clw 3

Question 1

how to calculate BMI

Answer 1

weight / height^2

Question 2

EF of HFrEF

Answer 2

≤40%

Question 3

what to monitor when on statins

Answer 3

Creatinine kinase, statin associated muscle symptoms

Question 4

when to start fibrates

Answer 4

when TG >5.8

Question 5

if CK >4xULN, can start statin?

Answer 5

no

Question 6

if lft more than 3xULN, stop statin?

Answer 6

yes

Question 7

high risk for future ASCVD events

Answer 7

ACS (within 12m)
MI /stroke
FH
DM
CKD

Question 8

target LDL for ASCVD, DM more than 10 years or DM with complications (neuropathy, retinopathy, microalbuminuria), familial history

Answer 8

1.8

Question 9

DM with no complications or less than 10 years

Answer 9

2.6

Question 10

doubling dose of statin gives reduction of how much

Answer 10

6-7% of LDL

Question 11

main benefit of statin

Answer 11

reduce risk of mortality, especially for those with underlying ascvd

Question 12

statin induced AE

Answer 12

dark urine, lethargy, anorexia, stomach pain, light coloured stools, jaundice

Question 13

monitoring statin: labs?

Answer 13

lipids: 8+-4 weeks when adjusting, else annually
ALT: 8+-4 weeks, routine repeat not recc
CK: not necessary unless got myalgia
hba1c: high dose statin only

Question 14

sglt2i AE

Answer 14

diabetic ketoacidosis, lightheadedness, fournier gangrene (practise good personal hygiene), UTI, increased urination

Question 15

GOT of anemia

Answer 15

correct blood loss
remove drug causes
correct iron/folate/b12 deficiency

Question 16

MOA of ESAs in CKD

Answer 16

Stimulate differentiation of erythroid progenitor stem cells and
induce release of reticulocytes from bone marrow

Question 17

how often to monitor hgb after esa administration

Answer 17

every 1-2 weeks, then 3 months

Question 18

AE of ESA

Answer 18

hypertension, flu-like syndrome, vascular access thrombosis (increases thickness of blood and chances of clotting)

Question 19

common side effects of ESA tx and what to co-administer

Answer 19

iron deficiency due to stimulation of erythropoiesis

iron

Question 20

oral iron administration

Answer 20

best taken without food, but can cause gastric discomfort

take apart from calcium salts, quinolones, H2RA, PPI

ADHERENCE!

Question 21

SE of PO iron intake

Answer 21

constipation, dark stools, NV

try to increase dibre intake to reduce constipation

Question 22

IV iron intake SE

Answer 22

allergy, hypotension, dizziness, dyspnea, headache, lower back pain, arthritis

Question 23

what to monitor in CKD

Answer 23

eGFR, corrected Ca, P, PTH, ALP, Vit D

Question 24

what is in the DASH diet for HTN

Answer 24

Eat this: vegetables, fruits, whole grains, fat-free or low-fat dairy, fish, poultry, beans, nuts and seeds, vegetable oils.

Limit this: fatty meats, full-fat dairy, sugar sweetened beverages, sweets, sodium intake

Question 25

when to stop metformin an why

Answer 25

egfr<30 due to lactic acidosis risk

Question 26

why SU and BB not preferred together

Answer 26

mask sx of hypofly

Question 27

when to start anemia tx and goal of hgb

Answer 27

hgb <10 goal: 10-11

Question 28

how to reduce dose of DM drugs when starting insulin

Answer 28

TZD discon SU discon/reduce by 50% dpp discon if got glp1

Question 29

non pharm MBD

Answer 29

avoid high phosphate foods (800-1000mg a day) such as red meat, choc, dairy

Question 30

if patient is having worsening ckd, why cannot increase dose of statin

Answer 30

may increase risk of rhabdo/SAMS

Question 31

when switching from acei to arni, washout period?

Answer 31

36h

Question 32

why do patients get tachycardia when they have HF?

Answer 32

in response to filling problem, to try and increase the filling hence do not start BB yet until stable

Question 33

if adherence is an issue for night statin doses, what to do

Answer 33

change to morning dosing is fine

Question 34

high intensity statin

Answer 34

ator 40mg

Question 35

why is hypercalcemia dangerous

Answer 35

can lead to high risk of calcification, formation of deposits and cvs mortality

Question 36

when assessing Ca, P, PTH, can you look at the numbers one off?

Answer 36

no, review over time

Question 37

calcium salt se for phosphate binding

Answer 37

hypercalcemia, constipation, loss of appetite, NV

Question 38

phosphate binder administration

Answer 38

- compliance! - take binders with meals/snacks to be effective - space apart from quinolones, antiepileptics, digoxin, warfarin

Question 39

vitamin d deficiency (Serum 25(OH)D) level

Answer 39

<15

Question 40

side effect of vit d drugs

Answer 40

increase GI absorption of Ca and P, causing hypercalcemia, hyperphosphatemia

Question 41

effect of calcimimetics

Answer 41

- increase sensitivity of calcium receptor on PTH gland - inhibit PTH synthesis, secretion - decrease ca and phosphate

Question 42

side effects of calcimimetics

Answer 42

NVD, hypocalcemia