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Cardiovascular Treatment Flashcards

(106 cards)

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1
Q

What are some modifiable risk factors of CVD

A

Smoking
Diet
Exercise
Weight
Alcohol

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2
Q

Non modifiable risks of CVD

A

Age
Ethnicity
Genetics
Males

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3
Q

Who gets statins regardless of their QRISK score

A

High risk patients

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4
Q

Whats the QRISK tool

A

A tool used to assess 10 year CVD risk. If they get 10% or more theyre at risk hence need primary prevention (20mg atorvastatin)

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5
Q

Primary prevention of CVD includes

A

20mg atorvastatin and lifestyle changes

Anti hypertensives if bp >140/80

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6
Q

What ages are at higher risk of CVD

A

50+yrs

85+yrs are at higher risk

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7
Q

What comorbidities of CVD are modifiable

A

Depression/anxiety
Abnormal lipids
Hypertension
T2DM
Social isolation

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8
Q

Whats the definition of cardiovascular disease

A

Group of disorders of the heart caused by atherosclerosis and thrombosis

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9
Q

Cardiovascular diseases include

A

MI
stroke
Angina

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10
Q

QRISK2 estimates….

A

10 year CVD risk

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11
Q

Qrisk 3 estimates

A

10 year CVD risk

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12
Q

JBS3 estimates

A

The lifetime risk of CVD events and 10 year

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13
Q

ASSIGN estimates

A

10 year risk of CVD

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14
Q

Which CVD risk tool is used in scotland

A

ASSIGN

The rest are used in england and wales

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15
Q

Who are the high risk patients of CVD who require statins regardless of the risk assessments

A

T1DM
established CVD
CKD
familial hypercholesterolaemia
80 yrs or over especially if they smoke or have hypertension
10% or more 10 yr CVD risk

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16
Q

Which drugs are used in primary prevention of CVD

A

Lipid regulating drugs

Antihypertensives (only high risk patients with BP >140/90mmHg)

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17
Q

Are antiplatelets used in primary prevention of CVD

A

No

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18
Q

Whens antihypertensives given in CVD primary prevention

A

If theyre high risk with a BP of >140/90mmHg

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19
Q

What drugs are used in CVD secondary prevention

A

Lipid regulating drugs such as high dose (atorvastatin 80mg)
Antihypertensives (bp >140/90mmHg)
Antiplatelets

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20
Q

A patient requires primary prevention as they achieved 14% on the QRISK tool. They also have anxiety and depression. What primary prevention would you give?

A

Lifestyle measures
If ineffective give a low dose statin

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21
Q

A patient requires primary prevention as they achieved 11% on the QRISK tool. They also have a history of familial hypercholestraemia. And they present with a blood pressure of 164/93mmHg. What primary prevention would you give?

A

Atorvastatin 20mg or ezetimibe
Antihypertensive because theyre high risk and have BP >140/90mmHg

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22
Q

In primary prevention what would be the first line?

A

Lifestyle if theyre not high risk

If ineffective give a low dose statin

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23
Q

In primary prevention we aim to reduce non HDL cholesterol by……

A

> 40%

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24
Q

What is hyperlipidaemia?

