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BNF > CHAPTER 2: CVS: Hyperlipidaemia > Flashcards

CHAPTER 2: CVS: Hyperlipidaemia Flashcards

1
Q

Those with over which percentage cardiac risk stand to benefit from treatment with lipid-regulating drugs?

A

Over 10%

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2
Q

Which 3 groups of people are risk calculators not suitable?

A
  1. Patients at high cardiovascular risk
  2. Type 1 Diabetes
  3. Over 85
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3
Q

Which parameters do the QRISK 2 and JBS3 calculator base their risk of cardiovascular disease on? (13)

A
  1. Lipid profile
  2. Systolic blood pressure
  3. Gender
  4. Age
  5. Ethnicity
  6. Smoking status
  7. BMI
  8. CKD
  9. Diabetes
  10. Atrial fibrillation
  11. Treated hypertension
  12. Rheumatoid arthritis
  13. Family history
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4
Q

In which patients do risk calculators underestimate risk? (5)

A
  1. Serious mental disorder
  2. Autoimmune disorders
  3. Antiretroviral treatment
  4. Medication causing dyslipidaemia
  5. Triglyceride concentration
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5
Q

Which medication can cause dyslipidaemia? (3)

A
  1. Antipsychotics
  2. Corticosteroids
  3. Immunosuppressants
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6
Q

Give 5 lifestyle modifications people at risk of cardiovascular disease can make

A
  1. Diet
  2. Exercise
  3. Smoking cessation
  4. Alcohol consumption
  5. Weight management
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7
Q

What is the first line drug for lipid regulation? Offered if lifestyle modifications are ineffective

A

Statins

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8
Q

Should statins be offered to all patients for secondary prevention of cardiovascular disease?

A

Yes

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9
Q

Why should patients with hypothyroidism receive replacement therapy before starting statins?

A

Because correcting hypothyroidism may correct lipids

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10
Q

Which drug and at which dose does NICE recommend for primary prevention in patients with a 10% 10 year risk?

A

Atorvastatin 20mg/day

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11
Q

Which drug does NICE recommend for secondary prevention?

A

Atorvastatin

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12
Q

As well as for primary and secondary prevention, in which other patients should a statin be considered?

A

Type 1 diabetes

  • especially if over 40
  • diabetes for over 10 years
  • diabetic nephropathy or any other risk factor
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13
Q

What should be checked 3 months after starting treatment with statins? (3)

A

Total cholesterol
HDL-cholesterol
non-HDL cholestrol

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14
Q

What is the % reduction aim for non-HDL cholesterol?

A

40%

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15
Q

What is the target non-HDL cholesterol aim?

A

below 2.5mmol/L

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16
Q

What dose can atorvastatin be increased to, to optimised treatment if non-HDL aims are not being met?

A

80mg

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17
Q

Which 4 drugs are not recommended for primary or secondary prevention?

A
  1. Fibrates
  2. Omega-3-fatty acid compounds
  3. Bile acid sequestrants
  4. Nicotinic acid
18
Q

As well as for reducing risk of cardiovascular events, what are statins also first choice to treat?

A

Hypercholesterolaemia and hypertriglceridaemia

19
Q

Severe hyperlipidaemia not adequately controlled with a maximal dose of a statin may require the use of an additional lipid-regulating drugs such as?

A

Ezetimibe

20
Q

As well as ezetimibe, which other drugs can be added to statins to help control hyperlipidaemia? (2)

A
  1. Fenofibrate

2. Nicotinic acid

21
Q

What does the combination of a statin and a fibrate or nicotinic acid increase the risk of?

A

Rhabdomyolisis

22
Q

What is the % reduction aim for LDL cholesterol when using a high intensity statin such as rosuvastatin?

A

50%

23
Q

If patients have contra-indications to statin, what must they be given as an alternative?

A

Ezetimibe

24
Q

What is a side effect of nicotinic acid which limits its value?

A

Vasodilation

25
Q

What is the mode of action of ezetimibe?

A

Inhibits the absportion of cholesterol

26
Q

What is the mode of action of fibrates?

A

Decrease serum triglycerides

27
Q

With use of fibrates, what must be monitored? (2)

A
  1. LFTs every 3 months during the first 12 months (discontinue if 3X upper limit)
  2. Creatinine
28
Q

In which patients are fibrates mainly used? (2)

A
  1. Serum-TGs over 10mmol/L

2. Cannot tolerate statins

29
Q

What is the MOA of statins?

A

Inhibition of the HMG CoA reductase enzyme involved in cholesterol synthesis

30
Q

What is a notable side effect of all statins?

A

Muscle effects

31
Q

A statin should not be started if the baseline creatine kinase is what?

A

5X above the upper limit of normal

32
Q

What should be managed adequately before starting statin treatment due to increased risk of muscle effects?

A

Hypothyroidism

33
Q

If creatine kinase or muscle pain is reported, other causes must be discounted. What are these other causes? (5)

A
  1. Rigorous physcial activity
  2. Hypothyroidism
  3. Infection
  4. Recent trauma
  5. Drug or alcohol addiction
34
Q

If a statin is discontined due to rhabdomylosis, can it be reintroduced when symptoms go and creatine kinase levels are back to normal?

A

Yes, at a lower dose with close monitoring

35
Q

Is routine monitoring of creatine kinase necessary?

A

No

36
Q

Are statins safe in pregnancy?

A

No, congenital anomalies have been reported

37
Q

Should patients take contraception while on statins?

A

Yes. and 1 month after

38
Q

What is the monitoring for statins?

A
  1. Lipid profile
  2. LFTs
  3. Creatine kinase if muscle pain - if 5X upper limit when done again 7 days later, do not start statins
  4. HbA1c if at risk of diabetes
39
Q

What should patients taking statins be counselled to report?

A

Muscle pain, weakness

40
Q

Which drug should not be given with statins but can if unavoidable? Reduce statin dose

A

Ciclosporins

41
Q

Can simvastain be sold OTC?

A

Yes, at a total daily dose of 10mg, as part of a cardiovascular risk reduction programme, maximum pack size 28

BNF (28 decks)

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