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1- Foundation year Cardiovascular > Hyperlipidaemia > Flashcards

Hyperlipidaemia Flashcards

1
Q

What is hyperlipidaemia?

A

high blood levels of cholesterol, triglycerides or both

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2
Q

what is the manifestations for hyperlipidaemia?

A

-cardiovascular disease
-it causes atherosclerosis and in:
~coronary heart disease (angina, MI), strokes and transient ischaemic attacks, peripheral arterial disease

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3
Q

when is prevention of cardiovascular disease needed? primary?

A

-primary prevention:
~type 1 diabetes
~type 2 diabetes only if CVD risk >10%
~QRISK2: 10 years CVD risk >10%
~chronic kidney disease or albuminuria
-familial hypercholestrolaemia
-85 years and above (reduce risk of non-fatal MI)

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4
Q

when is prevention of cardiovascular disease needed? Secondary?

A

-established CVD
~coronary heart disease (angina, MI), cerebrovascular disease (stroke/TIA) and peripheral arterial disease)

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5
Q

what is QRISK2?

A

-Recommend by NICE
-It assess cardiovascular risk in 84 years and under.
-10 year CVD risk score >10%= offer primary prevention

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6
Q

when is QRISK unsuitable?

A

-in patients with high cardiovascular risk. Including:
~type 1 DM
~established Cardiovascular
~over 85 years
~chronic kidney disease (eGFR <60ml/min/1.73m2)
-familial hypercholestrolaemia

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7
Q

what is the hyperlipidaemia diagnosis level?

A

6mmol/L total cholesterol

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8
Q

what is a healthy total cholesterol level in adults?

A

< or equal to 5mmol/L

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9
Q

what is a high risk total cholesterol level in adults?

A

< or equal to 4mmol/L

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10
Q

what is a healthy LDL level in adults?

A

< or equal to 3mmol/L

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11
Q

what is a high risk LDL level in adults?

A

< or equal to 2mmol/L

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12
Q

what is a healthy HDL level in adults?

A

> 1mmol/L the higher the better

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13
Q

what is a healthy triglycerides level in adults?

A

<2.3 mmol/L

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14
Q

what type of drugs can cause hyperlipidaemia?

A

-antipsychotics
-immuosuppressants
-corticosteriods
-antiretroviral (HIV drugs)w

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15
Q

what type of conditions can cause hyperlipidaemia?

A

-hypothyroidism
-liver or kidney disease
-diabetes
-family history of high cholestrol
-lifestyle factors: smoking, excess alcohol, obesity and poor fatty diet

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16
Q

what a different types of lipid-regulating drugs?

A

-statins
-fibrates
-ezetimine
-bile acid sequestrants
-nicotinic acid group
-lomitapide
-alirocumab

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17
Q

what are examples of fibrates?

A

-bezafibrate
-ciprofibrate
-fenofibrate
-gemfibrozil

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18
Q

what are some drug examples of bile acid sequestrates?

A

-colesevelam
-colestpol
-colestyramine

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19
Q

what types of drugs are nicotinic acid groups?

A

-acipimox
-nicotinic acid
omega-3 fatty acid

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20
Q

how do statins work?

A

-they lower LDL cholesterol synthesis by liver via inhibition of HMG-cOa reductase. (indirectly reduces triglycerides and increase HDL cholesterol )

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21
Q

when should statin be taken? time of day?

A

at night EXCEPT atorvastatin
(cholesterol synthesis greater at night, therefore more effective

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22
Q

what is the used choice of high-intensity statin?

A

-atorvastatin
-helps prevention of cardiovascular disease
-primary presentation 20mg OD
-secondary prevention 80mg OD

rosuvastatin 10mg
simvastatin 80mg (high risk of myopathy)

23
Q

what is first line for hyperlipidaemia?

24
Q

what is the the treatment for primary and familial hypercholesterolaemia?