A

High cholesterol, triglycerides or both

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25
What are the main causes of hyperlipidaemia?
Hypothyroidism Drugs — antipsychotics especially 1st gen, immunosuppressants, antiretrovirals and corticosteroids) Liver/ kidney disease Family history Diabetes Lifestyle- smoking, obesity
26
Which drugs can cause hyperlipidaemia
Antipsychotics especially 1st gen Antiretrovirals Corticosteroids Immunosuppressants
27
How do thyroid levels affect cholesterol
Low thyroid levels (hypothyroidism) causes high cholesterol levels
28
Patients at high risk of developing hyperlipidaemia include….
T1DM, T2DM if their CVD risk is 10% or more CKD family history Age CVD risk 10% or more
29
Which patients do you give statins regardless of serum cholesterol levels
Patients at high risk - T1DM, T2DM if their CVD risk >10% - CKD - family history - over 80 - CVD risk 10% or more
30
If you cant use statins in primary prevention of CVD, what is the second line?
First line is a low dose statin 2nd line is ezetimibe
31
What is a high intensity statin?
A statin which reduces LDL/ bad cholesterol by more than 40%
32
What are examples of high intensity statins?
Atorvastatin Rosuvastatin Simvastatin
33
For primary prevention of CVD what statins would you use and why
High intensity (Rosuvastatin, atorvastatin, simvastatin) or ezetimibe Because they reduce LDLs by more than 40%
34
Why are statins beneficial in 85yrs ans over in CVD disease risk
They reduce risk of non fatal MI
35
Can we use fibrates in primary and secondary prevention of CVD
No
36
What lowering lipid drugs cant we use in primary and secondary prevention of CVD Give examples
Fibrates Clofibrate Fenofibrate Gemfribrozil
37
What lowering lipid drugs aren’t recommended in primary and secondary prevention of CVD
Nicotinic acid, bile acid sequestrants and omega 3 fatty acid compounds
38
Healthy Range for HDL
>1
39
Range for triglycerides
< 1.8
40
LDL range in high risk patients
2 or less
41
LDL range in a healthy adult
3 or lower
42
TC range in high risk adults
4 or less
43
TC range in healthy adults
5 or less
44
Hyperlipidaemia diagnosis lipid range
6 or more
45
Hypercholesterolaemia drug of choice Why
Statins to reduce LDL by 50% or more
46
Hypercholesterolaemia first line, 2nd line and 3rd line
1. Statins 2. + Ezetimibe 3. Refer to specialist for nicotinic acid, bile acid or a fibrate
47
If triglyceride levels are high (>1.8mmol) what can be added to a statin and why
Fenofibrate Because theyre effective at lowering triglycerides than statins
48
Whats used to lower triglycerides and LDL cholesterol
Nicotinic acid
49
Statins interact with fibrates because
They increase the risk of rhabdomyolysis
50
Whats rhabdomyolysis
Muscle wastage
51
Statin monitoring
Liver function and creatinine kinase
52
How frequently would you monitor liver function in statin use
liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity
53
How frequently would you monitor creatinine kinase in statin use
Before treatment and in patients who have had persistent, generalised, unexplained muscle pain
54
When would you discontinue statins when monitoring liver function
If they have more than 3x the upper limit of the reference range
55
Measure hbA1c in those at high risk of diabetes who are using statins, how frequently
Before and after 3 months
56
Statin is contraindicated with ____ because of increased risk of rhabdomyolysis
Gemfibrozil
57
Which fibrate is contraindicated with statins
Gemfibrozil
58
Statins MOA
Inhibit HMG CoA reductase An enzyme involved in cholesterol synthesis in the liver
59
Can statins be given in pregnancy
No
60
Can statins be given in breastfeeding
Avoid
61
How prior would you stop statins before pregnancy
Stop statins 3 months before trying to conceive
62
Statins patient and carer advice, look out for_____
Rhabdomyolysis—> unexplained muscle pain, tenderness or weakness
63
Can statins be used in hepatic impairment
Use with caution But avoid in active liver disease or when there are unexplained persistent elevations in serum transminases (3x the upper limit)
64
Can statins be used in renal impairment
Discontinue if elevated creatinine kinase because of sign of myopathy
65
A patient is on simvastatin, he went in for his monitoring at 3 months and his creatinine kinase was elevated. What would you do and why?
Discontinue statins because its a sign of myopathy
66
Whats myopathy
Muscle weakness
67
Do the SE of statins increase with dose increase
Yes
68
Whats a common side effect of statins
Muscle toxicity
69
Which statins can you give anytime of the day and why
Atorvastatin and Rosuvastatin due to their long half life
70
Which statins do you need to give at night
Simvastatin Pravastatin Fluvastatin
71
Atorvastatin 80mg OD dose for
Secondary prevention if CVD
72
Simvastatin 80mg MHRA warning
Causes rhabdomyolysis
73
Whats the max strength of simvastatin with amlodipine Why
20mg simvastatin Because amlodipine increases statin exposure
74
Whats the max strength of atorvastatin with ciclosporin
10mg atorvastatin
75
Whats the max strength of Rosuvastatin with clopidogrel
20mg Rosuvastatin
76
Maximum strength of simvastatin with a fibrate
Simvastatin 10mg
77
Max strength of simvastatin with amlodipine
Simvastatin 20mg
78
Max strength of simvastatin with Amiodarone
20mg
79
Max strength of simvastatin with diltiazem
20mg
80
Max strength of simvastatin with verapamil
20mg
81
A patient presents to you with muscle pain and cramps in their legs, their on statins, what do you do?
Check creatinine kinase levels If 5x above upper limit repeat in 7 days Withhold statin until less than 5x the upper limit of the normal range then start at a lower dose
82
A patient on a statin needs their LFTs monitored how frequently
Before 3Months 12 months
83
Whats monitored before starting statins
LFTs U&Es Creatinine kinase HbA1c or fasting blood glucose Hypothyroidism Renal function
84
Whats monitored after starting statins
LFTs at 3 months and 12 months HbA1c in those at high risk of diabetes at 3 months
85
Important statin interactions
Nicotinic acid, fibrates, Amiodarone, colchicine Carbamazepine Clarithromycin/ erythromycin Grapefruit juice Ketoconazole/ miconazole Amlodipine
86
Statins and amlodipine interaction
Increases exposure of statin and increased risk of rhabdomyolysis
87
Statin interaction with ketoconazole/ miconazole
Increased exposure to statins
88
Grapefruit interaction with statins
Increases exposure to statin
89
Clarithromycin/ erythromycin snd statin interaction
Increases exposure to statin
90
Carbamazepine and statin interaction
Increased risk if Hepatotoxicity
91
Amiodarone interaction with statin
Increased risk of rhabdomyolysis
92
Colchicine interaction with statin
Increased risk of rhabdomyolysis
93
Nicotinic acid and statin interaction
Increased risk of rhabdomyolysis
94
Fibrates and statin interaction
Increased risk of rhabdomyolysis statins CI with Gemfibrozil
95
Max strength of simvastatin with Ronalazine
20mg
96
Simvastatin at high intensity strength is
80mg
97
Simvastatin strength at medium intensity is
40, 20mg
98
Simvastatin strength at low intensity
10mg
99
Simvastatin 20mg is what intensity
Medium
100
Atorvastatin high intensity strengths
20,40,80mg
101
Atorvastatin medium intensity strengths
10mg
102
Fluvastatin medium intensity strength
80mg
103
Fluvastatin low intensity strength
20,40mg
104
Pravastatin low intensity strengths
10,20,40mg
105
Rosuvastatin high intensity strengths
10,20,40mg
106
Rosuvastatin medium intensity strength
5mg

Cardiovascular (9 decks)

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