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cardiovascular disease Flashcards

1
Q

what is cardiovascular disease?

A

group of heart conditions that affect heart and blood vessels caused by atherosclerosis and thrombosis eg coronary heart disease, MI, stroke etc

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2
Q

who is at high risk of cardiovascular disease? [4]

A

men
ethnicity eg south asians
ppl with family history of CVD
ppl aged over 50 and risk increases with age

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3
Q

what are the 9 modifiable risk factors for cardiovascular disease?

A 
hypertension
abnormal lipids
obesity
smoking
excess alcohol
poor diet
diabetes
psychosocial eg anxiety and depression
low exercise
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4
Q

give examples of some risk calculators?

what do these do?

A

QRISK 2, QRISK 3, JBS3, ASSIGN

predict likelihood of cardiovascular event and deciding whether statins should be prescribed or nor

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5
Q

what drug is given when there is a 10 year cardiovascular risk?

A

primary prevention drug normally atorvastatin

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6
Q

what risk factors does the QRISK 2 and JBS3 tools use to assess CVD risk? [12]

A 
gender
age
ethnicity
smoking
BMI
lipid profile
systolic BP
chronic kidney disease
social status
family history of CVD
rheumatoid arthritis
atrial fibrilliation
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7
Q

there are certain pt at high risk of CVD that using a risk calculator could underestimate their score. it is unsafe to use a risk calculator for these pt. who are these high risk patients? [6]

A 
type 1 diabetes
established CVD
chronic kidney disease
familial hypercholesterolemia
risk increases with age [more than 85 years old]
10 year risk of CVD more than 10%
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8
Q

are aspirins recommended for primary prevention of cardiovascular disease?

when are antihypertensives recommended for primary prevention of CVD?

A

no

only for those who have a BP higher than 140/90

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9
Q

which drugs are recommended for primary prevention of CVD?

A

lipid lowering drugs

eg atorvastatin

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10
Q

why is atorvastatin preferred over high dose simvastatin for SECONDARY prevention of CVD?

A

bc high dose of simvastatin increases risk of myopathy [muscle weakness]

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11
Q

what drugs are recommended for SECONDARY prevention of CVD?

A

LOW dose aspirin, clopidogrel, dipyridamole

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12
Q

are antihypertensives used in SECONDARY prevention of CVD? and when?

A

yes but when blood pressure higher than 140/90

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13
Q

define hyperlipidaemia

A

high cholesterol, high triglycerides or both

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14
Q

what are the causes of hyperlipidaemia? [6]

A 
HYPOthyroidism
family history
lifestyle [smoking, diet]
liver/renal impairment
drugs [eg corticosteroids, immunosuppressants]
diabetes
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15
Q

which patients are at high risk of developing hyperlipidaemia and should be given a statin regardless of serum cholesterol levels? [6]

A 
type 1 diabetics
type 2 diabetics only if they have a CVD risk greater than 10%
chronic kidney disease
familial hypercholesterolemia
risk increases with age [over 85 yo]
10 year risk of cvd greater 10%
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16
Q

what is step 1 and step 2 for management of primary prevention of cardiovascular disease?

A

step 1: lifestyle

step 2: statins

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17
Q

what is step 1 and step 2 for management of SECONDARY prevention of CVD?

A

step 1: address secondary causes of hyerplipidaemia eg uncontrolled diabetes, hypothyroidism

step 2: statins again should be offered to everyone including elderly

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18
Q

what is a high intensity statin?

A

a statin that reduces LDL cholesterol by more than 40%

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19
Q

what strengths of atorvastatin are classed as high intensity?

A

20mg, 40mg, 80mg

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20
Q

what strengths of rosuvastatin are classed as high intensity?

A

10mg, 20mg, 40mg

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21
Q

what strength of simvastatin is classed as high intensity?

A

80mg

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22
Q

which statin is recommended for all patients with secondary prevention of CVD?

A

atorvastatin

23
Q

what must be monitored and checked 3 months after a patient starts statins?

A

lipid profile [total cholesterol, HDL and LDL and triglycerides]

24
Q

what is the amount of total cholesterol in mmol/L that warrants a diagnosis for HYPERlipidaemia?

A

more than 6mmol/L

25
Q

can fibrates be used routinely for primary and secondary cvd prevention?

A

no

26
Q

can nicotinic acid, bile sequestrants and omega 3 fatty acid be used for primary and secondary CVD prevention?

A

no

27
Q

what can be used if statins are not tolerated in hyperlipidaemia?

what can be used if statins ON ITS OWN ARE NOT EFFECTIVE?

