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PRE-REG-Thuri > CVD- HEART FAILURE + HYPERLIPIDAEMIA > Flashcards

CVD- HEART FAILURE + HYPERLIPIDAEMIA Flashcards

1
Q

What is Heart failure?

A

Clinical syndrome that is characterised by reduced cardiac output.

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2
Q

What is ejection fraction in HF?

A

Less than 40%

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3
Q

What are the 4 symptoms of HF?

A

Dyspnoea

Swollen ankles + legs

Cough - frothy + pink-tinged

Fatigue , low exercise tolerance

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4
Q

What is treatment for HF + fluid overload?

A

Loop OR thiazide diuretic.

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5
Q

When is thiazide diuretics be ineffective in HF?

A

If eGFR is less than 30

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6
Q

What thiazide diuretic is still effective in HF in severe RI?

A

Metolazone

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7
Q

What is 1st line treatment for HF?

A

ACEi + Beta blocker

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8
Q

What to give if ACEi intolerant in HF?

A

Give ARB- candesartan, valsartan or Losartan

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9
Q

What to give if ACEi + ARB intolerant in treating HF?

A

Hydralazine + Nitrate

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10
Q

What BB is recommended for HF treatment?

A

Bisoprolol, Carvedilol

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11
Q

What beta-blocker is given to treat HF patient if they are 70+ with mild-mod HF?

A

Nebivolol

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12
Q

What to give if HF symptoms continue even after 1st line tx?

A

Add aldosterone antagonist.

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13
Q

What to give if HF symptoms continue even after giving aldosterone antangonist?

A

Specialist advice+ consider sacubritril, valsartan, ivabradine, hydralazine + nitrate

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14
Q

What is cardiovascular disease?

A

Condition affecting heart or blood vessels

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15
Q

What are the 4 types of CVD?

A

Coronary artery disease - angina/ Heart attack

Cerebrovascular disease

Peripheral arterial disease

Aortic disease

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16
Q

What are 2 examples of coronary artery disease?

A

Angina

Heart attack

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17
Q

What are 2 examples of cerebrovascular disease?

A

Stroke

transient ischaemic attack

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18
Q

Describe the 3 steps that can cause a blood clot to form?

A
  1. healthy artery
  2. Atherosclerosis - plaque buildup
  3. Thrombosis - blood clot forms + can break, go to heart or brain.
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19
Q

What are 4 unmodifiable risk factors of CVD?

A

Men

50+ years

Family Hx

South asian, afro- Carribbean

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20
Q

What are 9 modifiable risk factors of CVD?

A

HTN
Dyslipidaemia
DM
Obesity
Poor diet
Inactivity
smoking
Excess alcohol
Psychosocial factors- depression

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21
Q

What things make up a cardioprotective diet?

A

Increased fibre,
Fruit + Veg
Oily fish
Less salt- less than 6g
Alcohol <14 units

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22
Q

What amount of exercise is cardioprotective?

A

2.5 hr moderate
1hr 15- high intensity

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23
Q

What 2 things make up the cardiovascular risk assessment?

A

being over 40 years.
estimated 10 year risk > 10%

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24
Q

What is used to calculate CVD risk?

A

QRISK - >10% bad

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25
Q

What are some risk factors of established CVD?

A

85+ years
DM - age 40+
Target organ damage

Chronic kidney disease- eGFR <60, albuminuria.

Familial hypercholesterolemia

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26
Q

What is primary prevention of CVD?

A

low dose of high intensity statin- atorvastatin

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27
Q

What are 3 high intensity statins?

A

atorvastatin
Rosuvastatin
simvastatin

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28
Q

What is order of intensity of statins based on 20mg dose?

A

Rosuvastatin
Atorvastatin
Simvastatin

pravastatin

fluvastatin

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29
Q

What dose of high intensity statin given?

A

atorvastatin 80MG OD.

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30
Q

When is 80mg atorvastatin given?

A

Secondary prevention of CVD

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31
Q

What antiplatelet dose is given for secondary prevention of CVD if atherosclerosis?

A

75mg aspirin Daily

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32
Q

What else is given for secondary prevention of CVD if stroke/TIA + sinus rhythm?

A

Clopidogrel OR dipyridamole + Aspirin

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33
Q

What CCB is safe for HF?

A

Amlodipine

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34
Q

Why should other CCBs (rate limiting and short-acting dihydropyridines) NOT be used in HF treatment?

A

they reduce cardiac contractility

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35
Q

What are 2 examples of short-acting dihydropyridines?

A

Nifedipine
nicardipine

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36
Q

Why are diuretics good in HF?

A

Relief of breathlessness and oedema in patients with fluid retention.

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37
Q

What is the first line diuretic used in HF?

