(chan) 4. Clinical Therapeutic Flashcards Preview

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What is NHS Health Check Programme?

- Government initiative to reduce cardiovascular disease through early identification of those at risk


Who is the target for NHS Health Check Programme?

- Target 40 - 74 years olds in England every 5 years- Excludes those already with CVD


What are the beneficial outcome estimations of NHS Health Check Programme?

PHE estimates it can- Prevent 1600 MIs annually saving 650 lives- Prevent 4000 cases of diabetes annually- Detect 20,000 cases of diabetes and CKD earlier and therefore reduce later complications


What risk factors are measured in NHS Health Check programme?

- Height- Weight- Blood pressure- Total Cholesterol and High density Cholesterol- Blood Sugar- Lifestyle factors: alcohol, physical activity, smoking- Dementia awareness (65-74 Y/O)


NHS Health Check Programme: What are the GP referral results?

- High Blood Sugar- High Blood Pressure- High TC:HDL (>6mmol/L)- High CV risk (>20%)


What are the different types of hypertension?

1. Primary/Essential- 95% of all cases- Quantitative deviation from the norm2. Secondary - 5% of all cases- Secondary to another cause


Is hypertension usually symptomatic or asymptomatic?

- Asymptomatic except in malignant hypertension


What are the classifications of hypertension?

Stage 1- Clinic BP greater than or equal to 140/90mmHg (ABPM or HBPM >135/85mmHg)Stage 2- Clinic BP greater than or equal to 160/100mmHg (ABPM or HBPM >150/95mmHg)Severe- Clinic systolic BP greater than or equal to 180mmHg or clinic diastolic greater than or equal to 110mmHg


When do you add pharmacological intervention to different classifications of hypertension?

Stage 1 hypertension- Under 80 plus target organ damage +/or established CV disease +/or renal disease +/or CV risk >20%Stage 2 - Of any ageSevere hypertension- Treat immediately


What is blood pressure and what are the targets of BP treatment?

- Blood pressure (BP) = CO x PVRCO = Cardiac OutputPVR = Pulmonary Vascular Resistance- Aim of the treatment is to reduce BP by reducing PVR without reducing CO


Why do we treat patients with diabetes more aggressively when managing BP?

Because people with type 2 diabetes are at high risk of- CVD, Diabetes eye damage, Renal diseaseImproving BP control reduces these adverse outcomes and also lower the risk of- Stroke, MI, Blindness, Renal failure


What are the BP targets in patients with hypertension alone?

Aim for target BP- 140/90mmHg in people aged under 80- 150/90mmHg in people aged 80 or overFor those with 'white coat effect (anxiety experienced during a clinic visit), aim for HBPM- 135/85mmHg in people aged under 80- 145/85mmHg in people aged 80 or over


What are the modifiable/non-modifiable cardiovascular risk factors?

Modifiable- Hypertension- Hyperlipidaemia- Diabetes- Smoking- ObesityNon-modifiable- Age- Gender- Genetics


What are lifestyle changes known to reduce BP?

- Lower risk alcohol intake (<14 units per week)- Reduce weight if obese (target BMI of 20-25)- Reduce salt intake- Regular physical exercise (> 30mins 3 times weekly)- Be realistic about what patient can achieve (SMART goals)


Which lifestyles are there that do not reduce BP but reduce CV risk?

- Stopping smoking- Reducing total intake of saturated fats- Increasing intake of oily fish


What are 1st line anti-hypertensive drug treatment for the following groups?1. General population2. People of African/Caribbean family origin3. Women who may become pregnant

1. General population- generic ACE inhibitor once daily2. People of African/Caribbean family origin- generic ACE inhibitor plus either a diuretic or a generic calcium-channel blocker3. Women who may become pregnant- generic calcium-channel blocker


What do you substitute for patients with ACE inhibitor intolerance?

- Angiotensin II-receptor antagonist


Briefly explain actions induced from ACEi and ARB

- Either prevents formation of or action of Antiotensin II which is a potent vasoconstrictor- Arterial and venous dilation- Increase K+ by reducing aldosterone


What are the side effects of ACEi and ARB?

- Renal Impairment- Hyperkalamia (High Blood Potassium)


What does Calcium Channel Blockers (CCB) do?

Interfere with inward displacement of calcium ions through the channels into cell membranes.Relaxation of vascular smooth muscle causes vasodilatation


What are the 3 types of Calcium Channel Blockers and what do they do?

1. Dihydropyridines- cause vasodilatation of coronary and peripheral blood arteries with little effect on heart rate2. Phenylalkalamines- rate limiting drug that reduces heart rate3. Benzothiazipine- rate limiting drug that reduces heart rate


How does Beta-Blockers work on Heart, Kidneys and CNS&PNS?

- Heart: reduces HR- Kidneys: reduces renin- CNS&PNS: reduces release of neurotransmitters & sympathetic nervous activity


Define Cardiovascular risk

Chance of someone experiencing a heart attack or a stroke at some point in the next 10 years if nothing about their current lifestyle changes


Which drug is used in primary prevention of cardiovasular risk?

Atorvastatin 20mg to people with a 10% or higher QRISK2 level


What are monitoring parameters and targets of cardiovascular risk prevention? So

- Measure liver transaminase enzymes within 3 months of starting treatment and at 12 months - Measure 'total cholesterol, HDL cholesterol and non-HDL cholsterol' in all patients who have been started on high intensity statin treatment at 3 months of treatment and aim for >40% reduction in non-HDL cholesterol


Case Example- A 49 year old lady, Mrs A, no existing medical conditions. - All bloods (renal function) and ECG come back normal- CV Risk calculated to be 13%- BP in clinic = 152/94mmHgWhat would you do for Mrs A?

Send for HBPM (Home Blood Pressure Monitoring)-------------------------------Mrs A continuedHBPM mean = 152/94mmHgThis repesents- Stage 1 hypertension but as CV risk <20% and no target organ damage, focus on lifestyle- Weight loss- Reduced Salt- Reduced Stress- Reduced Caffeine- Increased Exercise- Reduced Saturated Fat- Increased Oily fish- Balanced Diet- Reduced alcohol- Smoker?Follow up- Review BP and lifestyle modifications in 3 months and at 12months- Repeat Lipids screening


Define Acute Coronary Syndome (ACS)

A range of conditions including unstable angina, non-ST elevation MI and ST elevation MI


What is ischaemic event?

Reduced blood flow to the heart, causing pain- reduced blood to muscles when exercising, blood diverted elsewhere, therefore pain experienced


What are the typical symptoms of ACS?

- Chest Pain- Nausea- Sweaty- Clammy- Breathlessness- Palpitation


Which investigations help determine the urgency and type of treatment the patients receive regarding ACS?

- ECG trace- Blood Test (troponin)- Individual assessment of CV risk by using a scoring system