line treatment for primary prevention of cardiovascular disease if lifestyle measures are ineffective alone?
A statin.
What should be offered to all patients for the secondary prevention of cardiovascular disease?
A statin, combined with lifestyle advice.
What tests should be carried out before commencing statin treatment?
Total cholesterol, non-HDL cholesterol, LDL-cholesterol, HDL-cholesterol.
What is healthy range for total cholesterol?
Less than or equal to 5mmol/L.
What is the healthy range for non-HDL cholesterol?
Less than or equal to 4mmol/L.
What is the healthy range for LDL-cholesterol?
Less than or equal to 3mmol/L.
What is the healthy range for HDL-cholesterol?
Greater than or equal to 1mmol/L.
What is the first line treatment for hypercholesterolaemia, hypertriglyceridemia, and familial hypercholesterolaemia?
A statin.
If a statin alone is ineffective in the treatment of hypercholesterolaemia, hypertriglyceridemia, and familial hypercholesterolaemia, what may be added?
An additional lipid-controlling drug such as ezetimbe.
What may be added to treat resistant hyperlipidaemia?
Fenofibrates or nicotinic acid.
Statins are associated with an increased risk of muscle effects such as myopathy, myositis, and rhabdomyolysis. Which groups of patients are at a greater risk of this occurring?
Those with a family or personal history of muscle disorders, previous history of muscle toxicity, high alcohol intake, renal impairment, hypothyroidism, the elderly.
Combining a statin with which drugs leads to an increased risk of myopathy?
A fibrate or nicotinic acid.
Which antibiotic, seen in topical preparations, should be avoided in statin use?
Fucidic acid.
If fucidic acid is to be used by patients on statins, what course of action should be taken?
The statin should be stopped and restarted seven days after last dose.
Which drugs, when used with stating, increase the plasma concentration of said statin?
Macrolide antibiotics, imidazole and triazole antifungals, ciclosporin.
What monitoring is required for patients on statins?
Liver function and creatine kinase if muscular symptoms occur.
If severe muscular symptoms or raised creatine kinase occurs during statin treatment, what course of action should be taken?
Treatment should be discontinued. The statin should be reintroduced at a lower dose and the patient closely monitored. An alternative statin can be used if this is still not tolerated.
If patients being treated with a statin experience dyspnoea, cough, and weight loss, what should they do?
Seek medical attention. May be interstitial lung disease.
Correcting which metabolic condition may correct lipid abnormality?
Hypothyroidism.
Untreated hypothyroidism may increase the risk of what when lipid-regulating drugs are used?
Myositis.
How should liver enzymes be monitored when a patient is being treated with statins?
Before treatment, repeated within three months and at 12 months.
How should acute attacks of stable angina be treated?
Sublingual GTN spray, taken immediately before activity known to bring on an attack, if needed.
Stable angina should be treated with regular drug therapy if a patient has how many attacks per week?
More than twice per week.
What are unstable angina and NSTEMI caused by?
A partial blockage of a blood vessel.
What is the difference in myocardial necrosis between unstable angina and NSTEMI?
In unstable angina, no myocardial necrosis is seen. In NSTEMI, some necrosis may be seen.
What is STEMI caused by?
Complete blockage of a coronary vessel, causing irreversible necrosis of the heart and complications.
In the treatment of ACS, what is aspirin used for?
To limit clot size and allow blood flow.
In the treatment of ACS, what is morphine used for?
To relieve pain and anxiety.
In the treatment of ACS, what is metoclopramide used for?
To relieve the nausea from the morphine used.
In the treatment of ACS, what is oxygen used for?
To ease laboured breathing.
In the treatment of ACS, what is a nitrate used for?
To ease blood flow through vasodilating.
In the treatment of ACS, what are LMWHs used for?
To prevent clot growth.
In the additional acute management of unstable angina and NSTEMI, what are glycoprotein inhibitors used for?
To prevent a coronary clot.
What is a percutaneous intervention used in the acute management of STEMI?
Angioplasty plus a stent.
What is a coronary artery bypass graft (GABG)?
Replacing the damaged vessel(s) with one from elsewhere in the body.
What should patients be discharged with for the long-term management of ACS?
Dual anti platelet therapy for 12 months, beta-blocker reviewed after 12 months, ACEi, statin.
As one can develop a tolerance to nitrate treatment, what should be done to prevent this?
The patient should have a nitrate free period of 4 to 12 hours each day.
When should conventional isosorbide mononitrate be given?
Not more than twice a day unless small doses are given.
When should MR formulations of isosorbide mononitrate be given?
Only once daily.
What are fibrinolytics and how are they used?
They stimulate plasmin production to degrade thrombin, used in place of a PCI.
If severe bleeding occurs with fibrinolytic use, what course of action should be taken?
Discontinuation of the fibrinolytic and addition of coagulation factors and antifibrinolytics.
How should hypotension associated with fibrinolytic use be treated?
By raising the patient’s legs, reducing the rate of infusion, or stopping it a temporarily.
Which drugs are used to treat oedema in heart failure?
Loop, thiazide and potassium sparing diuretics.
How should oedema be treated in the elderly?
Initiate on low doses and adjust to renal function.
What should be used in place of diuretics in the elderly for the treatment of long term simple gravitational oedema?
Increased movement and stockings.
What electrolyte disturbance can be seen with thiazide and loop diuretics? Which has the greater effect?
Hypokalaemia, greater risk with thiazides.
Which diuretic is preferred for use in oedema from liver cirrhosis?
Spironolactone.
If a patient has an enlarged prostate, what should be established before they are treated for oedema?
Adequate urinary output.
Which diuretics can exacerbate diabetes and gout?
Loop and thiazide.
What symptoms seen when using diuretics require immediate referral?
Heaviness in the chest, water retention, depression, extreme tiredness, thirst, excessive urination, irregular heartbeat, muscle weakness, nausea, gout, dizziness.
What monitoring is required with diuretic use?
BP, sodium and potassium, weight to measure water loss.
What should be avoided when taking potassium sparing diuretics?
Potassium supplements.
An enhanced hypotensive effect is seen when diuretics are used with which drugs?
ACEis, alpha-blockers, ARBs.
An increased risk of hyperkalaemia is seen when potassium sparing diuretics or aldosterone antagonists are used with which drugs?
ACEis, ARBs, ciclosporin, potassium salts, tacrolimus.
Hypokalaemia caused by acetazolamide, loop diuretics, thiazides or thiazide like diuretics increases the risk of ventricular arrhythmias with which drugs?
Amisulpride, atomoxetine, pimozide, sotalol.
Hypokalaemia caused by diuretics increases the risk of cardiac toxicity with chich drugs?
Cardiac glycosides.
The plasma concentration of eplerenone is increased by which drugs?
Clarithromycin and itraconazole.
The plasma concentration of eplerenone is reduced by which drugs?
Carbamazepine, phenobarbital, phenytoin, rifampicin, St. John’s Wort.
There is an increased risk of ototoxicity when loop diuretics are given with which drugs?
Aminoglycosides, polymyxins, vancomycin.
