Chapter 2 BNF (Hyperlipidaemia) Flashcards

1
Q

What patients should be offered primary prevention of CVD?

A
Type 1 Diabetes 
Type 2 (with 10 year CVD risk above 10%)
Chronic kidney disease or albuminuria 
Familial hypercholesterolaemia
85 years or above
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2
Q

What patients should be offered secondary prevention of CVD?

A
Coronary Heart Disease (Angina MI)
Cerebrovascular disease (Stroke/ TIA)

Peripheral Arterial Disease

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3
Q

What is QRISK2?

A

Assesses risk in 84 years and below

gives 10 year CVD risk score

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4
Q

Which patients are unsuitable for QRISK2 because risk will be undermined?

A
Type 1 diabetes 
established heart disease
over 85
chronic kidney disease (eGFR below 60)
Familial hypercholesterolaemia
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5
Q

What are the targets for cholesterol?

A

Total choleresterol <5mmol/L in healthy adults
Total cholesterol in high risk <4mmol

LDL in healthy <3mmol/L
LDL in high risk <2mmol/L

HDL >1mmol/L
Trigylcerides <1.7mmol/L

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6
Q

Which drugs cause hyperlipidaemia?

A

Antipsychotics
Immunosuppressants
Steroids
Antiretrovirals

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7
Q

What conditions cause hyperlipidaemia?

A

HypOthyroidism
liver and kidney disease
diabetes
family history

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8
Q

Atorvastatin doses?

A

20mg for primary prevention

80mg for secondary

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9
Q

Which statins are high intensity?

A

Atorvastatin 20mg and above

Rosuvastatin 10mg and above

Simvastatin 80mg (myopathy MHRA)

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10
Q

Whats the treatment for primary and familial hypercholesterolaemia?

A

High intensity statin

if contraindicated/not tolerated

Ezetimibe

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11
Q

Whats the treatment for moderate hypertrigylceridaemia?

A

Statin

not tolerated

Fibrate

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12
Q

Statins side effects?

A

Myopathy, Myositis, Rhabdomyolysis

Lung Disease

raise HbA1c levels

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13
Q

Statins monitoring

A

Baseline lipid profile
renal function
thyroid function
hbA1c if at risk of diabetes

discontinue if creatinine if 5x baseline
discontinue if liver transaminases 5x baseline

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14
Q

Which drugs increase statin level and increase myopathy risk?

A
Amiodarone 
Grapefruit 
CCB
Imidazole 
triazole 
ciclosporin
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15
Q

How long after fusidic acid should statins be restarted?

A

7 days

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16
Q

Which statin fibrate combination should be avoided?

A

statin and Gemfibrozil

17
Q

Simvastatin dose adjustments due to interactions?

A

10mg with fibrate

20mg with Diltiazem, Amlodipine, Amiodarone , Verapamil

18
Q

Atorvastatin dose adjustments due to interactions?

A

10mg with ciclosporin

19
Q

Rosuvastatin dose adjustments due to interactions?

A

initially 5mg

Max 20mg

20
Q

Statins and pregnancy?

A

contraception during and 1 month after stoping

stop 3 months before conceiving and restart after breastfeeding

21
Q

Bile acid sequestrants counselling?

A

take other drugs 1 hour before or 4 hours after

4 hours before for coleveselam