Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular System > Cholesterol > Flashcards

Cholesterol Flashcards

1
Q

What are the modifiable factors of CVD?

A

Smoking, diet, exercise, alcohol and weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the non-modifiable factors of CVD?

A

Age, gender - males at higher risk, genetics, ethnicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is CVD risk assessed?

A

Assessed with QRISK, QRISK2, QRISK3, JBS3, or ASSIGN [Scotland].

But QRISK is not required in high risk patients - give them statin regardless.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is considered a high risk patient?

A
  • Type 1 diabetes and aged 40+
  • Type 2 diabetes if CVD risk is >10%
  • Chronic kidney disease (CKD)
  • Familial hypercholesterolaemia - give high intensity statin - atorvastatin or rosuvastatin to achieve more than 50% reduction
  • 85 years of age and over (esp if they smoke and have hypertension)
  • 10-year CVD risk >10%
  • Established CVD - like angina, MI, stroke, hypertension etc
  • Hypertension
  • Influenza
  • Serious mental health
  • Dyslipidaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do QRISK, JBS3 and ASSIGN assess?

A

The risk of someone’s chances of having a heart attack OR stroke in the next 10 years

JBS3 - estimates lifetime risk of CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

At what % risk must a statin be given?

A

If 10-year risk is greater than 10% = give a statin for primary prevention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What should high risk patients be given?

A

They should be given a statin regardless of cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do statins do?

A

Reduce the risk of CVD by reducing cholesterol levels.

They are the drug of choice for primary and secondary prevention of CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Hyperlipidaemia?

A

high cholesterol, high triglycerides, or both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is Hyperlipidaemia diagnosed?

A

When total cholesterol is 6mmol/L or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the different causes of Hyperlipidaemia?

A
  • Liver or kidney disease
  • Family history
  • Diabetes
  • Hypothyroidism
  • Lifestyle factors e.g. obesity, smoking
  • Medicines e.g. antipsychotics, immunosuppressant, antiretrovirals, corticosteroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are high intensity statins?

A

Statins that reduces LDL by more than 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examples of high intensity statin and the % of reduction for each station and dose?

A

Atorvastatin:
20mg - 43%
40mg - 49%
80mg - 55%

Rosuvastatin:
10mg - 43%
20mg - 48%
40mg - 53%

Simvastatin:
80mg - 42%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the recommended statin for primary prevention?

A

A high intensity statin - Atorvastatin 20mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the recommended statin for secondary prevention?

A

Atorvastatin 80mg

But check lipid ranges/profiles beforehand and 3 months after starting statin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which patients are always given secondary prevention?

A

Given to all patients with type 1 diabetes (esp those over 40 years, had diabetes for over 10 years, established nephropathy, or other risk factors for CVD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the lipid ranges?

A

High Density Lipids (HDL Cholesterol) - >1mmol/L

Triglycerides - <1.8mmol/L

Low Density Lipids (LDL Cholesterol) for high-
risk patients - <2mmol/L

Low Density Lipids (LDL Cholesterol) - <3mmol/L

Total Cholesterol for high-risk patients - <4mmol/L

Total Cholesterol for healthy adults - <5mmol/L

Hyperlipidaemia diagnosis - > and equal to 6mmol/L

18
Q

What must be monitored before starting a statin?

A
  • Lipid profile
  • Liver enzymes 3 months + 12 months
  • Creatine kinase
  • HbA1c or fasting blood glucose
  • Thyroid function - hypothyroidism
  • Renal function
19
Q

What must be monitored after starting a statin?

A

Liver enzymes - 3 month & 12 months after starting

HbA1c or fasting blood glucose - 3 months after starting.

20
Q

What is the mechanism of action for statins?

A

They competitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A
(HMG CoA) reductase, an enzyme involved in cholesterol synthesis, in the liver.

21
Q

What drug can be used if statins aren’t tolerated or effective?

A

Ezetimibe

As monotherapy and co-current use

22
Q

What should be done if patients can’t take a statin or ezetimibe?

