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Yr3: GP > Hypertension, CKD & Hyperlipidaemia > Flashcards

Hypertension, CKD & Hyperlipidaemia Flashcards

1
Q

Define CKD

A

Reduction in kidney function or structural damage (or both) present for more than 3 months with associated health implications.

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2
Q

Discuss the prevelance & aetiology of CKD

A
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3
Q

State some risk factors/potential causes of CKD

A
  • Hypertension
  • Diabetes
  • Glomerular disease e.g. glomerulonephritis
  • Chronic pyelonephritis
  • Current or previous history of AKI
  • Nephrotoxic drugs
  • Conditions associated with obstructive uropathy e.g. structural renal tract disease,recurrent urinary claliuli etc..
  • Multisystem disease e.g. SLE, vasculitis, myeloma
  • FH of CKD stage 5 or hereditary kidney disease e.g. autosomal dominant polycystic kidney disease
  • Cardiovascular disease
  • Obesity with metabolic syndrome
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4
Q

State some symptoms of CKD/discuss how CKD may present in primary care

A

Symptom often generalised and pts may be asymptomatic until a late stage; symptoms can include:

  • Fatigue
  • Pruritis
  • Loss of appetite
  • Nausea & vomitting
  • Breathlessness
  • Cramps (worse at night)
  • Weight loss
  • Polyuria
  • Oedema
  • Muscle weakness
  • Taste disturbance (ESRD)
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5
Q

State some signs of CKD

A
  • Pallor
  • Cacehexia
  • Uraemic odour (ammonia like smell of breath)
  • Uraemic flap
  • Tachypnoea
  • Dehydration/hypovolaemia
  • Hypertension (primary or secondary to CKD itself)
  • Peripheral oedema
  • Bibasal creptitations (if pulmonary oedema)
  • Ballotable polycystic kidneys (in PKD)
  • Hepatomegaly
  • Jaundice
  • Frothy urine
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6
Q

CKD is often asymptomatic in the early stages; true or false?

A

True

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7
Q

Discuss how CKD is diagnosed in primary care

A

CKD should be diagnosed in people with:

  • Markers of kidney damage e.g. urinary ACR >3mg/mmol, urine sediment abnormalities, electrolyte and other abnormalities, abnormalities related to histology, structural abnormalities determined by imaging etc…
  • A persistent reduction in renal function shown by a serum estimated GFR of < 60mL.min/1.73m2
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8
Q

Which pts would you arrange investigations for CKD in?

A

Arrange investigations to assess for CKD in people with:

  • Risk factors for CKD
  • Incidental finding of:
    • Rasied serum creatinine
    • eGFR <60mL/min/1.73m2
    • Proteinuria (ACR >3mg/mmol)
    • Persistent haematuria (2/3 dipstick show 1+ or more of blood)
    • Urine sediment abnormalities e.g. red blood cells, whit blood cells, granualar casts
  • Possible clinical features of CKD
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9
Q

Discuss what initial investigations you would do in primary care if you suspect CKD

A
  • U&E’s & eGFR (advise person not to eat meat for 12hrs prior): chekc for raised creatinine and decreased eGFR
  • Urine dipstick: check for heamturia
  • Early morning urine sample: for ACR
  • Blood pressure: CVD RF
  • BMI:CVD RF
  • Serum HbA1c: CVD RF
  • Lipid profile:CVD RF
  • Consider renal tract ultrasound
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10
Q

Discuss how CKD is classified

A

Classified using combination of eGFR and urinary albumin:creatinine ratio (ACR)

*NOTE: markers of kidney damage include albuminuria, urine sediment abnormalities, electrolyete & other abnormalities due to tubular disorders, abnormalities detected by histology, structural abnormalities detected by imaging or history of kindey trasnplantation

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11
Q

Remind yourself of the 5 aims of management in CKD (from Yr3 Medicine Renal: CKD)

