p.8
Primary and Secondary Prevention of CVD
Is aspirin recommended for primary prevention of cardiovascular disease (CVD)?
No, aspirin is not recommended.
p.7
Cardiovascular Disease Risk Factors
Which demographic groups are at greater risk for CVD?
Men, individuals with a family history of CVD, South Asians, and those over 50 years old.
p.7
Statin Use and Considerations
What is the threshold for prescribing statins for primary prevention?
A 10-year CVD risk greater than 10%.
p.5
Warfarin and Anticoagulants
What is the mechanism of action for Apixaban and Rivaroxaban?
Direct inhibitor of activated factor Xa.
p.9
Primary and Secondary Prevention of CVD
What should be done for patients intolerant to statins or ezetimibe?
Refer for bile acid sequestrant, nicotinic acid, or a fibrate.
p.2
Management of Intracerebral Haemorrhage
What is the initial management for intracerebral haemorrhage?
Treat hypertension and avoid all medications.
p.8
Hyperlipidaemia and Treatment Options
What are some causes of hyperlipidaemia?
Liver/kidney disease, family history of high cholesterol, hypothyroidism, lifestyle factors, and certain drugs.
p.3
Warfarin and Anticoagulants
What is the action to take for minor bleeding with an INR > 8?
Stop Warfarin and administer Vitamin K via slow IV injection.
p.2
Warfarin and Anticoagulants
What dietary changes should be avoided while on Warfarin?
Changes in intake of liver, sprouts, broccoli, green tea, salads, and leafy green vegetables.
p.4
Warfarin and Anticoagulants
What should be done regarding antiplatelet therapy and Warfarin therapy?
Withhold antiplatelet therapy until Warfarin therapy is complete and vice versa.
p.4
Warfarin and Anticoagulants
What is the mechanism of action of antiplatelets?
Decrease platelet aggregation and inhibit thrombus formation in arterial circulation.
p.7
Cardiovascular Disease Risk Factors
What are some modifiable risk factors for CVD?
Hypertension, abnormal lipids, obesity, diabetes mellitus, depression, low physical activity, poor diet, smoking, and excess alcohol.
p.5
Warfarin and Anticoagulants
What is the antidote for Warfarin?
Vitamin K [Phytomenadione].
p.7
Long Term Management of Stroke
What is the aim of treatment for CVD?
To prevent the occurrence of a CVD event by reducing modifiable risk factors through lifestyle changes and drug management.
p.9
Statin Use and Considerations
What is the mechanism of action of statins?
Statins inhibit HMG CoA reductase in the liver.
p.5
Warfarin and Anticoagulants
What are the criteria for reducing the dose of Apixaban?
Age > 80 years, body weight < 60 kg, serum creatinine > 133 micromol/L.
p.4
Warfarin and Anticoagulants
What is the role of Aspirin in cardiovascular disease?
Secondary prevention of established CVD.
p.5
Warfarin and Anticoagulants
What is the antidote for Apixaban and Rivaroxaban?
Andexanet alfa [Ondexxya].
p.3
Warfarin and Anticoagulants
How should Warfarin be adjusted for elderly patients?
They should receive a lower induction dose.
p.2
Warfarin and Anticoagulants
What should be avoided with Warfarin due to increased INR?
Cranberry juice and pomegranate juice.
p.3
Warfarin and Anticoagulants
What effect do enzyme inhibitors have on Warfarin?
They increase Warfarin concentration and INR.
p.1
Long Term Management of Stroke
What should be monitored in long-term management of stroke?
Blood pressure, targeting <130/80 mmHg.
p.4
Warfarin and Anticoagulants
What is a key characteristic of Heparin?
Rapid but short anticoagulation.
p.4
Warfarin and Anticoagulants
What is the indication for Dipyridamole?
Prophylaxis of thromboembolism associated with prosthetic heart valves.
p.8
Hyperlipidaemia and Treatment Options
What is the recommended lipid-lowering drug for patients with a 10-year CVD risk greater than 10%?
Atorvastatin at a low dose.
p.3
Warfarin and Anticoagulants
What should be done in case of major bleeding while on Warfarin?
Stop Warfarin and administer Vitamin K via slow IV injection and/or dried prothrombin complex/fresh frozen plasma.
p.1
Initial Management of TIA and Ischaemic Stroke
What is the initial management for TIA?
Immediately give Aspirin 300mg + PPI and arrange assessment by a specialist stroke physician.
p.6
Warfarin and Anticoagulants
What is the initial dose of Dabigatran for adults aged 18-74 after knee replacement?
110 mg for 1 – 4 hours after surgery, then 220 mg OD for 10 days.
p.5
Warfarin and Anticoagulants
What is the mechanism of action for Warfarin?
Inhibits Vitamin K, decreasing clotting factors 2, 7, 9, and 10.
p.9
Statin Use and Considerations
When should statins be discontinued in renal impairment?
If elevated creatinine kinase indicates signs of myopathy.
p.4
Warfarin and Anticoagulants
What is the indication for Clopidogrel?
