Cardiovascular- Hyperlipidaemia

Question 1

Who needs primary prevention?

Answer 1

Diabetes, CKD and/or albuminuria, familial hypercholesterolaemia

Question 2

What increases risk of hyperlipidaemia?

Answer 2

age over 85, especially if smoke or HTN

Question 3

Who in the risk calculator would benefit from drugs?

Answer 3

Those with 10yr risk >10%

Question 4

Who is the risk calculator unsuitable for?

Answer 4

patients over 85 and T1DM

Question 5

The risk calculator assesses CV based on…

Answer 5

Lipid profile, systolic BP, gender, age, ethnicity, smoking status, BMI, CKD, diabetes, AF, HTN, RA, FHx

Question 6

What is used for primary prevention?

Answer 6

Atorvastatin 20mg

Question 7

Why might over 85s benefit from atorvastatin?

Answer 7

reduce risk of non-fatal MI

Question 8

What is used for secondary prevention?

Answer 8

Atorvastatin 80mg

Question 9

When should you check cholesterol after starting a statin?

Answer 9

3 months

Question 10

What is the aim in reduction of non-HDL?

Answer 10

reduce by 40%

Question 11

What is the target non-HDL?

Answer 11

<2.5mmol/L

Question 12

What should you use in severe hyperlipidaemia not controlled my max dose statin?

Answer 12

Ezetimibe

Question 13

What should you use if trigylcerides remain high but LDLs low?

Answer 13

Fenofibrate

Question 14

What should you use for familial hypercholesterolaemia?

Answer 14

High intensity statin (over 40mg simvastatin) Use atorvastatin or rosuvastatin to reduce LDLs by 50%

Question 15

Name 3 bile acid sequestrants

Answer 15

Colesevelam, Colestipol, Colestyramine

Question 16

How do bile acid sequestrants work?

Answer 16

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

Question 17

What are the directions for administration of colesevelam?

Answer 17

Other drugs taken at least 4 hours before or after

Question 18

What are the directions for administration for colestipol and colestyramine?

Answer 18

1 hour before or 4-6 hours after

Question 19

How does Ezetimibe work?

Answer 19

Inhibits intestinal absorption of cholesterol

Question 20

What do fibrates do?

Answer 20

Decrease serum triglycerides, variable effects on LDLs

Question 21

What do you need to monitor with fibrates?

Answer 21

LFTs every 3 months

Question 22

How do statins work?

Answer 22

competitively inhibit HMG-CoA reductase. (enzyme involved in cholesterol synthesis, especially liver)

Question 23

How do statins affect muscles?

Answer 23

Muscle toxicity can occur with all statins. Increased dose has increased risk. Should not be used if CK <5x the upper limit

Question 24

What should you manage before starting statins?

Answer 24

Hypothyroidism

Question 25

What drugs interact with statins?

Answer 25

macrolides, imidazole and triazole antifungals, ciclosporin

Question 26

What should you monitor with statins if muscle pain?

Answer 26

LFTs and CK

Question 27

What should you monitor with statins?

Answer 27

Before starting treatment a full lipid profile, TSH, RF,LFTs and at 3 months and 12 months
Diabetes: HbA1c before and after 3 months

Question 28

When should you have a max of 20mg simvastatin

Answer 28

amiodarone, verapamil, dilitazem, amlodipine, ranolazine

Question 29

When should you have a max of 10mg simvastatin?

Answer 29

with bezafibrate