Hyperlipidaemia Flashcards
What is hyperlipidaemia?
High blood levels of cholesterol, triglycerides or both
What does hyperlipidaemia cause?
Atherosclerosis CHD Strokes TIA Peripheral arterial disease
When is primary prevention of cardiovascular disease needed?
T1DM
T2DM if CVD risk > 10%
When is secondary prevention of CVD needed?
When the patient has established CVD
When is the QRISK score needed?
84 and under
10 year CVD risk score > 10% offer primary prevention
When is QRISK unsuitable?
T1DM Established CVD 85+ CKD Familial hypercholesterolaemia
What are the levels of total cholesterol needed for hyperlipidaemia to be diagnosed?
6mmol/L total cholesterol
What are the cholesterol targets for healthy adults?
< 5 mmol/L total
< 3 mmol/L LDL
> 1 mmol/L HDL
< 1.7 mmol/L triglycerides
What are the cholesterol targets for high risk adults?
< 4mmol/L total
< 2 mmol/L LDL
> 1 mmol/L HDL
< 1.7 mmol/L triglycerides
What drugs cause hyperlipidaemia?
Antipsychotics
Immunosuppressants
Corticosteroids
Antiretrovirals
What conditions cause hyperlipidaemia?
Hypothyroidism Liver or kidney disease Diabetes Family history Lifestyle
What are the statins?
Atorvastatin Simvastatin Rosuvastatin Pravastatin Fluvastatin
What are the fibrates?
Bezafibrate
Ciprofibrate
Fenofibrate
Gemfibrozil
What are the bile acid sequestrants?
Colesevelam
Colestipol
Colestyramine
What are the nicotinic acid group?
Acipimox
Nicotinic acid
Omega 3 fatty acid
What are the other lipid regulating drugs?
Ezetimibe
Lomitapide
Alirocumab
What is the mechanism of action of statins?
Lowers LDL cholesterol synthesis by the liver via inhibition of HMG-CoA reductase
Indirectly reduces triglycerides and increases HDL cholesterol
Which statin does not need to be taken at night?
Atorvastatin
What are high intensity statins used for?
Prevention of cardiovascular disease
What are the high intensity statins?
Atorvastatin
- primary prevention 20mg OD
- secondary prevention 80mg OD
Rosuvastatin 10mg
Simvastatin 80 mg
What is the MHRA warning for simvastatin 80mg?
High risk of myopathy
Only give if high risk of CVD complications or severe hypercholesterolaemia and treatment goals not achieved at a lower dose
Are statins used for hyperlipidaemia?
Yes, first line
What are secondary causes of dyslipidaemia?
Hypothyroidism
Uncontrolled diabetes mellitus
Nephrotic syndrome
Liver disease
What are the side effects of statins?
Myopathy, myosotis, rhabdomyolysis
Interstitial lung disease
Diabetes
What are the counselling points of statins?
Report tender, weak and painful muscles
Report short breath, cough, weight loss
Can raise HBA1c
When is there an increased risk of muscle toxicity in statins?
History of muscle disorder
High alcohol
Renal impairment
Hypothyroidism
When is there an increased risk of myopathy with the use of statins?
Ezetimibe or fibrates
Fusidic acid - restart statin 7 days after last dose
What are the monitoring requirements for statins?
Baseline lipids Renal function Thyroid function HBA1c Severe muscle symptoms - discontinue Creatinine kinase - discontinue if 5X normal
Liver function - discontinue if liver transaminases 3x normal
What is the MHRA warning for amlodipine and statins?
Do not take more than 20mg simvastatin when taking amlodipine concomitantly
What are the interactions with statins that causes an increase in statin levels?
Amiodarone Grapefruit juice CCBs Imidazole/triazole antifungals Macrolides Ezetimibe/fibrates Fusidic acid
What are the counselling points needed for patients taking statins when they have been given a macrolide prescription e.g. Clarithromycin?
Stop taking statin until antibiotic course completed
When do you restart statin after taking oral fusidic acid?
7 days after last fusidic acid dose
What re the dose adjustments needed for simvastatin due to interactions?
Max 10 mg with fibrate
Max 20mg with amiodarone, amlodipine, diltiazem, verapamil
What is the dose adjustment required for atorvastatin when used with ciclosporin?
Max 10mg atorvastatin
What is the dose adjustment required for rosuvastatin with clopidogrel?
Initially 5mg
Max 20mg
Can statins be taken in pregnancy?
NO - teratogenic
Effective contraception during and 1 month after stopping
Stop taking 3 months before conceiving and restart after breastfeeding finished
What conditions can cause dyslipidaemia?
Hypothyroidism
Uncontrolled diabetes mellitus
Nephrotic syndrome
Liver disease
What is the mechanism of action of ezetimibe?
Reduces blood cholesterol by inhibiting the absorption of cholesterol by the small intestine
Alternative to statin in familial and primary hypercholesterolaemia
What is the interaction between statins and ezetimibe?
Myopathy (rhabdomyolysis)
What is the mechanism of action of fibrates?
Lowers blood triglyceride levels by reducing the livers production of VLDL and by speeding up the removal of triglycerides from the blood
What is severe hypertriglyceridaemia?
Levels above 10mmol/L
What are the fibrates?
Bezafibrate
Fenofibrate
Ciprofibrate
Gemfibrozil
Which fibrate is contraindicated when used with a statin?
Gemfibrozil
Do NOT use with statin as high risk of myopathy (rhabdomyolysis)
What are the interactions between fibrates and statins?
Causes myopathy
What happens if a patient has renal impairment and uses fibrates?
Can cause myopathy
What is the mechanism of action of bile acid sequestrants?
Binds and sequesters bile acids
Liver produces more bile acids to replace those that have been lost
Cholesterol is used to make bile acids, reducing the amount of LDL cholesterol circulating in the blood
What are the bile acid sequestrants?
Colesevelam
Colestipol
Colestyramine
What are the interactions of the bile acid sequestrants?
Impairs absorption of fat soluble vitamins ADEK and other drugs
When should you take bile acid sequestrants in relation to other drugs?
Take other drugs one hour before (4 hours for colesevelam) or 4 hours after bile acid sequestrants
