HTN + Hyperlipidaemia

Question 1

what is the 1st line in T2DM (caucasian, all ages)?

Answer 1

ACEi

Question 2

what’s the 1st line in T2DM in Affro-Carribean (all ages)?

Answer 2

ARB

Question 3

what are the options in stage 4 of the HTN pathway?

Answer 3

if potassium <4.5mmol/l = low dose spiro
if potassium >4.5mmol/l = alpha blocker or beta blocker

Question 4

what are the side effects of ACEi? CHHAReD

Answer 4

Cough - give ARB
Hyperkalaemia
Hepatic failure
Angioedma
Renal impairment
Dizziness and headaches

Question 5

do ARBS have the same side effects as ACEi?

Answer 5

yes except no cough or angioedema

Question 6

what 4 types in interactions do you need to look out for with ACEi?

Answer 6

1. increased risk of renal failure (avoid other nephrotoxic drugs, ARBs, K+ sparing diuretics, NSAIDs)
2. increase hyperkalameia (avoid other drugs ‘tequila always makes nurses smile’
3. increase risk of volume depletion - consider diuretics
4. increase plasma of lithium

Question 7

name the carioselective beta blockers. What’s the benefit of these? BAtMAN

Answer 7

Bisoprolol
Atenolol
Metoprolol
Acebutolol
Nebivolol

less likely to cause bronchospasam as selective to the receptors in the heart - give to asthmatics

Question 8

name the water soluble beta blockers.
What are the benefits if these? water CANS

Answer 8

Celiprolol
Atenolol
Nadolol
Sotalol

less likely to cross BBB = less nightmares

Question 9

name the intrinsic sympathomimetic beta blockers. What are the benefits of these? Ice PACO

Answer 9

Pindolol
Acebutolol
Celiprolol
Oxprenolol

less likely to cause cold extremeties

Question 10

what are the side effects beta blockers?

Answer 10

• bradycarida, or heart failure
• blunt the effects of hypoglycaemia
• can cause hyperglycaemia
• bronchospasams (contraindicated in asthmatics)

Question 11

what are the main interactions with beta blockers?

Answer 11

1. digoxin - can cause heart block
2. other hypotensives

Question 12

what are the 2 rate limiting CBB?

Answer 12

diltaizem, verapamil

Question 13

what are the 4 main side efects of CBB?

Answer 13

1. dizziness
2. gingival hyperplasia (enlarged gums)
3. vasodilatory effects (flushing, headaches, ankle swelling)
4. complete atrioventricular block (more in rate limitng)

Question 14

why don’t you give rate liming CBB in QT prolongation?

Answer 14

due to risk of atrioventricular block

Question 15

what would increase someones risk of pre-eclampsia in pregancy?
What is given to reduce the risk?

Answer 15

risk factors = HTN, diabetes, kindey disease, autoimmune disease

give aspirin from week 12 of pregnancy until birth

Question 16

what are the 1st and 2nd line antihypertensives in pregnancy and what is the BP aim?

Answer 16

1st = labetolol
2nd = nifedipine or methyldopa

135/85

Question 17

whats the clinic BP target if someone is less than 80?

Answer 17

140/90

Question 18

whats the clinic and home BP target if someone is over 80?

Answer 18

clininc = 150/90
home = 145/85

Question 19

whats the BP target in renal disease?

Answer 19

140/90

Question 20

whats the BP target in T1DM?

Answer 20

135/85

Question 21

what are the tatgers for good and bad cholesterol?

Answer 21

HDL 1 or above
LDL less than 3

Question 22

what 5 patient groups should lipid lowering medication be given to?

Answer 22

1. under 85yrs with 10-year risk of CVD >10%
2. patients with T2DM with 10yr risk <10%
3. all type 1 diabetics if over 40yrs, had diabetes for 10yrs, have established nephtopathy
4. CKD
5. familial hypercholesterolaemia

Question 23

what statins can be given any time of day?

Answer 23

atorvastatin and rosuvastatin

Question 24

what statins need to be taken at night?

Answer 24

simvastatin, pravastatin, fluvastatin

Question 25

whats the strongest statin avaialble?

Answer 25

atorva 80mg

Question 26

can someone with hypothyroidism immediately start a statin?

Answer 26

hypothyroidism should be managed before starting statin

Question 27

can patients at high risk of diabetes start statin straight away if high cholesterol?

Answer 27

they should have their HbA1c checked before starting statin due to relationship between hyperlipidaemia and diabetes - 1st line would be diet and exercise then repeat HbA1c in 3 months

Question 28

what baseline monitoring is needed for statins?

Answer 28

LFTs thyroid function renal function creatinine kinase

Question 29

when do LFTS need to be monitored?

Answer 29

baseline, 3 months, 12 months

Question 30

when do you stop a statin due to changes in serum transaminases?

Answer 30

if raised by 3x the upper limit

Question 31

is creatinine kinase measured in all patients on statins?

Answer 31

only those with persistent muscle aches

Question 32

what would prevent a patient being started on a statin in relation to creatinine kinase? How do you manage this?

Answer 32

if measurements 5x higher than upper limit don't start, remeasure in 7 days if still higher do not start statin if levels under 5 times upper limit then start at lower dose

Question 33

what are the 3 main SEs of statins?

Answer 33

1. rhabdomyolysis and myopathy 2. interstitial lung disease 3. teratogenic

Question 34

how long should statins be discontinued in someone planning to conceive?

Answer 34

3 months

Question 35

what are the 3 main types of interactions to look out for with statins?

Answer 35

1. CYP450 inducers = reduce the conc of inducers 2. CYP450 inhibitors = increase statin = increased rhabdomyolysis (avoid concurrent use of macrolides and grapefuit juice) 3. fusidic acid (oral) - stop statin and restart 7 days after last dose

Question 36

when is the maximum dose of simvastatin 20mg?

Answer 36

when prescribed alongside amlodipine, amiodarone, rate limiting CBB

Question 37

when is the maximum dose of simvastatin 40mg?

Answer 37

when given with ticagrelor

Question 38

when is the maximum dose of atorvastatin 10mg?

Answer 38

when given with ciclosporin or tipranavir

Question 39

what lipid lowering agent can't be used in patients with renal impairement?

Answer 39

fibrates - due to myotoxicity