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BNF Chapter 2 - Cardiology > Hyperlipidaemia, stable angina, ACS and oedema > Flashcards

Hyperlipidaemia, stable angina, ACS and oedema Flashcards

1
Q

What is QRISK2 used to calculate?

A

The 10-year risk of cardiac events.

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2
Q

What is JBS3 used to calculate?

A

Lifetime risk of cardiac events.

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3
Q

What percentage QRISK2 score is used to determine treatment?

A

10%+.

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4
Q

What compounds/drugs are not recommended for primary or secondary prevention of cardiovascular disease?

A

Fibrates, nicotinic acid, bile acid sequestrants, omega-3 fatty acid compounds.

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5
Q

Which individuals are at a high risk of developing cardiovascular disease?

A

Those with diabetes, hypertension, smokers, CKD, familial hypercholesterolaemia, age over 85.

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6
Q

What lifestyle changes should all people at a high risk of cardiovascular disease make?

A

Modifications to diet, exercise, weight-management, alcohol consumption, smoking cessation.

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7
Q

What is the first line treatment for primary prevention of cardiovascular disease if lifestyle measures are ineffective alone?

A

A statin.

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8
Q

What should be offered to all patients for the secondary prevention of cardiovascular disease?

A

A statin, combined with lifestyle advice.

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9
Q

What tests should be carried out before commencing statin treatment?

A

Total cholesterol, non-HDL cholesterol, LDL-cholesterol, HDL-cholesterol.

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10
Q

What is healthy range for total cholesterol?

A

Less than or equal to 5mmol/L.

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11
Q

What is the healthy range for non-HDL cholesterol?

A

Less than or equal to 4mmol/L.

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12
Q

What is the healthy range for LDL-cholesterol?

A

Less than or equal to 3mmol/L.

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13
Q

What is the healthy range for HDL-cholesterol?

A

Greater than or equal to 1mmol/L.

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14
Q

What is the first line treatment for hypercholesterolaemia, hypertriglyceridemia, and familial hypercholesterolaemia?

A

A statin.

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15
Q

If a statin alone is ineffective in the treatment of hypercholesterolaemia, hypertriglyceridemia, and familial hypercholesterolaemia, what may be added?

A

An additional lipid-controlling drug such as ezetimbe.

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16
Q

What may be added to treat resistant hyperlipidaemia?

A

Fenofibrates or nicotinic acid.

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17
Q

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?

A

Those with a family or personal history of muscle disorders, previous history of muscle toxicity, high alcohol intake, renal impairment, hypothyroidism, the elderly.

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18
Q

Combining a statin with which drugs leads to an increased risk of myopathy?

A

A fibrate or nicotinic acid.

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19
Q

Which antibiotic, seen in topical preparations, should be avoided in statin use?

A

Fucidic acid.

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20
Q

If fucidic acid is to be used by patients on statins, what course of action should be taken?

A

The statin should be stopped and restarted seven days after last dose.

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21
Q

Which drugs, when used with stating, increase the plasma concentration of said statin?

A

Macrolide antibiotics, imidazole and triazole antifungals, ciclosporin.

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22
Q

What monitoring is required for patients on statins?

A

Liver function and creatine kinase if muscular symptoms occur.

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23
Q

If severe muscular symptoms or raised creatine kinase occurs during statin treatment, what course of action should be taken?

A

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.

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24
Q

If patients being treated with a statin experience dyspnoea, cough, and weight loss, what should they do?

A

Seek medical attention. May be interstitial lung disease.

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25
Q

Correcting which metabolic condition may correct lipid abnormality?

A

Hypothyroidism.

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26
Q

Untreated hypothyroidism may increase the risk of what when lipid-regulating drugs are used?

A

Myositis.

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27
Q

How should liver enzymes be monitored when a patient is being treated with statins?

A

Before treatment, repeated within three months and at 12 months.

28
Q

How should acute attacks of stable angina be treated?

A

Sublingual GTN spray, taken immediately before activity known to bring on an attack, if needed.

29
Q

Stable angina should be treated with regular drug therapy if a patient has how many attacks per week?

A

More than twice per week.

30
Q

What are unstable angina and NSTEMI caused by?

A

A partial blockage of a blood vessel.

31
Q

What is the difference in myocardial necrosis between unstable angina and NSTEMI?

A

In unstable angina, no myocardial necrosis is seen. In NSTEMI, some necrosis may be seen.

32
Q

What is STEMI caused by?

A

Complete blockage of a coronary vessel, causing irreversible necrosis of the heart and complications.

