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High - Cardiovascular system > Hyperlipidaemia > Flashcards

Hyperlipidaemia Flashcards

1
Q

What are unmodifiable risk factors of cardiovascular diseases?

A
  • Men
  • 50+
  • Fx
  • South asian, Afro-caribbean
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2
Q

What is a cardioprotective diet?

A
  • INC: fibre, fruit + veg, oily fish
  • RED: sat fats, salt <6g, alcohol <14 units
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3
Q

What is used for cardiovascular risk assessment?

A

Offer to 40+ and those w/ estimated 10 year risk >10%

High risk:

  • QRISK: >10%
  • ASSIGN: >20%
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4
Q

Which group of people don’t require a cardiovascular risk assessment?

A

Don’t require calculating bc already at high risk:

Established CV

85+

Diabetes:

  • 40+
  • Type 1 >10 years
  • Type 2 >20 years
  • Target organ damage (nephropathy, retinopathy)
  • Significantly elevated CVD risk factors

CKD (GFR <60), albuminuria

Familial hypercholesterolemia

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5
Q

What is the primary prevention for a cardiovascular event?

A

High intensity statin = Atorvastatin 20mg

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6
Q

What is the secondary prevention for a cardiovascular event?

A

Secondary prevention: Atorvastatin 80mg

  • Atherosclerosis: 75mg aspirin daily
  • Stroke/TIA + sinus rhythm: Clopidogrel OR dipyridamole AND aspirin
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7
Q

Which drugs are a risk factor for hyperlipidaemia?

A
  • Antipsychotics
  • Immunosuppressants
  • Corticosteroids
  • Antiretrovirals (HIV)
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8
Q

What are the target levels for lipids?

A
  • Total cholesterol - 5 or less
  • Non-HDL (bad cholesterol) - 4 or less
  • LDL cholesterol (bad cholesterol) - 3 or less
  • Triglycerides (bad cholesterol) - 2.3 or less
  • HDL cholesterol (good cholesterol) - 1 or above
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9
Q

What is the treatment for hyperlipidaemia?

A

First line for high LDL cholesterol + moderately high triglycerides: Statin

  • Severe: ADD lipid lowering drug (ezetimibe)
  • If triglycerides still high: ADD fenofibrate

Familial hypercholesterolemia: High intensity statin

  • Alt: ezetimibe
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10
Q

Give examples of drugs that lower lipids

A

Statins: DEC LDL

Ezetimibe - statin alt

Fibrate: DEC TG

Bile acid sequestrant:

  • Colesevelam
  • Colestyramine
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11
Q

How do bile sequestrants work?

A
  • Interferes w absorption of fat soluble vitamins (ADEK)
  • Take 1 h BFORE (4h for coleveselam) OR 4h AFTER
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12
Q

What is the MOA of statins?

A

-Competitively block HMG-CoA reductase involved in cholesterol synthesis by the liver

-Most effective lowering LDL cholesterol

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13
Q

What is the indication of statins?

A

Hyperlipidaemia
CVD prevention

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14
Q

Which statins do you take at night?

A

Simvastatin + fluvastatin (Cholesterol synthesis at highest)

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15
Q

What are the types of high intensity statins?

A

Atorvastatin

  • Primary: 20mg
  • Secondary: 80mg

Rosuvastatin 10mg

Simvastatin: 80mg

  • MHRA: risk of myopathy
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16
Q

What are the side effects of statins?

A

Myalgia

Myasthenia gravis - muscle weakness
- MHRA: inform doctor if hx. Report weak arms/legs that worsen after activity, double vision, dropping eyelids, SOB. Seek immediate medical attention if severe breathing/swallowing problems

Myopathy, myositis, rhabdomyolisis
- Monitor: creatine kinase (5x upper limit- do not give statin)

Interstitial lung disease
- Counselling: Report dyspnoea, cough + weight loss

Diabetes - INC blood glucose + DEC glycaemic control

Hepatotoxicity
- Monitor: LFT - liver transaminase
- STOP 3x upper normal limit

17
Q

When would you be cautious to use statins?

A

Uncontrolled diabetes - INC cholesterol levels

  • Monitor: HbA1c, fasting blood glucose

Hypothyroidism - INC cholesterol levels

  • Monitor: TSH

Nephrotic syndrome (kidney damage)

  • Monitor: RFT

Liver disease

  • Monitor: LFT liver transaminases
18
Q

Are statins used in pregnancy?

A

Teratogenic

  • Child bearing age: effective contraception during treatment + 1 month after stopping
  • Should be discontinued 3 months before trying to conceive
19
Q

What are the interactions of statins?

A

Macrolides → INC statin level = myopathy
- Counsel: stop statin until abx course completed

Enzyme inhibitors → INC statin level = myopathy

Fibrate → INC rhabdomyolisis (AVOID gemfibrozil)

Hepatotoxic drugs (flucoxacillin, tetracyclines, azole antifungals, methotrexate, sulfasalazine, carbamazapine) → INC hepatotoxicity

20
Q

What are the dose adjustments of simvastatin?

A
  • 10mg: bezafibrate, ciprofibrate
  • 20mg: amiodarone, amlodipine, dilt + verapamil
21
Q

What are the dose adjustments of atorvastatin?

A

10mg: ciclosporin

22
Q

What are the dose adjustments of rosuvastatin?

A
  • 5mg: bezafibrate, ciprofibrate, fenofibrate
  • 5mg, 20mg: clopidogrel

High - Cardiovascular system (7 decks)

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