A

Loop diuretic - e.g. furosemide

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38
Q

What is problem with thiazide diuretics in HF patients?

A

Only effective in patients with eGFR > 30 + mild fluid retention.

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39
Q

What other drug is added for worsening/severe HF if patient in sinus rhythm as add-on?

A

Digoxin

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40
Q

What is monitoring req for ACEi/ARB?

A

Start baseline bloods: K+ and Na+, renal function, + BP should be checked.

Monitor bloods 2 weeks after starting + after dose changes

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41
Q

What is MHRA warning (Jan 2023) regarding Metolazone?

A

Caution when switching patients between metolazone preparations - differences in bioavailability + dosing instructions

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42
Q

What is hyperlipidaemia?

A

High blood lipid levels e.g. cholesterol, triglycerides.

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43
Q

What is the total cholesterol target?

A

<5mmol/L

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44
Q

What is the LDL cholesterol target?

A

<3mmol/L

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45
Q

What is the HDL cholesterol target?

A

> 1mmol/L

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46
Q

What is the target non-HDL cholesterol level?

A

<4mmol/L

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47
Q

What is target triglycerides?

A

<2.3mmol/L

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48
Q

What are some lifestyle factors that affect cholesterol?

A

Fatty diet

Smoking

Excess alcohol

Obesity

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49
Q

What 4 conditions can influence hyperlipidaemia?

A

DM

Kidney/ liver disease

Hypothyroidism

Family Hx

50
Q

What 4 drugs can cause high cholesterol?

A

Antipsychotics

Immunosuppressants

Corticosteroids

HIV

51
Q

What is 1st line tx for high cholesterol?

A

Statins

52
Q

What drug is used in severe hyperlipidaemia?

A

Statin + add Exetimibe

53
Q

What drug to add if triglycerides are still high?

A

Fenofibrate

54
Q

What drug to give in familial hyperlipidaemia?

A

High intensity statin OR

ezetimibe

55
Q

List 5 lipid- lowering drugs?

A

1.Statins

2.Ezetimibe - alternative

  1. fibrate
  2. bile acide sequestrant
  3. nicotinic acid group
56
Q

List 5 statins

A

Atorvastatin

Fluvastatin

Pravastatin

Rosuvastatin

Simvastatin

57
Q

What is the most intense statin?

A

Atorvastatin

58
Q

What is the least intense statin?

A

Fluvastatin

59
Q

List 4 fibrates?

A

Bezafibrate

Ciprofibrate

Fenofibrate

Gemfibrozil

60
Q

List 3 bile acid sequestrant?

A

Colesevelam

Colestipol

Colestyramine

61
Q

What lipid lowering drug class interferes with absorption of fat-soluble vits?

A

Bile acid sequestrants

62
Q

What are fat-soluble vitamins

A

vit A, D, E, K

63
Q

What counselling advice to give patients who take vits and bile acid sequestrants?

A

Take vitamins 1 hr BEFORE or 4 hrs after

64
Q

How long should vitamins be taken before coleveselam?

A

4 hours before

65
Q

List 2 drugs in nicotinic acid group?

A

Acipimox

Nicotinic acid

66
Q

What other drugs help reduce cholesterol?

A

Omega 3 fatty acids

Lomitapide

Evolocumab

Alirocumab

67
Q

What is moa of Statin?

A

Competitively blocks the HMG-CoA reductase involved in cholesterol synthesis in liver.

Most effective in lowering LDL.

68
Q

What is the indication of statin?

A

Hyperlipidaemia - CVD prevention

69
Q

What 2 statins are usually taken at night?

A

Simvastatin

Fluvastatin

70
Q

What is MHRA advice/warning for statins?

A

Risk of myopathy + myasthenia gravis

71
Q

What dose of statin is used for secondary CVD prevention?

A

80mg

72
Q

What is 1 common SE of Statin?

A

Myalgia - muscle pain

73
Q

What are 3 more uncommon SE of statin?

A

Myopathy

Myositis

rhabdomyoloysis

74
Q

What is counselling given to pt regarding statin SE?

A

report muscle pain, weakness or tenderness.

75
Q

What is monitored in statins?

A

LFT + lipids @ 3 months and 12 months

Creatine kinase - if 5x upper limit - do NOT give.

76
Q

What are 4 cautions to consider when a patient uses statin?

A

Family hx of muscle disorder/toxicity.

High alcohol intake

Renal impairment

Hypothyroidism

77
Q

What are 3 Rare SE of statins?

A

Interstitial lung disease

DM

Hepatotoxicity

78
Q

What counselling to give to prevent lung disease from statin?

A

Report cough, dyspnoea , weight loss

79
Q

What is monitored for patients on statin with DM?

A

Fasting glucose/Hb1ac done pre tx and 3 months in

still continue it.