A
  • Treat underlying disease
  • Reduce progression of CKD
  • Reduce risk of cardiovascular disease
  • Prevent or treat complications
  • Plan for future

This involves:

  • Blood pressure management
  • Management dyslipidaemia
  • Treating/optimising control of underlying cause
  • Treating e.g. aneamia, CKD mineral & bone disease
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12
Q

Discuss the non-pharmacological mangement of CKD

A
  • Provide sources of information, advice & support such as Kidney Care UK, leaflets on CKD etc…
  • Lifestyle measures:
    • Smoking cessation
    • Limiting alcohol consumption
    • Weight loss if appropriate
    • Healthy diet
    • Regular exercise
  • Ensure get influenza & pneumococcal vaccinations
  • Advise to avoid OTC NSAIDs where possible
  • Avoid herbal remedies
  • Use protein supplements with caution
  • Advise on increased risk of AKI if there is severe, intercurrent illness
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13
Q

Discuss the management of blood pressure in CKD, consider how management differs for:

  • ACR <30mg/mmol
  • ACR =/> 30mg/mmol and associated hypertension
  • ACR =/> 70mg/mmol
  • If have diabetes
A
  • If ACR <30mg/mmol manage via usual hypertension pathway (lifestyle, consider drug therapy)
  • If ACR of 30mg/mmol or more and associated hypertension prescribe ACE inhibitor or ARB e.g. lisinopril or losartan
  • ACR =/> 70m/mmol prescribe ACE inhibitor or ARB irrespective of blood presussure or CVD risk
  • If diabetic and have ACR >3mg/mmol or more prescribe ACE inhibitor or ARB

Blood pressure targets:

  • ACR <70mg/mmol: systolic <140, diastolic <90
  • ACR =/>70mg/mmol: systolic <130, diastolic <80
  • If have diabetes mellitus: systolic <130, diastolic <80

*NOTE: if person has ACR of 70mg/mmol or more refer to nephrology unless proteinuria is known to be due to diabetes and is managed appropriately

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14
Q

Discuss the blood pressure targets in CKD, consiser if person has:

  • ACR <70mg/mmol
  • ACR =/>70mg/mmol
  • Diabetes mellitus also
A

Blood pressure targets:

  • ACR <70mg/mmol: systolic <140, diastolic <90
  • ACR =/>70mg/mmol: systolic <130, diastolic <80
  • If have diabetes mellitus: systolic <130, diastolic <80

*NOTE: if person has ACR of 70mg/mmol or more refer to nephrology unless proteinuria is known to be due to diabetes and is managed appropriately

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15
Q

Discuss the management of dyslipidaemia in CKD

A

For ALL people with CKD prescribe a statin:

  • 20mg Atorvastatin for primary prevention
  • 80mg Atorvastatin for secondary prevention

*NOTE: renal impairment is a risk factor for myopathy & rhabdomyolysis adverse effects of statins therefore for people with eGFR of 30mL/min/1.73m2 or less consider seeking specialist advice prior to commencing statin

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16
Q

Discuss the management of oedema in primary care

A

Loop diuretic e.g 40mg Furosemide

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17
Q

When are antiplatelets prescribed in CKD?

A

For secondary prevention of CVD e.g. prescribe aspirin

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18
Q

Discuss which pts with CKD you should refer to specialist

A
  • eGFR <30mL/min/1.73m2
  • Accelerated progression of CKD
  • Urinary ACR of =/>70mg/mmol (unless proteinuria known to be associated with diabetes and is managed appropriately)
  • Urinary ACR of =/>30mg/mmol together with persistent haematuria
  • Hypertension that remains controlled despite use of 4 antihypertensive drugs at therapeutic doses
  • Suspected or confirmed rare or genetic cause of CKD
  • Suspected renal artery stenosis
  • Complicatinos of CKD such as:
    • Malnutrition, hyperkalaemia
    • Anaemia of chronic disease
    • Renal mineral & bone disease
    • Persistent metabolic acidosis
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19
Q

What is ‘accelerated progression of CKD’?