33
Q

In the treatment of ACS, what is aspirin used for?

A

To limit clot size and allow blood flow.

34
Q

In the treatment of ACS, what is morphine used for?

A

To relieve pain and anxiety.

35
Q

In the treatment of ACS, what is metoclopramide used for?

A

To relieve the nausea from the morphine used.

36
Q

In the treatment of ACS, what is oxygen used for?

A

To ease laboured breathing.

37
Q

In the treatment of ACS, what is a nitrate used for?

A

To ease blood flow through vasodilating.

38
Q

In the treatment of ACS, what are LMWHs used for?

A

To prevent clot growth.

39
Q

In the additional acute management of unstable angina and NSTEMI, what are glycoprotein inhibitors used for?

A

To prevent a coronary clot.

40
Q

What is a percutaneous intervention used in the acute management of STEMI?

A

Angioplasty plus a stent.

41
Q

What is a coronary artery bypass graft (GABG)?

A

Replacing the damaged vessel(s) with one from elsewhere in the body.

42
Q

What should patients be discharged with for the long-term management of ACS?

A

Dual anti platelet therapy for 12 months, beta-blocker reviewed after 12 months, ACEi, statin.

43
Q

As one can develop a tolerance to nitrate treatment, what should be done to prevent this?

A

The patient should have a nitrate free period of 4 to 12 hours each day.

44
Q

When should conventional isosorbide mononitrate be given?

A

Not more than twice a day unless small doses are given.

45
Q

When should MR formulations of isosorbide mononitrate be given?

A

Only once daily.

46
Q

What are fibrinolytics and how are they used?

A

They stimulate plasmin production to degrade thrombin, used in place of a PCI.

47
Q

If severe bleeding occurs with fibrinolytic use, what course of action should be taken?

A

Discontinuation of the fibrinolytic and addition of coagulation factors and antifibrinolytics.

48
Q

How should hypotension associated with fibrinolytic use be treated?

A

By raising the patient’s legs, reducing the rate of infusion, or stopping it a temporarily.

49
Q

Which drugs are used to treat oedema in heart failure?

A

Loop, thiazide and potassium sparing diuretics.

50
Q

How should oedema be treated in the elderly?

A

Initiate on low doses and adjust to renal function.

51
Q

What should be used in place of diuretics in the elderly for the treatment of long term simple gravitational oedema?

A

Increased movement and stockings.

52
Q

What electrolyte disturbance can be seen with thiazide and loop diuretics? Which has the greater effect?

A

Hypokalaemia, greater risk with thiazides.

53
Q

Which diuretic is preferred for use in oedema from liver cirrhosis?

A

Spironolactone.

54
Q

If a patient has an enlarged prostate, what should be established before they are treated for oedema?

A

Adequate urinary output.

55
Q

Which diuretics can exacerbate diabetes and gout?

A

Loop and thiazide.

56
Q

What symptoms seen when using diuretics require immediate referral?

A

Heaviness in the chest, water retention, depression, extreme tiredness, thirst, excessive urination, irregular heartbeat, muscle weakness, nausea, gout, dizziness.

57
Q

What monitoring is required with diuretic use?

A

BP, sodium and potassium, weight to measure water loss.

58
Q

What should be avoided when taking potassium sparing diuretics?

A

Potassium supplements.

59
Q

An enhanced hypotensive effect is seen when diuretics are used with which drugs?

A

ACEis, alpha-blockers, ARBs.

60
Q

An increased risk of hyperkalaemia is seen when potassium sparing diuretics or aldosterone antagonists are used with which drugs?

A

ACEis, ARBs, ciclosporin, potassium salts, tacrolimus.

61
Q

Hypokalaemia caused by acetazolamide, loop diuretics, thiazides or thiazide like diuretics increases the risk of ventricular arrhythmias with which drugs?

A

Amisulpride, atomoxetine, pimozide, sotalol.

62
Q

Hypokalaemia caused by diuretics increases the risk of cardiac toxicity with chich drugs?

A

Cardiac glycosides.

63
Q

The plasma concentration of eplerenone is increased by which drugs?

A

Clarithromycin and itraconazole.

64
Q

The plasma concentration of eplerenone is reduced by which drugs?

A

Carbamazepine, phenobarbital, phenytoin, rifampicin, St. John’s Wort.

65
Q

There is an increased risk of ototoxicity when loop diuretics are given with which drugs?

A

Aminoglycosides, polymyxins, vancomycin.

BNF Chapter 2 - Cardiology (10 decks)

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