Familial hypercholestrolemia

Question 1

When might you need to do a lipid profile test on a young person?

Answer 1

If someone in their family has had cardiac issues at a young age

Question 2

Why do you do a fasting lipid profile?

Answer 2

Triglycerides are predominantly carried by chylomicrons after a meal and by Very Low Density Lipoproteins (VLDL) particles at other times. The TG levels in the blood will vary after a meal. Patients are asked to fast for 12 hours before the cholesterol blood test by which time the chylomicrons ( which carry triglycerides) will have been cleared and only VLDL remain.

Question 3

What carries triglycerides after a meal?

Answer 3

Chylomicrons

Question 4

What carries triglycerides at other times?

Answer 4

VLDL

Question 5

What other things may cause cholesterol levels to rise?

Answer 5

Renal or hepatic impairment
Hypothyroidism (slow metabolism, therefore the cells don’t take in the cholestrol as well for metabolism, therefore it goes up in blood)
Medication e.g. ciclosporin or thiazide diuretics
Poorly controlled diabetes

Question 6

What is the treatment for FHC?

Answer 6

Lifelong medication
Exercise 5x/w
Total fat intake should be 30% or less of total energy intake
Stop smoking/alcohol

Question 7

Is the COCP contradicated with statins?

Answer 7

Not, but the increased risk of CV events means consider other options e.g. progesterone only pill

Question 8

Which three medications are commonly used to treat hyperlipidaemias?

Answer 8

Atorvastatin
Ezetimibe
Bezafibrate

Question 9

How does ezetimibe work?

Answer 9

inhibits the absorption of cholesterol, so the liver upregulates receptors for LDL and thus reduces their levels in the blood

Question 10

When is ezetimibe prescribe?

Answer 10

As an adjunct with statins

Question 11

How does bezafibrate work?

Answer 11

By reducing serum triglycerides

Question 12

When are statins indicated?

Answer 12

When lifestyle factors are ineffective or when the patients QRISK 2 is over 10%.

Question 13

SE of statins

Answer 13

Common: 
Asthenia
Headaches
GI disturbance
Sleep disturbance
Low blood platelet count 
Myositis 

Uncommon: 
Rhabdomyolysis 
Memory problems
Hair loss
Pins & needles
Hepatitis & possible flu like symptoms
Pancreatitis
Skin problems
Loss of libido/erectile dysnfucntion

Question 14

RARE SE of statins

Answer 14

Myositis

Question 15

When should you take care when prescribing statins?

Answer 15

History of liver disease/high alcohol intake

Question 16

What is asthenia?

Answer 16

Abnormal physical weakness or lack of energy

Question 17

Causes of hyperilpidemia besdies familial causes?

Answer 17

Uncontrolled DM
Untreated hypothyroidism
Anorexia nervosa
Alcohol excess
Obesity
Medications

Question 18

What medications may cause cholesterol levels to rise?

Answer 18

Ciclosporin

Thiazide diuretics

Question 19

Drug and other contraindications to statins

Answer 19

Clarithromyin
Grapefruit juice
Pregnancy and breastfeeding
Active liver disease

Question 20

If someone complains of muscle pain, what test would you need to do and why

Answer 20

Creatine kinase levels to check for muscle damage as a result of the statins