A

Defined as:

  • Sustained decrease in eGFR of 25% or more within 12 months and a change in CKD category
  • Sustained decrease in eGFR of 15mL/min/1.73m2 or more within 12 months
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20
Q

Discuss what follow up/monitoring is required in CKD

A
  • Monitor eGFR, serum creatinine, urinary ACR (see attached able for how often should be monitored- depends on disease severity.
  • Check lipids annually
  • Monitor for complications
    • ​FBC for anaemia in pts with CKD 3b, 4 and 5 or if develop symptoms of anaemia
    • Ca, phosphate, vit D, PTH for pt with CKD 4 or 5 or if suspect bone disease

*Should monitor renal function estimate rate of progression. To estimate rate of progression measure eGFR at least 3 times over 3 months. Baseline eGFR and trajectory can help you determine if referral to specialist is necessary

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21
Q

Discuss the impact of CKD on someone’s life

A
  • Inablity to do what they used to: work, exercise, look after family etc
  • Medication
  • Planning for future and impact of future treatments
  • Anxiety and depression associated with chronic disease
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22
Q

State some complications of CKD

A
  • AKI (this may initiate or accelerate CKD progression)
  • Hypertension
  • Dyslipidaemia
  • Cardiovascular diseae e.g. IHD, peripheral arterial disease, heart failure, stroke
  • Anaemia of chronic disease
  • CKD mineral and bone disorder
  • Malnutrition
  • Malignancy
  • ESRD
  • Peripheral neuroahty & myopathy (may present as parasthesia, sleep disturbance, restless leg syndrome)
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23
Q

Discuss sick day rules for CKD patients

consider temporary cessation of medicines at times of acute illness.4 9 10 That is, during these episodes, ‘any drug that reduces blood pressure, circulating volume or renal blood flow’ increases the risk of AKI.3 Medicines that exacerbate this risk include non-steroidal anti-inflammatory drugs (NSAIDS), diuretics, ACE inhibitors and angiotensin II receptor blockers (ARBs).3

A

When you have an illness that can make you dehydrated for example: nausea, vomiting, diarrhoea, fever, you should stop taking the following medications as they further increase dehydration risk and therefore increase risk of AKI:

  • Diuretics
  • ACE inhibitors
  • ARBs
  • Metformin
  • Diuretics

*Mneumonic: DAAMN

Restart medications when you are well (24-48hrs after eating & drinking normally).

Advice does not apply if single episode of diarrhoea or vomiting. If have heart failure only withhold for 48hr then seek specialist advice.

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24
Q

When should you suspect renal artery stenosis?

A
  • Greater than 25% reduction in eGFR within 3 months of starting (or increasing dose of) a renin-angiotension system antagonist
  • Refractory hypertension
  • Pulmonary oedema
  • Renal artery bruit
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25
Q

How long, after an AKI, should you monitor for the development or progression of CKD?

A

Monitor for development or progression of CKD for at least 2-3yrs after episode of AKI even if serum creatinine returned to normal

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26
Q

How can we prevent risk of AKIs?

A
  • Discuss risk of developing AKI with pt and educate on risk factors e.g. nausea & vomitting
  • Review drugs and where possible avoid nephrotoxic drugs
  • Sick day rules CKD
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27
Q

Define hypertension

A

Persistently raised arterial BP (>140/90)

  • Primary: idioapathic
  • Secondary: due to underlying cuase
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28
Q

Discuss the prevelance of HTN

A
  • 31% in menand 26% in women but rises to>50% in aged over 60yrs
  • Estimated that for every 10 people diagnosed with HTN, 7 remain undiagnosed
  • Globally 25% of adults have HTN worldwide
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29
Q

