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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?

A

-statins

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
Q

what is the treatment for moderate hypertriglyceridaemia?

A

if statin not tolerated or contra-indicated= fibrate

26
Q

what is added on if a patient has severe hyperlipidaemia or hypertriglycerides?

A

DONE UNDER SPECIALIST SUPERVISION
-ezitimibe for hyperlipidaemia
-if triglycerides are still high after LDL reduced: add fibrates OR nicotinic acid (also lowers LDL)

27
Q

what needs to be done before starting statins?

A

-address any secondary causes of dyslipidaemia:
~nephrotic syndrome
~hypothyroidism
~uncontrolled diabetes
~liver disease

28
Q

what are some side effects of statins? and counselling for them?

A

-myopathy
-myositis
-rhabdomyolysis
-interstitial lung disease
-diabetes

should report tender, weak and painful muscles

29
Q

what type of patients have a higher risk of muscle toxicity?

A

-personal or family history of muscle disorder
-high alcohol intake
-renal impairment
-hypothyroidism; treat before starting statin

30
Q

what can cause an increased risk of myopathy ?

A

-concomitant ezetimibe or fibrates, espically gemfibrozil
-concomitant fusidic acid- restart statin 7 days after last dose. (increase risk of rhabdomyolysis)

31
Q

what is some counselling points for interstitial lung disease? report?

A

report short breath, cough, weight loss

32
Q

why can statins cause diabetes?

A

-statins can raise HbA1c or blood glucose levels
-caution, diabetic patients or these at high risk of diabetes

33
Q

what needs to be monitored for the use of statins?

A

-baseline lipid profile
-renal function
-thyroid function
-HbA1c if high risk of develop diabetes
-liver function

34
Q

what should be done if a patients has severe muscle symptoms, 5X normal creatine kinase or if 3X liver transaminase?

A

discontinue

35
Q

what is caused by increased statin levels?

A

increased myopathy

36
Q

what drugs cause increased statin levels?

A

-amiodarone
-grape fruit
-CCB e.g. diltiazem
-amlodipine
-imidazole/triazole anti fungal e.g. itraconazole, ciclosporin

37
Q

what is the type of interaction between statins and macrolide antibiotics like clarithromycin? +patient counselling

A

-stop taking unit antibiotics course completed. There is no need to contact prescriber

38
Q

what is the type of interaction between statins and ezetimibe? +patient counselling

A

should be avoided. Increased risk of rhabdomylsis

39
Q

what should be done if the patient is taking fusidic acid and statins?

A

restart statin 7 days after last fusidic acid (oral) dose

40
Q

what are the simvastatin dose adjustments due to interactions?

A
  • max 10mg with fibrates
    -max 20mg with amiodarone, amlodipine, diltiazem, verapamil
    -max 40mg ticagrelor
41
Q

what is the atorvastatin dose adjustments due to interactions?

A

-max 10mg with ciclosporin and tipranavir

42
Q

what is the Rosuvastatin dose adjustments due to interactions?

A

initially 5mg, max. 20mg with clopidogrel

43
Q

what can happen when pregnant and using statins?

A

teratogenic
-effective contraception during and 1 month after stopping
-stop taking 3 months before conceiving and restart after breastfeeding finished

44
Q

what is ezetimibe? how does it work?

A

-reduces blood cholesterol by inhibiting the absorption of cholesterol by the small intestine.
-alternative to statin in familial and primar hypercholesterolaemia

45
Q

what are some alternatives to statins?

A

if they are contraindicated or not tolerated in primary or familial hypercholesterolaemia can use ezetimibe

46
Q

what are some interactions of ezetimibe?

A

with statins, cause cause myopathy rhabdomyolysis

47
Q

what are fibrates and how do they work?

A

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
Q

what drugs should be given to patients that have severe hypertriglyceridaemia >10mmol/L or in those who cannot tolerate a statin (specialist) ?

A

-bezafibrate
-fenofibrate
-ciprofibrate
-gemfibrozil: don’t use with statin= high risk of myopathy

49
Q

when can bile acids sequestrates be used? and how ?

A

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
Q

what are some examples of bile acid sequestrats?

A

-colesevelam
-colestipol
-colestyramine

51
Q

what interactions occur with bile acid sequestrants?

A

-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
Q

what are nicotinic acid groups?

A

-used limited by flushing (prostaglandin-mediated

53
Q

what is omega-3-fatty acids? when should they be used?

A

-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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