Wk 1 Cardioresp

Question 1

stage 1 HTN=

Answer 1

clinic Bp 140/90

home/average Bp 135/85

Question 2

stage 2 HTN =

Answer 2

clinic =160/100

average Bp= 150/95

Question 3

severe HTN=

Answer 3

clinic over 180/ 110

Question 4

with stage 1 HTN when do you treat (5)

Answer 4

• target organ damage
• established CVD
• renal disease
• diabetes
• Q risk -20%

Question 5

investigation for people with HTN (4)

Answer 5

• U&Es
• serum cholesterol and HDL cholesterol
• fundi examination
• 12 lead ECG

Question 6

when offer lipid lowering therapy

Answer 6

Q risk above 10

Question 7

HTN treatment <55 years old not african or caribbean

Answer 7

ACEi or ARB
CCB
thiazide like diuretic
spironolactone

Question 8

HTN treatment >55

Answer 8

offer CCB first

Question 9

ACEi works in 2 ways

Answer 9

1. reduce peripheral resistance -efferent arteriole v sensitive
2. increase excretion of Na via aldosterone decrease

Question 10

adverse drug events with ACEi (5)

Answer 10

• hypotension
• persistent dry cough
• hyperkalaemia
• worsen renal failure
• angioedema

Question 11

is ACEi teratogenic

Answer 11

yes

Question 12

NSAID + ACEi –>

Answer 12

possible AKI

Question 13

spironolactone + ACEi–>

Answer 13

hyperkalaemia

Question 14

4 lifestyle interventions for lowering cholesterol

Answer 14

diet 
physical activity 
weight management 
alcohol consumption 
smoking cessation

Question 15

how do statins work

Answer 15

HMG-CoA reductase inhibitors increasing LDL receptor expression increasing endocytosis of LDL and lowering serum LDL

Question 16

adverse drug events of statins (5)

Answer 16

• headache
• GI disturbance
• rhabdomyolysis (muscle aches, myopathy)
• rise in liver enzymes
• drug induced hepatitis

Question 17

statins in pregnancy

Answer 17

avoid -congenital abnormalities reported

Question 18

what reduces statin metabolism

Answer 18

cytochrome P450 inhibitors

Question 19

CP450 inhibitors to avoid using with statin (6)

Answer 19

Amiodarone 
diltiazem 
itraconazole 
macrolide antibiotics 
protease inhibitors 
clarithromycin

Question 20

what to do when giving clarithromycin and statin

Answer 20

discontinue statin until antibiotic finished

Question 21

problem with CP450 inhibitors + statin

Answer 21

increase amount of statin in body increasing risk of adverse event (induced muscle injury biggest concern)

Question 22

which statins should avoid grapefruit juice

Answer 22

simvastatin

atorvastatin

Question 23

which statins are preferred when concurrent therapy with a strong inhibitor of CYP3A4 cannot be avoided

Answer 23

fluvastatin

rosuvastatin

Question 24

why no grapefruit juice and statin

Answer 24

grapefruit contains furanocourmarins potent CYP450 inhibitor

Question 25

when should simvastatin and pravastatin be taken (short half-lives)

Answer 25

before bed to maximise there effect as HMG-CoA reductase is more active at night

Question 26

when do you check LFTs with statin therapy

Answer 26

3 and 12 months

Question 27

when would you stop a statin with deranged LFTs

Answer 27

ALT rise 3x upper limit of normal and restart lower dose once enzymes normal again

Question 28

when do you check creatinine kinase with statin therapy

Answer 28

if patient reports muscle symptoms

Question 29

does lipid profile need to be routinely checked with statins

Answer 29

• in primary prevention before starting treatment

- in secondary prevention efficacy should be checked