State some risk factors for HTN

A
  • Age
  • Sex (up to 65yrs women tend to have lower BP than men. Between 65 and 74yrs women tend to have higher BP than men)
  • Ethnicity (black african & black carribean)
  • Genetics
  • Social deprivation
  • Smoking
  • Excessive alcohol consumption
  • Excess dietary salt
  • Lack of physical activity
  • Obesity
  • Anixiety & emotional stress (can raise BP due ot increased adrenaline & cortisol)
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30
Q

State some causes of secondary hypertension

A
  • Renal disorders (MOST COMMON):
    • Chronic pyelonephritis
    • Diabetic nephropathy
    • Glomerulonephritis
    • PKD
    • Obstructive uropathy
    • Renal cell carcinoma
  • Vascular disorders:
    • Coarctation of aorta
    • Renal artery stenosis
  • Endocrine disorders:
    • Primary hyperaldosteronism
    • Phaeochromocytoma
    • Cushing’s syndrome
    • Acromegaly
    • Hypothyroidism
    • Hyperthyroidism
  • Drugs & other substances (NOT ALL LISTED):
    • Alcohol
    • Corticosteroids
    • EPO
    • COCP
    • Cocaine
    • NSAIDS
  • Other conditions:
    • Scleroderma
    • SLE
    • OSA
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31
Q

Discuss the stages of hypertension

A
32
Q

Do people with hypertension often have symptoms?

A

Often asymptomatic unless presenting with hypertensive emergency. Symptom they may experience is headache.

33
Q

State some signs of hypertension

A

Alongside high BP may see signs associated with risk factors and signs associated with end organ damage.

  • High BP
  • Retinopathy
  • Signs of underlying disease e.g. phaechromocytoma,, renal disease, Cushing’s
  • Renal bruits
  • Displaced apex beat
  • Proteinuria
  • Features of acromegaly
  • Radiofemoral delay (if coarctation of aorta)
34
Q

Remind yourself of the correct way to measure someone’s BP

A
  • Measure BP in a relaxed, temperate setting with person quiet & seated and their arm outstretched
  • Measure in both arms using appropriate cuff size
  • If difference between arms is >15mmHg repeat measurements
  • If difference still >15mmHg measure subsequent BPs in arm with higher reading
35
Q

If someone has pulse arrhythmia, how must you measure BP?

A

Manually

36
Q

Remind yourself of how to mesure BP manually

A
  • Ensure arm is supported at the heart level with palm facing upwad
  • Ensure cufffits
  • Wrap cuff around arm- aligning brachial artery to markers on the cuff
  • Inflate cuff until radial pulse can no longer be felt (provides estimation of systolic BP). In exam, verbally report the estiamated pressure.
  • Deflate cuff completely and wait 15-30 seconds before continuing
  • Inflate cuff to a pressure of 30mmHg or higher than estimated systolic BP
  • Place diaphragm of stethoscope over brachial artery
  • Deflat cuff at 2-3mmHg per second or per heartbeat
  • Note systolic BP when minimum of two repetitive Korotkoff sounds are first heard
  • Continue to deflate cuff
  • Note diastolic BP when Korotkoff sounds disappear
  • Fully deflate cuff, remove & clean
37
Q

Discuss how HTN (<180/120mmHg) is diagnosed in primary care- including what investigations are done

A
  1. Measure BP in clinic
  2. If BP >140/90 in clinic, take a second measurement during consultation
  3. If BP still >140/90 (but less than 180/120) offer ABPM or HBPM (if ABPM unsuitable)
  4. Whilst waiting for confirmation of HTN do investigations to assess for end organ damage:
    • Urine dipstick (haematuria)
    • Urinary ACR
    • Lipid profile
    • HbA1c
    • U&Es, eGFR
    • Fundoscopy
    • ECG
    • Consider further investigations if think secondary cause/consider referral
  5. Assess cardiovascular risk using Q risk score
38
Q

