Hyperlipidaemia Flashcards
What are the healthy levels of total cholesterol?
5 or below
What are the healthy levels of HDL (good)?
1 or above
What are the healthy levels of LDL (bad)?
3 or below
What are the healthy levels of non-HDL (bad)?
4 or below
What are the healthy levels of triglycerides?
2.3 or below
who should lipid lowering agents be offered to?
- pt < 85yr with 10yr risk of CVD > 10%
- pt TY2D with 10yr risk of CVD >10%
- all TY1D = 40+, 10yr of diabetes, established nephropathy
- pt with CKD
- familial hypercholesterolaemia
- familial hypercholesterolaemia = genetic condiition where liver cannot
examples of statins
atorvastatin
rosuvastatin
simvastatin
fluvastatin
pravastatin
when should statins be taken and why
at night as there is high production of cholesterol at night but atorvastatin and rovostatin anytime
what strength of atorvastatin is strongest for secondary prevention?
80mg
which condition should be managed with statins
hypothyroidism
what should pt at high risk of diabetes check before starting statins
-fasting blood concentration or HbA1C
-repeat after 3 months
before initiation monitoring/tests of statins
full lipid
thyroid function
renal function
liver function
liver function monitoring with statins
-liver enzymes monitored before tx * every 3 months * every 12 months
-STOP if serum transaminase are higher than 3x upper limit
creatinine kinase monitoring with statins
-measured in pt who previously had persistent muscle aches
-if measurement 5x higher than upper limit remeasure in 7DY
->if still higher do not initiate statins
->if lvls are high but under 5x limit start statins at low dose*
s/e of statins
- myopathy and rhabdomyolysis
- interstitial lung disease
- teratogenic x gv in pregn (x give 3MT before conceiving)
myopathy and rhabdomyolysis symptoms
(s/e of statin)
muscle toxicity = give medical if experiencing msucle symptoms including pain, tenderness, weakness
interstitial lung disease symptoms
(s/e of statin)
give medical advice if experiencing dyspnoea, cough, weight loss
teratogenic
(s/e of statin)
-Don’t give in pregnancy
-Don’t give 3 months before conceiving
statins interactions
- cyp450 inducers
- cyp450 inhibitors
- fusidic acid (oral)
CYP450 inducers (statin interaction)
lower concentration of statins
CYP450 inhibitors
(interaction of statin)
-increases concentration of statins which inc risk of rhabdomyolysis
- pt who are taking macrolides should stop statin during tx
- avoid grapefruit juice
can you take statins with oral fusidic acid?
(statin interaction)
no STOP statins and restart after 7DY last dose
max dose of amiodarone and simvastatin
20mg
max dose of amlodipine and simvastatin
20mg
max dose of dilitazem/verapamil and simvastatin
20mg
max dose of ticagrelor and simvastatin
40mg
max dose of ciclosporin and atorvastatin
10mg
max dose of tipranavir and atorvastatin
10mg
what are the other lipid lowering drugs
-ezetimibe
-fibrates
ezetimble interaction
- ezetimibe + statins increase rhabomyolysis
examples of fibrates
aprofibrates, fenofibrates, gemfibozil
s/e of fibrates
-lowers lipid profile
-myotoxicity in renal impairment
monitoring of fibrates
LFT every 3 months for first year
interaction of fibrates
statin + fibrates = increased risk of muscle related s/e
