CV hyperlipidemia Flashcards
total cholesterol should be X or below
5
HDL (good cholesterol) should be Y or above
1
LDL (bad cholesterol) should be X or below
3
Non-HDL (bad cholesterol) should be X or below
4
Triglycerides should be X or below
2.3
what 3 main drugs used in dyslipidaemias
statins
fibrates
ezetemibe
When to offer lipid-lowering agents?
<85 with QRISK > 10
Type 2 diabetes with QRISK > 10
ALL Type 1 diabetes:
>40years
Diabetes>10 years
Established nephropathy
CKD
Familial Hypercholesterolaemia
when should atorvastatin and rosuvastatin be taken and why?
any time of day
long half life
when should SFP: simvastatin fluvastatin pravastatin be taken and why?
night
highest cholesterol produced at night
Atorvastatin strongest dose, and used when?
Atorvastatin 80mg- used in secondary prevention (e.g. had a heart attack)
in this case, Hypothyroidism should be managed when?
Manage BEFORE starting statin
because thyroid hormone has effect on lipid levels
pt as high risk of diabetes- what should be measured before statin started?
Measure Fasting BG/HbA1C BEFORE starting statin
Repeat after 3 months
as strong link between diabetes and hyperlipidaemia as both happen due to lifestyle and diet
3 main SEs of statins TRIM
teratogenic
rhabdo
interstitial lung disease
myopathy
myopathy and rhabdo is why we measure CK with statins.
when should pt seek med advice
muscle toxicity- seek medical advice if they develop muscle symptoms (pain/tenderness/weakness)
with interstitial lung disease when should pt on statin seek med attention
if patients develop dyspnoea/cough/weight loss
statin can affect lung function
statins teratogenic so avoid in pregnancy and discontinue X before conceiving. timeframe
3months
what 3 types of drug do statins mainly interact with
CYP450 enzyme inducer
CYP450 enzyme inhibitor
Fusidic acid (oral)
CYP450 enzyme inducers (SCRAP GP) interact w statin to do what
reduce statin conc
rifampicin
phenytoin
phenobarbital
CYP450 enzyme inhibitors (AV MEDICC/ SICK FACES.COM) interact w statin to do what
(erythromycin, ketoconazole, diltiazem, colchicine)
Increases statin conc -> increased risk of rhabdomyolysis
Patients prescribed macrolides-> stop taking statin during treatment
Avoid drinking grapefruit juice
why should pt on oral fucidic acid stop statin during tx and restart 7 days after last dose
FA increases risk of rhabdo when given w statin due to affecting breakdown of muscle tissue
STATINS- MAXIMUM DOSES
AMIODARONE+SIMVASTATIN?
20mg
STATINS- MAXIMUM DOSES
AMLODIPINE+SIMVASTATIN?
20mg
most common
STATINS- MAXIMUM DOSES
DILTIAZEM/VERAPAMIL+SIMVASTATIN?
20mg
STATINS- MAXIMUM DOSES
TICAGRELOR+SIMVASTATIN?
40mg
STATINS- MAXIMUM DOSES
CICLOSPORIN+ATORVASTATIN?
10mg
STATINS- MAXIMUM DOSES
TIPRANAVIR+ATORVASTATIN?
10mg
STATINS- MAXIMUM DOSES
BUT SIMVASTATIN AND FIBRATES?
10mg
OTHER LIPID-LOWERING AGENTS- SIDE-EFFECTS?
ezetimibe
Statins+ezetimibe= increased risk of rhabdomyolysis
OTHER LIPID-LOWERING AGENTS- SIDE-EFFECTS?
fibrates
Bezofibrate/Ciprofibrate/Fenofibrate/Gemfibrozil
Myotoxicity in renal impairment
LFTs/3 months for the first year
Statins+fibrates= increased risk of muscle related side-effects