Compare ABPM and HBPM, include how to do/what is required for both

A

ABPM

  • Portable device that measures BP at regular intervals
  • Ensure that at least 2 measurements taken per hour during persons usual waking hours and use the average value of at least 14 measurements takenduring the persons usual waking hours to confirm diagnosis

HBPM

  • Measure BP at home using blood pressure machine (not portable)
  • For each reading, 2 consecutive measurements must be taken at least 1 minute apart
  • Pt must be seated and be shown correct BP taking technique
  • BP recorded twice daily, once in morning and once in evening
  • Must take BP readings for at least 4 days- ideally 7 days
  • Discard the measurements taken on first day and use average of all remaining measureements

**CHECK: when do two measurements for one reading do you record the highest measurement

39
Q

Discuss the non-pharmacological/conservative management of HTN

A
  • Lifestyle advice: smokingcessation, physical activity, healthy diet, decrease caffeine, decrease dietary salt, decrease alcohol consumption
  • Offer pt information leaflets on HTN
40
Q

Discuss the pharmacological management of stage 1 HTN

A

REMEMBER ALL SHOULD GET Lifestyle advice

  • Discuss starting antihypertensive drug treatment iin addition to lifestyle in people under 80yrs who have 1 or more of: target organ damage, established CVD, renal disease, diabetes, QRISK >10%
  • Consider in antihypertensive drug treament in those <60yrs with QRISK <10% (as QRISK may underestimate)
  • Consider antihypertensive drug treatment in those over 80yrs with BP over 150/90
41
Q

Discuss the pharmacological management of stage 2 hypertension

A

REMEMBER ALL SHOULD HAVE lifestyle advice

  • Offer antihypertensive drug treatment in additiont o lifestyle regardless of age
42
Q

If someone is less than 40yrs but has stage 2 hypertension what should you consider?

A

Consider specialist evaluation of secondary causes

43
Q

Discuss what you would do in primary care if a pt has BP >180/120mmHg

A
  • Refer for same day specialist assessment if:
    • Signs fo retinal heamorrhage and/or papilloedema (malignant hypertension)
    • Life threatening symtpoms e.g. chest pain, new onset confusion, HF signs, AKI
    • Suspected phaeochromocytoma
  • If no symptoms or signs indicating same day referral carry out investigations for target organ damage as soon as possible; if target organ damage is identified consider starring antihypertensive treatment immediately without waiting for esutls of ABPM or HBPM
44
Q

How do we treat secondary HTN?

A

Treat underlying cause

45
Q

How often do pts have a hypertensive review IF they’re BP is well controlled?

A
  • Generally have review annually if good control of BP
  • If initiate or alter treatment, recheck BP in 4 weeks
46
Q

What should be done at an annual hypertensive review?

A
  • Check BP
  • Check compliance
  • Encourage adherence to treatment
  • Check renal function: U&E’s
  • Reasses QRISK
47
Q

State some potential complications of HTN

A

Increase risk of number of conditions such as:

  • Heart failure
  • Coronary artery disease
  • Stroke
  • CKD
  • Peripheral arterial disease
  • Vascular dementia

**Hypertension is the single biggest risk factor for cardiovascular disease and related disability

48
Q

Discuss the potential impact of HTN on a patients lifestyle

A

May have to make significatn lifestyle changes e.g. smoking cessation, healthy eating, exercise etc.. Can be very difficult and may help to get family/partner involved to help

49
Q

What is ‘accelerated’ or ‘malignant hypertension’?

Discuss how you should manage this in primary care

A
  • Severe increase in BP to 180/120mmHg or higher (and often over 220/120) with signs of retinal haemorrhage and/or papilloedema. Usually associated with new or progressive target organ damage
50
Q

What is is white coat hypertension?

