Dyslipdaemias

Question 1

high intensity statin definition

Answer 1

dose at which reduction in LDL-cholesterol of greater than 40% achieved,

Question 2

hyperlipidaemia

Answer 2

high levels of cholesterol and triglycerides

Question 3

QRISK2

Answer 3

assess cardiovascular risk in <84y

10 y cardiovascular risk score >10% = offer primary prevention

Question 4

who is QRISK unsuitable for

Answer 4

~ T1DM
~ Established CVD
~ >85y
- CKD (<60 eGFR)
~ familial hypercholesterolemia

Question 5

cholesterol target for healthy adults

Answer 5

<5 mmol/L total cholesterol
<3 mmol/L LDL

Question 6

cholesterol targets for high risk adults

Answer 6

<4 mmol/L total cholesterol
< 2 mmol/L LDL

Question 7

HDL targets

Answer 7

> 1 mmol/L

Question 8

triglycerides target

Answer 8

<1.7 mmol/L

Question 9

cholesterol levels for hyperlipidaemia diagnosis

Answer 9

6 mmol/L total cholesterol

Question 10

drug causes of hyperlipidaemia

Answer 10

~ antipsychotics
~ immunosuppressants
~ corticosteroids
~ anti-retroviral (HIV drugs)

Question 11

conditions that cause hyperlipidaemia

Answer 11

1. HyPOthyroidism
2. Liver/Kidney disease
3. DM
4. FHx of high cholesterol
5. Lifestyle factors, smoking, alcohol, obesity, poor fatty diet

Question 12

list of lipid regulating drug classes

Answer 12

1. Statins
2. Fibrates
3. Ezetimibe
4. Bile acid sequestrants
5. Nicotinic acid group
6. Lomitapide
7. Alirocumab

Question 13

Statins MOA

Answer 13

Lowers LDL cholesterol synthesis by liver via inhibition of HMG-CoA reductase (indirectly reduces triglycerides and increases HDL)

Question 14

Statins administration

Answer 14

TAKEN at night (except atorvastatin)
as cholesterol synthesis > at night)

Question 15

use high intensity statin for

Answer 15

prevention of CVD

Question 16

3 high intensity statins

Answer 16

1. Atorvastatin (20-80mg)
2. Rosuvastatin 10mg
3. Simvastatin (80mg)

Question 17

Atorvastatin doses in intensity

Answer 17

primary prevention = 20mg OD
Secondary prevention = 80mg OD

Question 18

MHRA for Simvastatin

Answer 18

~ very infrequent reports of myasthenia gravis
~ myopathy

Question 19

Hypercholesterolaemia (primary & secondary) tx steps

Answer 19

1. High intensity statin
2. if not tolerated/CI = Ezetimibe

Question 20

Moderate Hyper-triglyceridemia tx

Answer 20

1. High intensity statins
2. if not tolerated/ CI = Fibrates

Question 21

before starting statins

Answer 21

FIX secondary causes of dyslipidaemia !!!

~ hypothyroidism
~ uncontrolled DM
~ Nephrotic syndrome (albuminuria)
~ liver disease e.g. alcoholic cirrhosis

Question 22

severe hyperlipidaemia tx

Answer 22

1. high intensity statin
2. ADD ON ezetimibe
3. if triglycerides still high after LDL reduced = add fibrate or Nicotinic acid

Question 23

Statins side effects

Answer 23

1. Myopathy, Myositis, Rhabdomyolysis
2. Interstitial lung disease (SOB, cough, weight loss)
3. Diabetes

Question 24

Statins and myopathy/myositis/rhabdomyolysis side effects

Answer 24

report = tenderness, weakness, painful muscles

high risk in
- personal/FHx of muscle disorder
- high alcohol intake
- renal impairment
- hypothyroidism (tx before starting)

Question 25

Myopathy risk increased in concomitant use of statins with ...

Answer 25

1. Ezetimibe or Fibrates (gemfibrozil) = AVOID 2. Fusidic acid oral (restart statin 7 days after last dose) - rhabdomyolysis risk

Question 26

Statins and Diabetes

Answer 26

statins = raise HbA1C / BG levels caution in diabetes / at high risk of diabetes

Question 27

Statins monitoring

Answer 27

1. Baseline lipid 2. Renal function 3. Thyroid function 4. HbA1c (if diabetes risk)

Question 28

Statins and creatinine kinases

Answer 28

discontinue if x5 normal (if returns to normal & symptoms resolve = reintroduce at lower doses)

Question 29

Statins + liver function

Answer 29

discontinue if liver transaminases x3 normal

Question 30

Statins interactions (increased myopathy risk with)

Answer 30

- amiodarone - grapefruit juice - CCBs - Antifungals

Question 31

Statins + Macrolides

Answer 31

e.g. clarithromycin STOP taking statin until ABX course finishes (no need to contact prescriber)

Question 32

Simvastatin dose adjustments

Answer 32

1. Fibrates = 10mg 2. Amiodarone, Amlodipine, Diltiazem, Verapamil = 20mg

Question 33

Atorvastatin dose adjustments

Answer 33

1. Ciclosporin = 10mg MAX

Question 34

Rosuvastatin dose adjustments

Answer 34

1. Clopidogrel = initially 5mg => 20mg

Question 35

Statins + pregnancy

Answer 35

Teratogenic + not for BF !! - effective contraception during & 1 month after stopping ~ STOP taking 3 months before conceiving & restart after breastfeeding finished !

Question 36

Ezetimibe MOA

Answer 36

reduces cholesterol by inhibiting absorption of cholesterol in small intestine

Question 37

Fibrates MOA

Answer 37

lowers triglycerides by reducing livers production of VLDL and removes triglycerides from blood

Question 38

Severe hypertriglyceridaemia >10 mmol/L or if intolerant to statin =

Answer 38

Fibrates Bezafibrate Fenofibrate Ciprofibrate Gemfibrozil (NOT with statin as high risk of myopathy)

Question 39

Bile acid sequestrants MOA

Answer 39

binds & sequestrants bile acid = more bile acid produced by liver = cholesterol used up to make bile acid = reduces LDL cholesterol in blood

Question 40

Bile acid sequestrants e.g.

Answer 40

Colesevelam Colestipol Cholestyramine

Question 41

Bile acid sequestrants interactions

Answer 41

impairs absorption of fat-soluble vitamin ADEK 1h before (4hours for colesevelam) or 4 hours after bile acid sequestrant