Cardiovascular- Hyperlipidaemia Flashcards
Who needs primary prevention?
Diabetes, CKD and/or albuminuria, familial hypercholesterolaemia
What increases risk of hyperlipidaemia?
age over 85, especially if smoke or HTN
Who in the risk calculator would benefit from drugs?
Those with 10yr risk >10%
Who is the risk calculator unsuitable for?
patients over 85 and T1DM
The risk calculator assesses CV based on…
Lipid profile, systolic BP, gender, age, ethnicity, smoking status, BMI, CKD, diabetes, AF, HTN, RA, FHx
What is used for primary prevention?
Atorvastatin 20mg
Why might over 85s benefit from atorvastatin?
reduce risk of non-fatal MI
What is used for secondary prevention?
Atorvastatin 80mg
When should you check cholesterol after starting a statin?
3 months
What is the aim in reduction of non-HDL?
reduce by 40%
What is the target non-HDL?
<2.5mmol/L
What should you use in severe hyperlipidaemia not controlled my max dose statin?
Ezetimibe
What should you use if trigylcerides remain high but LDLs low?
Fenofibrate
What should you use for familial hypercholesterolaemia?
High intensity statin (over 40mg simvastatin) Use atorvastatin or rosuvastatin to reduce LDLs by 50%
Name 3 bile acid sequestrants
Colesevelam, Colestipol, Colestyramine
How do bile acid sequestrants work?
Bind bile acids, preventing reabsorption
Promote hepatic conversation of cholesterol into bile acid
Increases liver cell LDL-R activity- increased clearance of LDL cholesterol from plasma
What are the directions for administration of colesevelam?
Other drugs taken at least 4 hours before or after
What are the directions for administration for colestipol and colestyramine?
1 hour before or 4-6 hours after
How does Ezetimibe work?
Inhibits intestinal absorption of cholesterol
What do fibrates do?
Decrease serum triglycerides, variable effects on LDLs
What do you need to monitor with fibrates?
LFTs every 3 months
How do statins work?
competitively inhibit HMG-CoA reductase. (enzyme involved in cholesterol synthesis, especially liver)
How do statins affect muscles?
Muscle toxicity can occur with all statins. Increased dose has increased risk. Should not be used if CK <5x the upper limit
What should you manage before starting statins?
Hypothyroidism