A

-high-intensity statin if statin not tolerated or contra-indicated= ezitimibe

25
what is the treatment for moderate hypertriglyceridaemia?
if statin not tolerated or contra-indicated= fibrate
26
what is added on if a patient has severe hyperlipidaemia or hypertriglycerides?
DONE UNDER SPECIALIST SUPERVISION -ezitimibe for hyperlipidaemia -if triglycerides are still high after LDL reduced: add fibrates OR nicotinic acid (also lowers LDL)
27
what needs to be done before starting statins?
-address any secondary causes of dyslipidaemia: ~nephrotic syndrome ~hypothyroidism ~uncontrolled diabetes ~liver disease
28
what are some side effects of statins? and counselling for them?
-myopathy -myositis -rhabdomyolysis -interstitial lung disease -diabetes should report tender, weak and painful muscles
29
what type of patients have a higher risk of muscle toxicity?
-personal or family history of muscle disorder -high alcohol intake -renal impairment -hypothyroidism; treat before starting statin
30
what can cause an increased risk of myopathy ?
-concomitant ezetimibe or fibrates, espically gemfibrozil -concomitant fusidic acid- restart statin 7 days after last dose. (increase risk of rhabdomyolysis)
31
what is some counselling points for interstitial lung disease? report?
report short breath, cough, weight loss
32
why can statins cause diabetes?
-statins can raise HbA1c or blood glucose levels -caution, diabetic patients or these at high risk of diabetes
33
what needs to be monitored for the use of statins?
-baseline lipid profile -renal function -thyroid function -HbA1c if high risk of develop diabetes -liver function
34
what should be done if a patients has severe muscle symptoms, 5X normal creatine kinase or if 3X liver transaminase?
discontinue
35
what is caused by increased statin levels?
increased myopathy
36
what drugs cause increased statin levels?
-amiodarone -grape fruit -CCB e.g. diltiazem -amlodipine -imidazole/triazole anti fungal e.g. itraconazole, ciclosporin
37
what is the type of interaction between statins and macrolide antibiotics like clarithromycin? +patient counselling
-stop taking unit antibiotics course completed. There is no need to contact prescriber
38
what is the type of interaction between statins and ezetimibe? +patient counselling
should be avoided. Increased risk of rhabdomylsis
39
what should be done if the patient is taking fusidic acid and statins?
restart statin 7 days after last fusidic acid (oral) dose
40
what are the simvastatin dose adjustments due to interactions?
- max 10mg with fibrates -max 20mg with amiodarone, amlodipine, diltiazem, verapamil -max 40mg ticagrelor
41
what is the atorvastatin dose adjustments due to interactions?
-max 10mg with ciclosporin and tipranavir
42
what is the Rosuvastatin dose adjustments due to interactions?
initially 5mg, max. 20mg with clopidogrel
43
what can happen when pregnant and using statins?
teratogenic -effective contraception during and 1 month after stopping -stop taking 3 months before conceiving and restart after breastfeeding finished
44
what is ezetimibe? how does it work?
-reduces blood cholesterol by inhibiting the absorption of cholesterol by the small intestine. -alternative to statin in familial and primar hypercholesterolaemia
45
what are some alternatives to statins?
if they are contraindicated or not tolerated in primary or familial hypercholesterolaemia can use ezetimibe
46
what are some interactions of ezetimibe?
with statins, cause cause myopathy *rhabdomyolysis*
47
what are fibrates and how do they work?
the lower triglyceride levels by reducing the livers production of VLDL (the triglycerides-carrying particle that circulates in the blood) and by speeding up the removal of triglycerides from the blood
48
what drugs should be given to patients that have severe hypertriglyceridaemia >10mmol/L or in those who cannot tolerate a statin (specialist) ?
-bezafibrate -fenofibrate -ciprofibrate -gemfibrozil: don't use with statin= high risk of myopathy
49
when can bile acids sequestrates be used? and how ?
under specialist use -bind and sequesters bile acids. The liver then produces more bile acids to replace those that havee been lost. The body uses cholesterol to make bile acid , this reduces the amount of LDL cholesterol circulating in the blood.
50
what are some examples of bile acid sequestrats?
-colesevelam -colestipol -colestyramine
51
what interactions occur with bile acid sequestrants?
-it impairs absorption of fat-soluble vitamins ADEK and other drugs -take other drugs 1 hour before (4hours for coleveselam) or 4 hours after bile acid sequestrant
52
what are nicotinic acid groups?
-used limited by flushing (prostaglandin-mediated
53
what is omega-3-fatty acids? when should they be used?
-there is no evidence for use -used an adjunct to statins and diet to lower triglycerides

1- Foundation year Cardiovascular (7 decks)

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