Chapter 2: CVD Prevention Flashcards
What is given for primary prevention of CVD?
High intensity statin: atorvastatin 20mg OD
OFFERED WHEN QRISK IS 10% OR MORE OR OVER THE AGE OF 85.
What is given in secondary prevention in CVD?
Atorvastatin 80mg OD
What are high intensity statins?
Atorvastatin 20mg, 80mg
Simvastatin 80mg
What are medium intensity statins?
Atorvastatin 10mg
Simvastatin 20mg, 40mg
Low intensity statins?
Simvastatin 10mg
What is the mechanism of action for statins?
Inhibits HMG CoA reductase, An enzyme involved with cholesterol synthesis, especially in the liver.
What are the cautions of statins?
- Elderly
- High alcohol intake
- Hx of liver disease
- Hypothyroidism
- Patients at an increased risk of muscle toxicity (including family history, renal impairment etc.
What condition should be managed 1st before starting statin therapy?
Hypothyroidism
For patients with an increased risk of muscle effects, When should statins not be started?
Should not be usually started if the baseline creatitine kinase conc is more than 5X the upper limit of normal.
What are the common side effects of statins?
- Asthenia (abnormal physical weakness or lack of energy)
- constipation and diarrhoea
- dizziness
- GI discomfort
- myalgia
With regards to the muscle toxicity side effects, when should statins be discontinued? When should they be reintroduced?
- When statin is suspected to be the cause of myopathy
- And creatitine kinase conc is markedly raised
- Or if muscular symptoms is severe
-if symptoms resolve and Cr kinase returns to normal, statin should be introduced at a lower dose and monitored closely.
What should be advised if a patient develops lung issues with statins? What are the symptoms?
Seek medical attention!
- SOB
- cough
- weight loss
What is the conception and contraception advice with statins?
Adequate contraception should be used during treatment and 1 month afterwards.
What is the pregnancy advice with statins?
- Statins should be avoided in pregnancy
- Discontinue 3 months before attempting to conceive
- Congenital abnormalites has been reported and decreased cholesterol synthesis possibly affects foetal development.
What is the hepatic impairment advice with statins?
- Use with caution in those with a history of liver disease
- AVOID IN active liver disease or when there is unexplained persistent rise in serum transaminase.
What should be monitored BEFORE taking taking statins and their intervals?
- At least 1 full non fasting lipid profile (total cholesterol, HDL, non-HDL, triglyceride concs)
- Thyroid stimulating hormone
- renal function
- (if at risk of diabetes) fasting BG concs or HbA1c before starting THEN EVERY 3 MONTHS
- liver enzymes before starting THEN REPEAT WITHIN 3 MONTHS, and at 12 months of starting
- Cr kinase: measured before in patient with persistent, unexplained muscle pain. If raised but less than 5X upper limit- start at lower dose.
What should be done if the serum transaminase conc are raised more than 3 times of the upper limit?
Discontinue statins
What is are the patient/carer advice for statins?
Report promptly unexplained, muscle pain, tenderness or weakness.
What is the mechanism of action of bile acid sequestrants?
- They bind to bile acid and prevent their reabsorption.
- This promotes the hepatic conversion of cholesterol into bile acid.
- this increases the clearance of LDL cholesterol from the plasma.
What should be done when atorvastatin must be taken by a patient on ciclosporin?
The max dose of atorvastain should not exceed 10mg OD.
When should the MAX dose of simvastatin 20mg be allowed?? (What drugs?)
-amiodarone, amlodipine, ranolazine
With CYP3A4 inhibitors:
-verapami, diltiazem
