High cholesterol

Question 1

What drugs can lead to increased statin concentration

-antibiotics/antifungals

Answer 1

1. Clarithryomycin
2. Erythromycin
3. Ketoconazole (antifungal)

Question 2

What drugs can lead to increased statin concentration

-heart condition drugs

Answer 2

1. CCB (eg amlodipine, verapamil)

2. Amiodarone

Question 3

What food/drink can lead to increased statin concentration

Answer 3

Grapefruit juce

Question 4

Side effects of statins

-HPB/ GI

Answer 4

• Liver injury, deranged LFTs

* GI upset

Question 5

Side effects of statins

-MSK

Answer 5

• Myalgia, myositis (elevated CK levels)

* Skin rash

Question 6

Side effects of statins

-neuro

Answer 6

• Peripheral neuropathy

* Sleep disturbance

Question 7

Side effects of statins

-endocrine

Answer 7

• Very small increased risk of diabetes in non-diabetic population

Question 8

Effect of fibric acid derivatives on cholesterol levels

Answer 8

Reduce VLDL and LDL levels

Increase HDL levels

Question 9

How does ezetimibe work

Answer 9

Reduces transport of cholesterol from intestinal lumen (by inhibiting NPC1L1)

Question 10

How do PCSK9 inhibitors work

Answer 10

Normally, PCSK9 binds to LDL receptor on hepatocyte

This is blocked.
Lowers LDL, IDL, VLDL levels

Question 11

People with what QRISK2 score should be started on statin?

How much statin?

Answer 11

QRISK2 >10%

Question 12

People with existing CVD should be put on how much statin

Answer 12

80mg atorvastatin

Question 13

What drug is used in pts if statins are contraindicated

Answer 13

Ezetemibe

Question 14

When should pts with T2DM be started on statins

Answer 14

QRISK2 >10%

Question 15

When should pts with T1DM be started on statins

Answer 15

1. > 40yo OR
2. Diabetes for over 10 years OR
3. Established nephropathy OR
4. Other CVD risk factors

Question 16

Treatment aims in putting someone on statins

target cholesterol levels

Answer 16

Reduce non-HDL cholesterol by 40%

Consider adding ezetimibe to statin if this is not achieved