Hyperlipidaemia Flashcards
What are secondary causes of dyslipidaemia?
Uncontrolled diabetes, hepatic disease, nephrotic syndrome, excessive alcohol consumption, hypothyroidism. By treating these underlying conditions lipid balance may normalise
If hypothyroidism is left untreated how can this interact with statins?
Increase risk of myositis
What statin does NICE recommend for those with a 10% 10 year risk of a CV event?
Atorvastatin, a dose of 20mg/day or higher makes it a high intensity statin
Tha aim of statin therapy is to reduce the non-HDL cholesterol by more than _?
40%, if this is not achieved ensure lifestyle changes have been implemented and consider increasing dose
What other drug can be used if high dose statin doesnt resolve hyperlipidaemia?
Ezetimibe
Why isnt a statin with nicotinic acid or a fibrate commonly used?
Increases risk of rhabdomlysis, should be given under specialist supervision, monitor liver function and creatine kinase
Ezetimibe is a safe alternative to a statin if CI, if both drugs are CI what other drugs can be used?
Bile acid sequestrant (colesevelam, colestyramine), Fibrate (bezafibrate) or nicotinic acid, required specialist
How are high intensity statins classified?
If it porduces greater LDL lowering percentage than simvastatin 40mg (classed as medium intensity)
True or False. Stains are better at lowering LDL however fibrates are better at lowering triglycerides?
True, statins reduce CV events and total mortality irrespective of initial cholesterol concentration
How does the MOA of lipid lowering drug classes (statins, ezetimibe, fibrates, bile acid sequestrants) differ?
Statins: inhibit enzyme HMG-coA reductase used in cholesterol synthesis
Bile acid sequestrants: Binds bile acids to stop reabsorption to promote conversion of cholesterol to bile acids
Ezetimibe: Inhibits intestinal absorption of cholesterol
Fibrates: ? reduce serum triglycerides
Nicotinic acid: Inhibits synthesis of cholesterol and TG
What antibiotic requires monitoring if the patient is taking colesvelam?
Ciclosporin, colesvelam can change abdosrption curve. Need to monitor levels of ciclosporin before, during and after tx with colesvelam
What which of these patientds are more at risk of muscle toxicity of statins? Rheumatoid arthirits Family history of muscular disorder History of muscular toxicity PTs with high intake of alcohol Renal impariment Hypothyroidism
All except RA pts
If a patient at risk of muscle effects is being started on a statin and their baseline creatine kinase conc is 5x the upper limit of normal, can the patient be given a statin?
Yes, although not usually given however some pts may have high elevated levels due to a physical occupation or rigorous exercise, need to consider lifestyle of the patient.
If a patient complains of muscle pains due to a statin does this make the patient CI?
No. Reports of myalgia is common, however true muscle toxicity is rare. If a stain is discontinued and symptoms resolve and creatine kinase conc return to normal then a statin can be reintroduced but at a lower dose with close monitoring.
Statins are known to slightly increase blood glucose levels. Should the statin be discontinued if this occurs?
No, benefits continue to outweigh the risks
What respiratory symptoms should be a major concern in a patient taking statins?
Difficulty or laboured breathing, coughing, weight loss. Statins associated with risk of interstitial lung disease
Statins should be avoided in pregnancy, when should statins be stopped if the patient wnats to concieve?
Atleast 3 month before attempting to concieve
What initial monitoring requirments should be taken before starting a patient on statins?
Full lipid profile, liver function, creatine kinase, blood glucose of hba1c if at risk of diabetes.
Statins should be avoided in patients with active liver disease and used in caution for hx of liver disease. Should a patient with raised serum transaminse (x2 upper limit) be started on a statin?
Yes, pts with raised transaminase levels but less than 3 times the upper limit should NOT be routinely excluded form statin therapy. If levels are more than 3 statin should be discontinued.
