Hyperlipidaemia

Question 1

What are secondary causes of dyslipidaemia?

Answer 1

Uncontrolled diabetes, hepatic disease, nephrotic syndrome, excessive alcohol consumption, hypothyroidism. By treating these underlying conditions lipid balance may normalise

Question 2

If hypothyroidism is left untreated how can this interact with statins?

Answer 2

Increase risk of myositis

Question 3

What statin does NICE recommend for those with a 10% 10 year risk of a CV event?

Answer 3

Atorvastatin, a dose of 20mg/day or higher makes it a high intensity statin

Question 4

Tha aim of statin therapy is to reduce the non-HDL cholesterol by more than _?

Answer 4

40%, if this is not achieved ensure lifestyle changes have been implemented and consider increasing dose

Question 5

What other drug can be used if high dose statin doesnt resolve hyperlipidaemia?

Answer 5

Ezetimibe

Question 6

Why isnt a statin with nicotinic acid or a fibrate commonly used?

Answer 6

Increases risk of rhabdomlysis, should be given under specialist supervision, monitor liver function and creatine kinase

Question 7

Ezetimibe is a safe alternative to a statin if CI, if both drugs are CI what other drugs can be used?

Answer 7

Bile acid sequestrant (colesevelam, colestyramine), Fibrate (bezafibrate) or nicotinic acid, required specialist

Question 8

How are high intensity statins classified?

Answer 8

If it porduces greater LDL lowering percentage than simvastatin 40mg (classed as medium intensity)

Question 9

True or False. Stains are better at lowering LDL however fibrates are better at lowering triglycerides?

Answer 9

True, statins reduce CV events and total mortality irrespective of initial cholesterol concentration

Question 10

How does the MOA of lipid lowering drug classes (statins, ezetimibe, fibrates, bile acid sequestrants) differ?

Answer 10

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

Question 11

What antibiotic requires monitoring if the patient is taking colesvelam?

Answer 11

Ciclosporin, colesvelam can change abdosrption curve. Need to monitor levels of ciclosporin before, during and after tx with colesvelam

Question 12

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

Answer 12

All except RA pts

Question 13

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?

Answer 13

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.

Question 14

If a patient complains of muscle pains due to a statin does this make the patient CI?

Answer 14

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.

Question 15

Statins are known to slightly increase blood glucose levels. Should the statin be discontinued if this occurs?

Answer 15

No, benefits continue to outweigh the risks

Question 16

What respiratory symptoms should be a major concern in a patient taking statins?

Answer 16

Difficulty or laboured breathing, coughing, weight loss. Statins associated with risk of interstitial lung disease

Question 17

Statins should be avoided in pregnancy, when should statins be stopped if the patient wnats to concieve?

Answer 17

Atleast 3 month before attempting to concieve

Question 18

What initial monitoring requirments should be taken before starting a patient on statins?

Answer 18

Full lipid profile, liver function, creatine kinase, blood glucose of hba1c if at risk of diabetes.

Question 19

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?

Answer 19

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.