Hyperlipidaemia Flashcards
Target total cholesterol
5 or below
Target HDL
1 or above
Target LDL
3 or below
Target non-HDL
4 or below
Target triglycerides
2.3 or below (most dangerous)
What percentage reduction in non-HDL cholesterol should you aim for after starting lipid-lowering therapy?
> 40%
When should you offer a lipid-lowering agent to a patient?
Patients under 85 with a 10 year risk of CVD greater than 10%
Patients with T2DM with a greater than 10% risk of CVD in next 10 years
All T1DM with:
- Age over 40
- Diabetes for over 10 years
- Established nephropathy
Patients with CKD
Patients with familial hypercholesterolaemia presenting with high cholesterol
What is offered if the maximum tolerate dose of statin fails to control cholesterol levels?
Combination with ezetimibe
OR alternative statin
What is offered if statins and ezetimibe are not tolerated?
Fibrates or bile acid sequestrants (colestyramine, or colestipol hydrochloride) under specialist advice
Side effect of using a statin and fibrate in combination?
Rhabdomyolysis
Which statins are to be taken at night?
Simvastatin, Pravastatin, Fluvastatin
Which statins are to be taken at any time of the day?
Atorvastatin and rosuvastatin
Which disorder should be managed prior to commencing a statin?
Hypothyroidism
Monitoring requirement for patients at high risk of diabetes before starting statin
HbA1c and repeat at 3 months
Maximum dose of simvastatin when used with amiodarone
20mg
Maximum dose of simvastatin when used with amlodipine
20mg
Maximum dose of simvastatin when used with RL-CCB
20mg
Maximum dose of simvastatin when used with ticagrelor
40mg
Maximum dose of atorvastatin when used with ciclosporin
10mg
Maximum dose of atorvastatin when used with tipranavir
10mg
Monitoring requirements before starting a statin
Full lipid profile
Thyroid function
Renal function
LFTs
How often are the monitoring requirements for statins repeated?
3 months after starting
Annually
When to discontinue statin if liver enzymes are abnormal?
When serum transaminases are raised by more than 3 times the upper limit
When to measure creatine kinase levels?
Measured in patients who have previously had persistent muscle aches prior to initiating statin
Management if creatine kinase is 5 times the upper limit?
Remeasure in 7 days
Management if CK is still higher than 5 times the upper limit
Do not initiate statin
Management if levels are raised but below 5 times the upper limit
Start statin at low dose
Side effects of statins
Myopathy and rhabdomyolysis
o Muscle toxicity: seek medical advice if they develop muscle symptoms (pain, tenderness or weakness)
Interstitial lung disease
o Seek medical attention if patient develops dyspnoea, cough and weight loss
Teratogenic
o Statins should be avoided in pregnancy (discontinue 3 months before conceiving)
Hyperglycaemia
Statin interactions
CYP450 enzyme inducers: reduces the concentration of statin
CYP450 enzyme inhibitors: increases the concentration of statin therefore increased risk of rhabdomyolysis
Macrolides: stop taking their statin during treatment
Grapefruit juice
ORAL Fusidic acid: stop statin during treatment and restart 7 days after last dose
Examples of fibrates
Bezafibrate, ciprofibrate, fenofibrate, gemfibrozil
Monitoring requirements of fibrates
LFTs every 3 months for the first year
Side effect of fibrate when used in renal impairment
Myotoxicity
Maximum dose of Rosuvastatin with Clopidogrel
20mg
Maximum dose of Rosuvastatin with Clopidogrel
20mg