A

Ezetimibe

a combination of statins and ezetimibe

28
Q

what can be used if patients cannot take statins or ezetimibe for hyperlipidaemia?

A

pt must be referred to specialist for either bile acid sequestrants, fibrates, nicotinic acid

29
Q

when may fenofibrates need to be added to statins to treat hyperlipidaemia?

A

if the pt has particularly high triglycerides as fibrates are better than statins at reducing trigylycerides

30
Q

what is the mechanism of action of statins?

A

inhibit the HMG CoA reductase enzyme [3 hydroxy 3 methylglutaryl coenzyme A] which is an enzyme that is involved in cholesterol synthesis, especially in the liver

31
Q

what is the main key side effect of statins? what must pt report about this?

A

muscle toxicity

pt must report signs of muscle pain, tenderness, weakness

32
Q

what is the conception and contraception advice regarding all statins?

A

wear contraception during treatment and for 1 month after

33
Q

are statins safe to use in pregnancy?

A

no - must discontinue 3 months before trying to concieve

34
Q

are statins ok for breastfeeding women?

A

no - avoid

35
Q

what is the pt and carer advice for statins?

A

pt must promptly report unexplained muscle pain, tenderness, weakness

36
Q

what are the monitoring requirements BEFORE starting statins? [6]

A
  • monitor lipid profile
  • liver function
  • creatinine kinase
  • renal function
  • thyroid stimulating hormones
  • if pt is at high risk of diabetes, monitor HBA1C before statin treatment and then at 4 months
37
Q

what should be monitored AFTER statin treatment? [2]

A

after 3 months monitor HBA1C

after 3 months and at 12 months check liver function [LFTs]

38
Q

can statins be used in liver impairment?

A

use with caution in liver impairment

do not use in ACTIVE liver disease

39
Q

can statins be used in renal impairment?

A

do not use when there is elevated creatine kinase as this is a sign of myopathy

40
Q

what are the important interactions with statins? [8]

A
  • carbamazepine - increases risk of hepatoxicity
  • erythromycin/clarithromycin [macrolides] - increase simvastatin exposure
  • fibrates - increase risk of side effects eg rhabdomyolysis
  • gemfibrozil: increases risk of rhabdomyolysis
  • grapefruit juice: increases exposure to simvastatin
  • ketoconazole/miconazole [antifungals]- increase simvastatin exposure
  • amlodipine: increase risk of rhabdomyolysis
  • amiodarone, colchicine, nicotinic acids, fibrates: rhabdomyolysis
41
Q

which statins can be given at any time of the day and why?

A

atorvastatin and rosuvastatin bc they are long acting

42
Q

which statins can only be given at night time and why?

A

simvastatin, fluvastatin, pravastatin bc they are short acting

43
Q

what is the MHRA warning regarding concomitant use of amlodipine and simvastatin?

A

maximum dose of simvastatin should be 20mg when used with amlodipine due to increased risk of rhabdomyolysis

44
Q

what is the MHRA warning of concomitant use of simvastatin with either one of amiodarone, ranolazine, diltiazem or verapamil?

A

maximum dose of simvastatin should be 20mg when given with either of these drugs

45
Q

what is the MHRA warning of concomitant use of simvastatin and bezafibrate or ciprofibrate?

A

simvastatin maximum dose should be 10mg when given with these drugs

46
Q

what is the MHRA warning of concomitant use of clopidogrel and rosuvastatin?

A

maximum dose of rosuvastatin should be 20mg when given with clopidogrel

47
Q

what is the MHRA warning of concomitant use of atorvastatin and ciclosporin?

A

maximum dose of atorvastatin is 10mg

48
Q

what is the MHRA warning regarding simvastatin 80mg?

A

increases risk of rhabomyolysis

49
Q

what is the dose of atorvastatin in:

Primary prevention of cardiovascular events in patients at high risk of a first cardiovascular event

A

20mg ONCE DAILY

50
Q

What is the dose of atorvastatin in…

Secondary prevention of cardiovascular events

A

80mg ONCE DAILY

51
Q

what is the dose of simvastatin in…

Primary hypercholesterolaemia, or combined (mixed) hyperlipidaemia in patients who have not responded adequately to diet and other appropriate measures

A

10-20mg oNCE DAILY

52
Q

what is the dose of simvastatin in …

Homozygous familial hypercholesterolaemia in patients who have not responded adequately to diet and other appropriate measures

A

80mg ONCE DAILY

53
Q

WHAT is the dose of simvastatin in…

Prevention of cardiovascular events in patients with atherosclerotic cardiovascular disease or diabetes mellitus

A

20-40mg ONCE DAILY

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