Hyperlipidemia

Question 1

What are the healthy levels in a lipid full profile?

Answer 1

Total cholesterol = 5 or below
HDL (good) = 1 or above
LDL (bad) = 1 or above
Non-HDL = 4 or below
Triglycerides = 2.3 or below

Question 2

What is the criteria to be initiated lipid lowering agents?

Answer 2

• under 85 with 10 year risk of CVD greater than 10%
• T2D patient with 10 year risk of CVD greater than 10%
• ALL T1D patients with:
  
  • who are 40 years or older
  • who have had diabetes for over 10 years
  • established neuropathy
• patients with chronic kidney disease
  -patients with familial hypercholesterolaemia (genetic)

Question 3

What are the three lipid lowering agents used to treat cholesterol

Answer 3

-statins
-ezetimibe
- fibrates

Question 4

What the the 5 names of statins

Answer 4

Atorvastatin
Pravastatin
Rosuvastatin
Simvastatin
Fluvastatin

Question 5

Which two satins are used any time of the day

Answer 5

Atorvastatin and rosuvastatin

Question 6

Why is 80mg atorvastatin used for

Answer 6

Secondary prevention of heart attacks

Question 7

What should be managed before starting statins

Answer 7

Hypothyroidism

Question 8

Patients who have high risk of diabetes should have what done

Answer 8

They should have fasting blood glucose concentration or HbA1c levels checked before starting statins and should be repeated after 3 months

Question 9

Why is pravastatin, simvastatin and fluvastatin be taken at night

Answer 9

Due to cholesterol being made at night

Question 10

What monitoring is required when taking statins

Answer 10

• before initiation a full lipid profile, thyroid function and renal function should be assessed
• liver function and liver enzymes should be measured before treatment after 3 months and after 12 months
• discontinue if serum transaminase are raised by more than 3x the upper limit
• creatinine kinase is measured in patients who have previously had persistent muscle aches
  If measurement is higher than the 5x upper limit- re measure after 7 days
  If still 5x higher than upper limit then don’t start statins
  If levels are raised but are lower than 5x upper limit then start at a lower dose

Question 11

Statins side effects

Answer 11

Myopathy and rhabdomyoisis- muscle toxicity = seek medical advice if experiencing Pain, tenderness or weakness

Interstitial lung disease- seek medical attention if patient develops weight loss, cough or Dyspnoea

Teratogenic - avoid in pregnancy and discontinue 3 months before conceiving

Question 12

What are the interactions of statins

Answer 12

CYP450 enzyme inducers- reduces conc of statins

CYP450 enzyme inhibitors- increases the conc of statins and therefore and increased risk of rhabdomyolysis

Patients who are prescribed macrolide should stop taking statins during treatment

Avoid grapefruit juice

Fusidic acid (oral) stop taking statins during treatment and restart after 7 days of the last dose

Question 13

What are stains maximum dose

Answer 13

Amiodarone + simvastatin 20mg
Amlodipine + simvastatin 20mg
Diltiazem/verapamil + simvastatin 20mg
Ticagrelar + simvastatin 40mg
cyclosporine and atorvastatin 10mg
Tipranavir + atorvastatin 10mg

Question 14

Ezetimibe and stains can cause what?

Answer 14

Increased risk of rhabdomyloysis

Question 15

What are fibrates

Answer 15

Bezafibrate, fenofibrate and ciprofibrate and gemifibrozil
Myotoxicity in renal impairment
- measure LFTs every 3 months for the first year
Statins and fibrates has an increased risk of muscle related side effects