Cholesterol

Question 1

Three risk conditions that require primary CV prevention

Answer 1

CKD (eGFR

Question 2

10 year cadiovascular risk of over ….% should have primary prevention

Answer 2

10% (QRISK 2)

Question 3

CV risk tool don’t take into account ………. which may also contribute to risk (5)

Answer 3

• serious mental disorder
• autoimmune disorder (lupus)
• antiretroviral treatment
• meds increasing cholesterol
• tirglyceride concentration >4.5mmol/L

(also those with controlled BP and those who have stopped smoking)

Question 4

Three med classes that can increase cholesterol

Answer 4

antipsychotics
corticosteroids
immunosupressants

Question 5

before starting statin treatment causes of hyperlipidaemia should be address such as (4)

Answer 5

diabetes
hepatic disease
nephrotic syndrome
hypothyroidism

Question 6

what is the effect of hypothroidism on lipids

Answer 6

should be corrected first ans lipid dysregulation may then correct itself.
Also - untreated increases risk of myosistis with lipid regulating drugs

Question 7

Statins that are high intensity (3)

Answer 7

Atrovastatin 20mg +
Rosuvastatin 10mg +
Simvstatin 80mg +

Question 8

when should a statin be considered in T1DM?

Answer 8

40years+
had diabetes for over 10 years
established nephopathy

Question 9

What are the NICE targets of statin therapy

Answer 9

total chol reduction of over 40%

non-HDL

Question 10

what are 2, 3, 4 lines after statins

Answer 10

ezetimibe
fenofibrate
nicotinic acid

Question 11

Does omega three fatty acid reduce cholesterol

Answer 11

no evidence of this

Question 12

What is the definition of a high intensity statin

Answer 12

one that produces a reduction in cholesterol greater that simv 40mg

Question 13

Coucelling for cholestyramine

Answer 13

Take sachet with 150ml of fluid

Take other meds at least 1 hour before or 4-6 hours after to reduce possible interferance with absorbtion

Question 14

What is the class of cholestyramine

Answer 14

bile acid sequestrant

Question 15

which patients are particularly at risk of statins muscle effects

Answer 15

muscle disorders
high alcohol intake
renal impairment
hypothyroidism

Question 16

when should statin be discontinued due to muscle pain

Answer 16

if creatanine is 5x the upper limit of normal

if pain is severe

Question 17

what should be suspected if a statin patient presents with dyspnoea, cough, weightloss

Answer 17

interstitial lung disease

Question 18

should statin be discontinued if they cause and increase in HbA1c

Answer 18

no - usually the benifits outweigh the risks

Question 19

at what level or LFT derangement should we definately not be using statins

Answer 19

discontinue if serum transaminases are 3x upper limit of normal

Question 20

3 monitoring tests for statins

Answer 20

HbA1c (may develop diabetes esp those at risk)
LFTs
CrCl

Question 21

drugs that interact with statins

Answer 21

fibrates
nicotinic acid
fusidic acid
and drugs that alter plasma statin levels:
imidazole and tiriazole antifungals
macrolides

Question 22

what statin can be sold OTC

Answer 22

simv 10

Question 23

max doses of simvastatin with other drugs stated in the BNF

Answer 23

10mg with bezafibrate
20mg with amiodarone, verapamil, diltiazem, amlodipine, ranolazine
40mg with lomitapide

Question 24

which statin interacts with clopidogrel?

what is the max dose

Answer 24

maximum dose of rousovastatin with clopidogrel

20mg