A

They should be referred to a specialist for a
bile acid sequestrant, a fibrate, or nicotinic acid.

23
Q

What drugs can be given if statins and ezetimibe cannot be tolerated?

A

Bile acid sequestrant, a fibrate, or nicotinic acid.

24
Q

What should be done if triglyceride levels are high?

A

Add a fibrate

25
Q

What can Nicotinic acid be used for?

A

To lower triglycerides and LDL concentration.

26
Q

What is the main side effect of statins?

A

Muscle toxicity - causes Rhabdomyolysis (the destruction of muscle cells)

So must tell patients to report any muscle pain

27
Q

What advice should patients taking statins be given?

A

Report any unexplained muscle pain, tenderness and weakness.

28
Q

What warnings are given with statins?

A

Simvastatin 80mg can cause rhabdomyolysis

29
Q

Can statins be given during pregnancy?

A

NO! Because they are teratogenic.
All statins must be avoided in pregnancy.

Therefore adequate contraception is required during treatment and 1 month after treatment.

OR if planning pregnancy, discontinue 3 months before attempting to conceive.

30
Q

How long must statins be discontinued for, before attempting to conceive?

A

3 months

31
Q

When should statins be taken? Is there an exception?

A

Statins must be taken at night.

BUT atorvastatin and rosuvastatin can be taken at any time of the day, due to their long duration of action

32
Q

What are the common dose adjustments for statins?

A

Amlodipine, Amiodarone, Ranolazine, or rate limiting CCB + Simvastatin = Max dose of Simvastatin 20mg

Ciclosporin + Atorvastatin = Max dose of Atorvastatin 10mg

Clopidogrel + Rosuvastatin = Max dose of Rosuvastatin 20mg

Fibrate + Simvastatin = Max dose of Simvastatin 10mg

33
Q

Which drugs increase the risk of rhabdomyolysis when taken with statins?

A

Amiodarone, Amlodipine, Colchicine, Nicotinic Acid and Fibrates

34
Q

Which drugs increase the exposure of simvastatin?

A

Clarithromycin, Erythromycin, Ketoconazole, Miconazole and Grapefruit Juice

35
Q

Which drug increases the risk of hepatotoxicity?

A

Carbamazepine

36
Q

Which drugs cannot be taken with drugs? (There are 6)

A

Amiodarone, Amlodipine, Colchicine, Nicotinic Acid, Carbamazepine and Fibrates

37
Q

Which drugs cannot be taken with just simvastatin?

A

Clarithromycin, Erythromycin, Ketoconazole, Miconazole and Grapefruit Juice

38
Q

What’s the connection of hypothyroidism and lipids?

A

Hypothyroidism is when thyroid levels are low. When low, LDL cholesterol builds up in the body.

So patients with hypothyroidism must be given thyroid replacement first, before a statin.

39
Q

Important interactions of statins?

A

Statin + fibrate (or nicotinic acid) - increases risk of S.E eg. Rhabdomyolysis

Statin + Gemfibrozil - increases risk of S.E eg. Rhabdomyolysis largely
SO DO NOT USE THIS COMBINATION

Amlodipine, amiodarone, colchicine, nicotinic acid, fibrates - increases risk of rhabdomyolysis.

Carbamazepine - increases risk of hepatoxicity

Clarithromycin/Erythromycin, grapefruit juice, ketoconazole/miconazole - Increases exposure to simvastatin.

40
Q

When should statins be avoided and discontinued?

A

In active liver disease and unexplained elevations in serum transaminases.

Discontinue in elevated creatinine kinase - sign of myopathy - leg cramps

41
Q

What are the medium intensity?

A

Atorvastatin - 10mt

Rosuvastatin - 5mg

Simvastatin - 40mg, 20mg

Fluvastatin - 80mg

42
Q

What are the medium intensity?

A

Atorvastatin - N/A

Rosuvastatin - N/A

Simvastatin - 10mg

Fluvastatin - 20mg, 40mg

Pravastatin - 10mg, 20mg, 40mg (ONLY HAS LOW INTENSITY)

Cardiovascular System (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions