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PR - CARDIOVASCULAR SYSTEM > HYPERLIPIDAEMIA > Flashcards

HYPERLIPIDAEMIA Flashcards

1
Q

Total cholesterol

A

5 or below

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2
Q

HDL (good cholesterol)

A

1 or above

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3
Q

LDL (bad cholesterol)

A

3 or below

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4
Q

Non-HDL (bad cholesterol)

A

4 or below

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5
Q

Triglycerides

A

2.3 or below

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6
Q

Hyperlipidaemia

A

High blood levels of cholesterol, triglycerides or both

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7
Q

Lipid lowering agents should be offered in

A

Lipid Lowering agents should be offered in:
Patients under 85 with a 10-year risk of CVD greater than 10%
Patients with type 2 diabetes 10-year risk of CVD greater than 10%
All type 1 diabetic patients with:
* Age over 40
* Diabetes for over 10 years
* Established nephropathy
Patients with chronic kidney disease
Patients with familial hypercholesterolaemia

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8
Q

QRISK2

A

Assesses cardiovascular risk in those aged 84 or under.
QRISK score > 10% = offer primary prevention.
Unsuitable in those at risk of CVD:
- Type 1 diabetes
- Established CVD
- 85+
- CKD (eGFR <60)
- Familial hypercholesterolemia

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9
Q

Primary prevention

A

Actions taken to prevent the onset of high cholesterol levels before they occur.
Given to high risk groups:
- Type 1 diabetes
- Type 2 diabetes (if CVD risk >10%)
- QRISK score >10%
- CKD or albuminuria
- Familial hypercholesterolaemia
- 85+ (reduces risk of non-fatal MI)

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10
Q

Secondary prevention

A

Aimed at individuals who have already been diagnosed with hyperlipidemia or have experienced CVD events:
- CHD (angina, MI)
- Cerebrovascular disease (stroke/TIA)
- Peripheral arterial disease

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11
Q

Statins examples

A

Atorvastatin Rosuvastatin Simvastatin Fluvastatin Pravastatin

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12
Q

What time of the day should you take statins?

A

Atorvastatin and Rosuvastatin can be taken any time during the day
Cholesterol synthesis is greater at night, therefore it will be more effective.

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13
Q

Prevention of CVD

A

High intensity statin.
Atorvastatin:
- Primary prevention = 20 mg
- Secondary prevention = 80mg

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14
Q

Hyperlipidaemia - primary hypercholesterolaemia

A

High-intensity statin
If statin not tolerated or contra-indicated give ezetimibe.

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15
Q

Hyperlipidaemia - familial hypercholesterolaemia

A

High-intensity statin
If statin not tolerated or contra-indicated give ezetimibe.

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16
Q

Hyperlipidaemia - moderate hypertriglyceridaemia

A

If statin not tolerated or contra-indicated give fibrate

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17
Q

Severe hyperlipidaemia

A

Add on ezetimibe

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18
Q

Resistant hyperlipidaemia

A

Triglycerides still high after LDL reduced
- Add fibrate or nicotinic acid (also lowers LDL)

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19
Q

atorvastatin 80mg

A

strongest
used in secondary prevention (heart attack)

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20
Q

Hypothyroidism and statins

A

Hypothyroidism should be managed before starting statin

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21
Q

Patients at high risk of diabetes mellitus

A

should have fasting blood-glucose concentration or HbA1C checked before starting statin
Repeat after 3 months

22
Q

Monitoring

A

Before initiation
full lipid profile
thyroid function
renal function
liver function
creatine kinase

23
Q

Monitoring - liver function

A

Liver enzymes measured: before treatment → 3 months → 12 months
Discontinue if serum transaminases are raised by more than 3 x UL

24
Q

Monitoring - Creatine kinase

A

Measured in patients who have previously had persistent muscle aches
If measurement 5 x more than UL - remeasure in 7 days

If still higher than 5 times the limit - do not initiate statins

If levels are raised but under 5 times the limit - start at lower dose

25
Q

Statins - side effects

A

Myopathy and Rhabdomyolysis
Interstitial Lung Disease
Teratogenic

26
Q

Myopathy and Rhabdomyolysis

A

Muscle toxicity → seek medical advice if they develop muscle symptoms (pain, tenderness, or weakness)

27
Q

Interstitial Lung Disease

A

Seek medical attention if patient develops dyspnoea, cough, and weight loss

28
Q

Teratogenic

A

Statins should be avoided in pregnancy (discontinue 3 months before conceiving)

29
Q

Statins - interactions

A

CYP450 Enzyme Inducers
CYP450 Enzyme Inhibitors
Fusidic Acid (oral)

30
Q

Interactions - CYP450 Enzyme Inducers

A

Reduces the concentration of statin

31
Q

Interactions - CYP450 Enzyme Inhibitors

A

CYP450 Enzyme Inhibitors
Increases the concentration of statin → increased risk of rhabdomyolysis
Patients prescribed macrolides should stop taking their statin during treatment
Avoid drinking grapefruit juice

32
Q

Interactions Fusidic Acid (oral)

A

Stop statin during treatment → restart 7 days after last dose

33
Q

Clari and atorvastatin

A

tell pt stop statin whilst on clarity

34
Q

Statin max doses

A

Amiodarone + Simvastatin = 20mg
Amlodipine + Simvastatin = 20mg
Diltiazem / Verapamil + Simvastatin = 20mg
Ticagrelor + Simvastatin = 40mg
Ciclosporin + Atorvastatin 10mg
Tipranavir + Atorvastatin = 10mg

35
Q

Amlodipine + Simvastatin = 20mg

A

important interaction
statin may not exceed 20mg
amlodipine increases levels of simvastatin
increased risk of rhabdomyolysis

36
Q

statin + ezetimibe

A

increased risk of rhabdomyolysis

37
Q

Fibrates

A

Bezafibrate Ciprofibrate Fenofibrate Gemfibrozil

38
Q

Fibrates - side effects

A

Myotoxicity in renal impairment

39
Q

Fibrates - monitoring

A

LFTs every 3 months for first year

40
Q

Statin + Fibrates =

A

increased risk of muscle related side-effects
rhabdomyolysis
Statin + gemfibrozil (do not use together)

41
Q

Bile Acid Sequestrants - MOA

A

Binds to and sequesters bile acids.
Liver then produces more bile acids to replace those lost.
Body uses cholesterol to make bile acids = reduced LDL cholesterol circulating in the blood.

42
Q

Bile Acid Sequestrants - examples

A

Colesevelam
Colestipol
Colestyramine

43
Q

Bile Acid Sequestrants - initiation

A

Must be initiated by a specialist

44
Q

Bile Acid Sequestrants - interactions

A

Impairs absorption of fat-soluble vitamins (ADEK) and other drugs

45
Q

Bile Acid Sequestrants - administration counselling points

A

Take other drugs 1 hour before (4 hours for colesevelam) or 4 hours after bile sequestrant.

46
Q

Nictoinic acid - examples

A

Acipimox
Nicotinic acid
Omega-3 fatty acid

47
Q

Nicotinic acid - MOA

A

Lowers cholesterol and triglyceride concentrations by inhibiting synthesis.
Increases HDL cholesterol

48
Q

Nicotinic acid - indication

A

Adjunct to statin OR alone if statin not tolerated

49
Q

Nicotinic acid - CI

A

Active peptic ulcer disease
Arterial bleeding

50
Q

Omega-3 Fatty Acids - Indication

A

Used in adjunct to statin/diet.
Not be used alone
No evidence for use

51
Q

Omega-3 Fatty Acids - cautions

A

Anticoagulant treatment
Haemorrhagic disorders
- Has natural anticoagulant properties so can thin the blood

52
Q

Omega-3 Fatty Acids - side effects

A

AF
Burping
Constipation
GI distubrances
N + V

PR - CARDIOVASCULAR SYSTEM (48 decks)

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