Prevention of atherothrombotic events such as Ischaemic stroke and ACS.
p.8
Primary and Secondary Prevention of CVD
What blood pressure level indicates the need for antihypertensives in high-risk patients?
Blood pressure greater than 140/90 mmHg.
p.8
Primary and Secondary Prevention of CVD
Which medications are used for secondary prevention of CVD to prevent strokes?
Low dose aspirin, clopidogrel, and dipyridamole.
p.8
Hyperlipidaemia and Treatment Options
What is the diagnosis threshold for hyperlipidaemia?
Cholesterol level greater than or equal to 6 mmol/L.
p.9
Statin Use and Considerations
What is the recommendation for statin use in patients with hepatic impairment?
Caution in liver disease; avoid in active liver disease or unexplained persistent elevations in serum transaminases.
p.6
Warfarin and Anticoagulants
What is the maintenance dose of Warfarin?
3 – 9 mg at the same time each day.
p.3
Warfarin and Anticoagulants
What effect do enzyme inducers have on Warfarin?
They reduce Warfarin concentration and INR.
p.5
Warfarin and Anticoagulants
What is the adult dose of Apixaban for stroke prophylaxis?
5 mg BD, reduced to 2.5 mg BD for certain patients.
p.8
Hyperlipidaemia and Treatment Options
What is the target reduction in non-HDL cholesterol for patients on atorvastatin?
A reduction greater than 40%.
p.7
CVD Risk Assessment Tools
What is the purpose of risk calculators in CVD?
To predict the likelihood of a CVD event occurring and determine whether a statin should be given for primary prevention.
What are the three types of strokes?
1. Haemorrhagic Stroke 2. Ischaemic Stroke 3. Transient Ischaemic Attack (TIA)
p.6
Warfarin and Anticoagulants
What is the prophylactic dose of Apixaban for hip replacement?
2.5 mg BD for 28 – 32 days.
p.2
Warfarin and Anticoagulants
What is the risk associated with Warfarin during pregnancy?
Teratogenic effects and increased risk of hemorrhage.
p.9
Statin Use and Considerations
What advice should be given to patients regarding muscle symptoms while on statins?
Report ASAP for unexplained muscle pain, tenderness, or weakness.
p.7
Cardiovascular Disease Risk Factors
What are some disorders included in CVD?
Atherosclerosis, thrombosis, CHD (angina & MI), stroke, peripheral arterial disease, and aortic disease.
p.5
Warfarin and Anticoagulants
What is the mechanism of action for Edoxaban?
Direct and reversible inhibitor of activated factor Xa.
p.9
Statin Use and Considerations
What should be done regarding statin use in pregnancy?
Avoid statins and discontinue 3 months before attempting to conceive.
p.1
Long Term Management of Stroke
What is the recommended statin for stroke patients?
High Intensity statin, e.g., Atorvastatin (20 – 80 mg) 48 hours after stroke.
p.3
Warfarin and Anticoagulants
What are some indications for Warfarin use?
Prophylaxis of embolization in rheumatic heart disease and AF, prophylaxis after insertion of prosthetic heart valve, prophylaxis and treatment of VTE, PE, TIAs.
p.2
Warfarin and Anticoagulants
What are the colors of Warfarin tablets and their corresponding dosages?
0.5mg - white, 1mg - brown, 3mg - blue, 5mg - pink.
p.7
CVD Risk Assessment Tools
What additional risk factors does QRISK3 consider?
CKD stage 3+, migraine, corticosteroid use, SLE, atypical antipsychotic use, severe mental illness, erectile dysfunction, and systolic BP variability.
p.1
Initial Management of TIA and Ischaemic Stroke
What is the duration for administering Alteplase in Ischaemic Stroke?
Within 4.5 hours for 24 hours.
p.4
Warfarin and Anticoagulants
Why is Heparin suitable for patients at high bleeding risk?
Its effects can be stopped rapidly by stopping the infusion.
p.9
Primary and Secondary Prevention of CVD
What are the first-line treatments for Familial Hypercholesterolaemia?
High-intensity statins (Atorvastatin/Rosuvastatin) for > 50% LDL reduction.
p.1
Initial Management of TIA and Ischaemic Stroke
What should be given if a patient is intolerant to Aspirin?
Clopidogrel 75mg OD (unlicensed).
p.5
Warfarin and Anticoagulants
What is the mechanism of action for Dabigatran?
Direct thrombin inhibitor with a rapid onset of action.
p.4
Warfarin and Anticoagulants
What are examples of LMWH?
Dalteparin, Enoxaparin, Tinzaparin.
p.1
Long Term Management of Stroke
What lifestyle changes should be advised to stroke patients?
Modify diet, exercise, weight, and reduce alcohol/smoking.
p.4
Warfarin and Anticoagulants
What is a significant advantage of LMWH over Heparin?
Lower risk of HIT and no monitoring required.
What does the acronym F.A.S.T stand for in recognizing signs of stroke?
F (Face Drop), A (Arm Weakness), S (Speech Slurred), T (Time to Dial 999).
p.4
Warfarin and Anticoagulants
What should be given with Aspirin to reduce high bleeding risk?
Proton Pump Inhibitor (PPI).