80
Q

What is monitored to prevent statin hepatotoxicity?

A

LFT- stop if 3x ULN

81
Q

What is myopathy?

A

Diseases of muscles

82
Q

What is myositis?

A

Muscle inflammationq

83
Q

What is rhabdomyolysis?

A

life- threatening condition where damaged muscle releases proteins into blood.

This damages kidney + heart.

84
Q

What to monitor in uncontrolled DM?

A

HBA1C , fasting blood glucose

85
Q

What to do if patient has hypothyroidism?

A

Hypothyroidism should be managed adequately BEFORE starting treatment with a statin.

86
Q

Monitoring requirement in statins if patient has hypothyroidism?

A

TSH

87
Q

Can statins be used in pregnancy?

A

Teratogenic -NO

88
Q

After stopping statins, how long to continue contraception?

A

Continue 1 month after stopping statin

89
Q

What to do if planning to conceive and taking statins?

A

Discontinue statin 3 months before attempting to conceive

90
Q

What is max statin dose?

A

80mg OD

91
Q

What dose adjustment if taking statin with ciclosporin?

A

If need to use both together,
max statin dose CANNOT exceed 10 mg daily.

92
Q

What dose adjustment if taking statin with elbasvir with grazoprevir?

A

max 20mg daily of statin

93
Q

What is MHRA advice regarding statins?

A

infrequent reports of myasthenia gravis

94
Q

What is myasthenia gravis?

A

rare condition causing weak muscles

95
Q

What steps should pharmacist do if a patient gets myasthenia gravis from statin use?

A

Refer patient with symptoms to neurologist.

96
Q

What counselling to give to pt with myasthenia gravis?

A

Continue taking their statin unless they are advised to stop.

If swallowing issues, breathless - seek immediate help

Inform GP if muscle weakness in arms/ legs worsening after activity, double vision, droopy eyelids

97
Q

What drug class increases statin toxicity?

A

Macrolide abx - Clarithromycin + erythromycin

98
Q

What counselling to give patient on statin if they starting antibiotics?

A

Stop statin until abx course completed

99
Q

What drink item cannot be given with statins?

A

Grapefruit juice- increases toxicity.

100
Q

What 3 drug classes increase statin toxicity?

A

Amiodarone

Fungals - fluconazole

CCB (e.g. verapamil)

101
Q

What drug class increases rhabdomyolysis with statin use?

A

Fibrates

102
Q

What fibrate drug rhabdomyolysis with statin use?

A

AVOID gemfibrozil

103
Q

What antibiotics increase hepatotoxicity with statins?

A

Flucozacillin + tetracyclines

104
Q

What 4 drug classes increase hepatotoxicity with statins?

A

MTX, isoniazid, sulfasalazine, carbamazepine, valproate.

105
Q

Should statins be stopped if pt has diabetes?

A

NO- statin has more benefits than risk

106
Q

What dose of simvastatin is given if patient also takes amiodarone, amlodipine, diltiazem and verapamil? (VADAR)

A

20mg

107
Q

What is the dose adjustment of rosuvastatin when taking with clopidogrel?

A

5mg initially, max 20mg

108
Q

What is the dose adjustment of rosuvastatin when taking with bezafibrate, ciprofibrate, fenofibrate?

A

5mg

109
Q

Interaction between statin and gemfibrozil

A

Rhabdomyolysis

110
Q

List 3 loop diuretics?

A

Furosemide

bumetanide

torasemide

111
Q

List 3 BB licensed for HF?

A

Bisoprolol

carvedilol

nebivolol

112
Q

List 3 Thiazide like diuretics?

A

metolazone, indapamide, and chlorthalidone

113
Q

What condition is ACEI contra-indicated in?

A

Angiodema

114
Q

Patients on ACEI, starting sacubritirl , what should we do?

A

Stop ACEI 36 hours before for washout period

115
Q

What is ramipril dose if CrCL 30-60ml/min?

A

Max. daily dose 5 mg if creatinine clearance 30–60 mL/minute

116
Q

What ramipril dose if CrCL less than 30 mL/min?

A

Max. initial dose 1.25 mg OD (do not exceed 5 mg daily)

117
Q

What is simvastatin max dose if given with amlodipine, amiodarone, ranolazine?

A

20mg

118
Q

What is max simvastatin dose with bezafibrate or ciprofibrate?

A

10mg daily

119
Q

Interaction between statin + oral fusidic acid?

A

Rhabdomyolosis- AVOID

120
Q

Rosuvastatin must be taken in caution with what ethnicity —?

A

Asian

121
Q

If creatine kinase more than 5 times for statin what to do?

A

Repeat after 7 days

If the repeat concentration remains above 5 times the ULN, statin treatment should not be started.

PRE-REG-Thuri (44 decks)

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