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MPharm 2 - PH2113 > Unit 6 - Cardiovascular system 7 > Flashcards

Unit 6 - Cardiovascular system 7 Flashcards

1
Q

Where is the majority of cholesterol produced?

A

Liver

- contribution from diet

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2
Q

What is cholesterol essential for?

A 
Cell membrane integrity
Precursor in production of
- steroid hormones
- bile acids
- vitamin D
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3
Q

What can lead to an atherosclerotic plaque?

A

LDL-C susceptible to oxidation at damaged endothelium

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4
Q

Why is HDL called “good cholesterol”?

A

HDL-C carrier of cholesterol away from circulation to liver for recycling

it helps remove other forms of cholesterol from your bloodstream

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5
Q

What is cholesterol screening?

A 
Part of CVD screening and used in predicting 10 year CVD risk
- utilisation of QRISK
Capillary (pin prick) test
- total
- HDL cholesterol
- non-fasting
Venous test
- total
- HDL-C
- non-HDL-C
- triglycerides
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6
Q

What other tests can be used to assess risk of CVD?

A

Renal function
Liver function
Thyroid stimulating hormone
Blood pressure

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7
Q

What are statins?

A

Competitive inhibitors of HMG-CoA reductase

  • rate controlling enzyme in mevalonate pathway
  • affect production of cholesterol
  • increases LDL receptor expression
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8
Q

What are statins used for?

A

Improve endothelial function
Modulate inflammatory response
Maintain plaque stability
Prevent thrombus formation

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9
Q

Which statin is used for primary prevention?

A

20 mg Atorvastatin once daily
(10 year CVD risk > 10% using QRISK)
- 40% reduction in non HDL-C at 3 months

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10
Q

What dose is used for secondary prevention?

A

80 mg Atorvastatin one daily

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11
Q

Which cholesterol medication is contraindicated in pregnancy?

A

Statins

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12
Q

What are the side effects of statins?

A

Pain
Tenderness or weakness in muscles
- measure creatinine kinase levels
- explore other possibilities of symptoms

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13
Q

What effect does grapefruit juice have on statins?

A

Interferes with first pass metabolism of statins

- elevates levels of active drug

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14
Q

What are the treatment aims of chronic stable angina?

A
  1. Stop or minimise symptoms
  2. To improve quality of life and long term morbidity
    - increase exercise tolerance by getting better perfusion of the heart and decreasing demand
  3. Reduce the risk of a major cardiovascular event
    - plaque rupture and thrombus formation
    - MI
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15
Q

How can acute attacks of chronic stable angina be managed?

A

Short acting sublingual nitrate therapy

  • glyceryl trinitrate (GTN) tablets or buccal spray
  • nitrolingual
  • glytrin
  • nitromin
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16
Q

When should the emergency services be called when using GTN spray?

A

Rapid pain relief

  • if not gone, repeat dose after 5 mins
  • if pain persists, call emergency services
17
Q

When can GTN spray be used?

A

Before exercise or exertion

18
Q

How does GTN spray work?

A

Mechanism is principally rapid venodilation and reduction in cardiac preload
- reduced cardiac work / O2 demand

19
Q

What is the long term management of chronic stable angina?

A

All patients should receive treatment with drugs which reduce cardiac O2 demand in the longer term
- minimises the frequency of acute attacks
Selection will depend of LV function and how well tolerated
- caution if LV systolic dysfunction or congestive heart failure

20
Q

What is step 1 of long term management of chronic stable angina?

A

Either beta-adrenoceptor antagonist (beta-blocker) OR rate limiting Ca2+ channel blocker (CCB)
- depending on tolerance / preference

If LV dysfunction DO NOT USE verapamil

21
Q

What is step 2 of long term management of chronic stable angina?

A

If inadequate response in step 1, consider switching or using a combination of the two

22
Q

What are the options if no adequate response to beta blockers or Ca2+ channel blockers when managing chronic stable angina?

A 
Long acting nitrate
OR
Ivabradine
OR
Nicorandil
OR
Ranolazine
23
Q

What causes chronic stable angina?

A

Coronary blood flow is limited during systole

  • extravascular compression
  • coronary arteries blocked off by the aortic valve

Maximise time in diastole to increase perfusion by reducing heart rate

24
Q

How do beta blockers treat chronic stable angina?

A
  • reduce heart rate
  • reduce contractility
  • reduce arterial pressure (afterload)
  • reduces the oxygen demand of the heart
25
Q

How do Ca2+ channel blockers treat chronic stable angina?

A
  • cause systemic vasodilation
  • reduces arterial pressure (overload)
  • reduces the oxygen demand of the heart

Rate limiting Ca2+ channel blockers also decrease heart rate and contractility

  • verapamil
  • diltiazem
26
Q

What should be considered for people with stable angina whose symptoms are not satisfactorily controlled with optimal medical treatment?

A

Revascularisation

27
Q

What are the two types of revascularisation that can be considered for people with stable angina whose symptoms are not satisfactorily controlled with optimal medical treatment?

A
  • percutaneous coronary intervention (PCI)

- coronary artery bypass grafy (CABG)

28
Q

How do doctors make a decision between coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI)?

A

Angiography

29
Q

What are the drug therapy options for secondary prevention of chronic stable angina?

A

Lifestyle modification
Aspirin
- 75 mg daily for people with stable angina
- take into account the risk of bleeding and co-morbidities to prevent thrombotic evens
Statin treatment
- irrespective of non-HDL-C levels
- up to 80mg Atorvastatin once daily
- amended according to adverse reactions / drug interaction
Consider angiotensin-converting enzyme (ACE) inhibitors
- if not already taking for associated disease
- hypertension

30
Q

What are the treatment aims of Acute Coronary Syndromes?

A
  1. Reduce and relieve acute symptoms and distress
  2. Prevent, or limit the extent of myocardial necrosis
  3. Reduce the risk of early death due to arrhythmia or acute heart failure
    - cardiac arrest
    - cardiogenic shock
  4. Reduce risk of recurrence
    - secondary prevention
  5. Limit the development of chronic ischaemic cardiomyopathy and heart failure
31
Q

What is the initial treatment of Acute Coronary Syndrome?

A

While awaiting diagnosis:

  • GTN
  • to reduce cardiac preload and work/O2 demand
  • Oxygen
  • if needed
  • Aspirin
  • offer a loading dose of 300mg to reduce further thombus formation unless clear evidence of allergy
  • Morphine IV (diamorphine)
  • relieve pain and distress
  • activates the sympathetic nervous system and increases O2 demand
  • influencing extension of infarct
  • Anti-emetic
  • relieve nausea/vomiting caused by fear, pain, morphine use

MPharm 2 - PH2113 (50 decks)

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