A
  • BP is unusually raised when measured during consultations with clinicians but is normal when measured in ‘non-threatening’ siutations (occur in about 15–30% population)
  • Suspect if discrepancy of more than20/10mmHg betwen clinic and average daytime ABPM/HBPM and
51
Q

Discuss target blood pressure for:

  • <80yrs
  • =/> 80yrs
  • T1DM
  • T2DM
  • CKD with ACR <70mg/mmol
  • CKD with ACR >70mg/mmol
A
  • <80yrs: <140/90mmHg
  • =/> 80yrs: <150/90mmHg
  • T1DM: <130/80mmHg
  • T2DM: SAME AS NORMAL AGE DEPENDENT
  • CKD with ACR <70mg/mmol: <140/90
  • CKD with ACR >70mg/mmol: <130/80
52
Q

What is the QRISK tool?

What factors does it consider?

A

Calculates risk of major caridovascular event in next 10yrs. Factors consider include:

  • Age
  • Sex
  • Smoking status
  • Systolic BP
  • Medical conditions e.g. diabetes, CKD
  • Stron FH history
  • Ethnicity
  • etc…

See image for QRISK2

53
Q

Who should we measure standing & sitting BP in?

A
  • T2DM
  • Symptoms postural hypotension
  • 80yrs and over
54
Q

Summary from NICE

A
55
Q

Summary from NICE

A
56
Q

Lipids modification is an important part of reducing CVD risk; discuss whether the following are used in lipid modificaiton therapy:

  • Total cholesterol
  • Non-HDL-C
  • Triglycerides
A
  • Total cholesterol is an important predictor of CVD events; however, non-HDL-C (this has replaced LDL-C) is a powerful risk factor. We calculate non-HDL-C by doing (total cholesterol - HDL-C)
  • Raised triglyceride level is risk factor for CVD and is independent of total cholesterol
57
Q

When should you suspect familial hypercholesterolaemia?

A

​Suspect in adult if:

  • Total cholesterol >7.5mmol/L and/or
  • There is personal or family history of premature CHD (an event before 60yrs in an index person or first degree relative)
58
Q

What is familial hypercholesterolaemia?

A

Inherited conidition characterised by high cholesterol concentration in the blood. Present from birth and may lead to early development of CVD

59
Q

Most people with familial hypercholesterolaemia are homozygous; true or false?

A

FALSE- most just inherit one defective gene so heterozygous

60
Q

Discuss what investigations should be done in primary care if you suspect familial hypercholesterolaemia

A
  • Two measurements of LDL cholesterol
  • Assess for clinical signs of FH e.g. tendon xanthomas, premature corneal arcus
  • Secondary hypercholesterolaemia should be excluded
  • Simon Broome or Dutch Lipid Clinic Network criteria should be used to make clinical diagnosis
61
Q

Discuss the management of familial hypercholesterolaemia in priamary care

A
  • Refer all to specialist for confirmation of diagnosis and further testing (involves identification of affected relatives by DNA testing)
  • All homozygous should be managed by specialist
  • All children should be managed by specialist
  • For heterozygous, if pt at high risk of coronary event should be managed by specialist (e.g. if have established CVD, FH of premature CVD, two or more other CVD risk factors). All other adults can be managed in primary care once got diagnosis; management includes:
    • Lifestyle advice
    • Lipid modification therapy e.g. atorvastain 20mg or 10mg rosuvastatin or ezetimibe
    • Treating other CVD risk factors e.g. hypertension
    • Advice for support groups e.g. HEART UK

All treated with with high intensity statin or ezetimibe

62
Q

Waht reduction in non-HDL-C do you aim for in pts with familial hypercholesterolaemia?

A

>50% reduction from baseline

63
Q

Remind yourself of the Frederickson criteria for familial hypercholesterolaemia

A
64
Q

What common conditions & drugs can cause secondary hypercholesterolaemia?

