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Cardiovascular Disease > Hyperlipidaemia > Flashcards

Hyperlipidaemia Flashcards

1
Q

Target total cholesterol

A

5 or below

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2
Q

Target HDL

A

1 or above

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3
Q

Target LDL

A

3 or below

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4
Q

Target non-HDL

A

4 or below

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5
Q

Target triglycerides

A

2.3 or below (most dangerous)

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6
Q

What percentage reduction in non-HDL cholesterol should you aim for after starting lipid-lowering therapy?

A

> 40%

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7
Q

When should you offer a lipid-lowering agent to a patient?

A

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

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8
Q

What is offered if the maximum tolerate dose of statin fails to control cholesterol levels?

A

Combination with ezetimibe
OR alternative statin

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9
Q

What is offered if statins and ezetimibe are not tolerated?

A

Fibrates or bile acid sequestrants (colestyramine, or colestipol hydrochloride) under specialist advice

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10
Q

Side effect of using a statin and fibrate in combination?

A

Rhabdomyolysis

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11
Q

Which statins are to be taken at night?

A

Simvastatin, Pravastatin, Fluvastatin

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12
Q

Which statins are to be taken at any time of the day?

A

Atorvastatin and rosuvastatin

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13
Q

Which disorder should be managed prior to commencing a statin?

A

Hypothyroidism

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14
Q

Monitoring requirement for patients at high risk of diabetes before starting statin

A

HbA1c and repeat at 3 months

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15
Q

Maximum dose of simvastatin when used with amiodarone

A

20mg

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16
Q

Maximum dose of simvastatin when used with amlodipine

A

20mg

17
Q

Maximum dose of simvastatin when used with RL-CCB

A

20mg

18
Q

Maximum dose of simvastatin when used with ticagrelor

A

40mg

19
Q

Maximum dose of atorvastatin when used with ciclosporin

A

10mg

20
Q

Maximum dose of atorvastatin when used with tipranavir

A

10mg

21
Q

Monitoring requirements before starting a statin

A

Full lipid profile
Thyroid function
Renal function
LFTs

22
Q

How often are the monitoring requirements for statins repeated?

A

3 months after starting
Annually

23
Q

When to discontinue statin if liver enzymes are abnormal?

A

When serum transaminases are raised by more than 3 times the upper limit

24
Q

When to measure creatine kinase levels?

A

Measured in patients who have previously had persistent muscle aches prior to initiating statin

25
Q

Management if creatine kinase is 5 times the upper limit?

A

Remeasure in 7 days

26
Q

Management if CK is still higher than 5 times the upper limit

A

Do not initiate statin

27
Q

Management if levels are raised but below 5 times the upper limit

A

Start statin at low dose

28
Q

Side effects of statins

A

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

29
Q

Statin interactions

A

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

30
Q

Examples of fibrates

A

Bezafibrate, ciprofibrate, fenofibrate, gemfibrozil

31
Q

Monitoring requirements of fibrates

A

LFTs every 3 months for the first year

32
Q

Side effect of fibrate when used in renal impairment

A

Myotoxicity

33
Q

Maximum dose of Rosuvastatin with Clopidogrel

A

20mg

34
Q

Maximum dose of Rosuvastatin with Clopidogrel

A

20mg

Cardiovascular Disease (11 decks)

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