Cholesterol Flashcards
Three risk conditions that require primary CV prevention
CKD (eGFR
10 year cadiovascular risk of over ….% should have primary prevention
10% (QRISK 2)
CV risk tool don’t take into account ………. which may also contribute to risk (5)
- 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)
Three med classes that can increase cholesterol
antipsychotics
corticosteroids
immunosupressants
before starting statin treatment causes of hyperlipidaemia should be address such as (4)
diabetes
hepatic disease
nephrotic syndrome
hypothyroidism
what is the effect of hypothroidism on lipids
should be corrected first ans lipid dysregulation may then correct itself.
Also - untreated increases risk of myosistis with lipid regulating drugs
Statins that are high intensity (3)
Atrovastatin 20mg +
Rosuvastatin 10mg +
Simvstatin 80mg +
when should a statin be considered in T1DM?
40years+
had diabetes for over 10 years
established nephopathy
What are the NICE targets of statin therapy
total chol reduction of over 40%
non-HDL
what are 2, 3, 4 lines after statins
ezetimibe
fenofibrate
nicotinic acid
Does omega three fatty acid reduce cholesterol
no evidence of this
What is the definition of a high intensity statin
one that produces a reduction in cholesterol greater that simv 40mg
Coucelling for cholestyramine
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
What is the class of cholestyramine
bile acid sequestrant
which patients are particularly at risk of statins muscle effects
muscle disorders
high alcohol intake
renal impairment
hypothyroidism
when should statin be discontinued due to muscle pain
if creatanine is 5x the upper limit of normal
if pain is severe
what should be suspected if a statin patient presents with dyspnoea, cough, weightloss
interstitial lung disease
should statin be discontinued if they cause and increase in HbA1c
no - usually the benifits outweigh the risks
at what level or LFT derangement should we definately not be using statins
discontinue if serum transaminases are 3x upper limit of normal
3 monitoring tests for statins
HbA1c (may develop diabetes esp those at risk)
LFTs
CrCl
drugs that interact with statins
fibrates nicotinic acid fusidic acid and drugs that alter plasma statin levels: imidazole and tiriazole antifungals macrolides
what statin can be sold OTC
simv 10
max doses of simvastatin with other drugs stated in the BNF
10mg with bezafibrate
20mg with amiodarone, verapamil, diltiazem, amlodipine, ranolazine
40mg with lomitapide
which statin interacts with clopidogrel?
what is the max dose
maximum dose of rousovastatin with clopidogrel
20mg