A
  • Hypothyroidism
  • Cholestatic liver disease (such as primary biliary cirrhosis).
  • Nephrotic syndrome.
  • Cushing’s syndrome.
  • Anorexia nervosa.
  • Drugs: androgens, ciclosporin, beta blokers, anaobli steroids, diuretics, amiodarone, antidepressants, prednisolone, oral oestrogens

Others that can cause secondary hypercholesterolaemia but also tend to cause hypertriglyceridaemia:

  • Diabetes
  • Obesity
  • Pregnancy
  • Excess alcohol
  • CKD
  • HIV
65
Q

State some different statins that are available and discuss how they are gropued into low, medium & high intensity

A

Atorvastatin 10mg= medium intensity

Atorvastatin 20mg, 40mg, 80mg = high intensity

66
Q

What clinical assessment & blood tests should be done before starting statin treatment?

A

Clinical assessment: assess other modifialb CVD risk factors e.g. smoking, alcohol, BMI, BP

Blood tests:

  • Non fasting lipid profile
  • LFTs
  • U&E’s and eGFR
  • Creatine kinase (if person has persistent generalised muscle pain)
  • TSH
  • HbA1c
67
Q

What follow up is needed after prescribing a statin and at what intervals?

A
  • Measure total, HDL-C and non-HDL-C in all pts after 3 months of statin treatment
  • Recheck LFTs within 3 months of starting treatment & again at 12 months (after this further monitoring is not necessary unless clinically indicated e.g. signs of hepatotoxicity)
  • Routinely monitor for adverse effects e.g. if unexplained muscle symptoms check CK
68
Q

If someone presents wtih unexplained muscle symptoms after starting a statin discuss what you would do

A
  • Check creatine kinase
  • Explore other causes of muscle pain & weakness & raised CK (if present) if they have previously tolerated statin therapy for 3 months
  • Stop statin treatment if CK is 5x upper limit of normal
  • Consider stopping treatment if muscle symptoms are severe and cause daily discomfort even if CK levels not 5x upper limti
69
Q

What reduction in non-HDL cholesterol do we aim for?

A

40% reduction

70
Q

Discuss what you would do if:

  • Start pt on statin and >40% reduction in non-HDL-C not achieved
A
  • Discuss adherence and timing of dose
  • Optimise diet and lifestyle
  • Consider increasing dose of atorvastatin if on less than 80mg

*If try above and still doesn’t work consider adding ezetimibe and seeking specialist advice

71
Q

If someone is having advers effects due to statin, what could you do?

A
  • Stop statin and try again when symptoms resolve to see if it is the statin
  • Reduce dose within same intensity group
  • Change statin to lower intensity group
72
Q

Discuss who should be offered statins for primary prevention

A

Offer 20mg atorvastatin to:

  • <84yrsand QRISK is 10% or more
  • T1DM who are:
    • >40yrs
    • Had diabetes >10yrs or have established neprhopathy
    • Other CVD risk factors
  • PTs with CKD
  • Pts with familial hypercholesterolaemia

Consider offering to pts who are 85yrs and over; look at other CVD risk factors and consider risk and benefits

73
Q

What first line statin should be offered for primary prevention?

A

Atorvastatin 20mg

74
Q

What first line statin should be offered for secondary prevention?

A

80mg Atorvastatin

75
Q

State some common ADRs of statins

A

Common onces inlcude:

  • GI disturbance e.g. constipation, flatulence, dyspesia
  • Myalgia
  • Back pain
  • Headache
  • Hepatotoxicity
76
Q

What is the NHS health check programme?

A

Health check-up for adults in England aged 40 to 74. It’s designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes or dementia. Offered to those eligible every 5yrs.

The check is for people who are aged 40 to 74 who do not have any of the following pre-existing conditions:

  • heart disease
  • chronic kidney disease
  • diabetes
  • high blood pressure (hypertension)
  • atrial fibrillation
  • transient ischaemic attack
  • inherited high cholesterol (familial hypercholesterolemia)
  • heart failure
  • peripheral arterial disease
  • stroke
  • currently being prescribed statins to lower cholesterol
  • previous checks have found that you have a 20% or higher risk of getting cardiovascular disease over the next 10 years

Yr3: GP (21 decks)

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