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Week 1 - Hypertension > Lipid Management > Flashcards

Lipid Management Flashcards

1
Q

What type of molecule is cholesterol?

A

Steroid.

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2
Q

Where is cholesterol primarily synthesized?

A

Liver and intestines.

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3
Q

What role does LDL-C play in atherosclerosis?

A

LDL-C crosses the endothelial barrier, becomes trapped, and forms plaque in blood vessels.

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4
Q

What are some key functions of cholesterol?

A

Regulates cell membrane fluidity, used for vitamin D production, steroid hormones, bile acids, and energy storage.

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5
Q

What can happen when a plaque disrupts or breaks?

A

It can lead to the formation of a blood clot (thrombus), potentially causing unstable angina or myocardial infarction (MI).

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6
Q

How does atherosclerosis affect cardiovascular disease risk?

A

As LDL-C levels rise, cardiovascular disease risk increases.

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7
Q

What are the cholesterol targets according to NICE guidelines?

A

Total cholesterol > 9 mmol/L or non-HDL > 7.5 mmol/L requires specialist assessment.

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8
Q

What LDL-C guideline does the European recommendation emphasize?

A

Lowering LDL-C reduces cardiovascular disease (CVD) risk.

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9
Q

What is familial hypercholesterolemia (FH)?

A

A genetic condition where high LDL-C levels are inherited.

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10
Q

How is familial hypercholesterolemia (FH) inherited?

A

Autosomal dominant pattern.

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11
Q

What is the difference between heterozygous and homozygous FH?

A

Heterozygous FH inherits one mutated gene (more common), while homozygous FH inherits two (more severe).

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12
Q

What is the primary prevention treatment for patients without previous cardiovascular history?

A

Atorvastatin 20 mg daily if QRISK3 is 10% or more.

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13
Q

When is primary prevention offered?

A

Offered to all patients with T1DM aged more than 40 years, have had diabetes for more than 10years or established nephropathy or other CVD risk factors

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14
Q

When is primary prevention considered?

A

Consider T1DM aged 18-40.

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15
Q

What are patients aged 85 or over based on?

A

Clinical judgement, not QRISK3.

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15
Q

What are patients with CKD offered?

A

Atorvastatin 20mg.

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16
Q

What is the goal of treatment in primary prevention according to NICE?

A

Achieve a reduction of more than 40% in non-HDL-C levels.

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17
Q

What is the recommended treatment for secondary prevention of cardiovascular disease?

A

Atorvastatin 80 mg daily.

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18
Q

What are the LDL-C and non-HDL-C targets in secondary prevention?

A

LDL-C ≤ 2.0 mmol/L and non-HDL-C ≤ 2.6 mmol/L.

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19
Q

How do statins work?

A

They inhibit the enzyme HMG-CoA reductase, reducing cholesterol synthesis in the liver.

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20
Q

How do statins reduce LDL-C levels?

A

They increase LDL receptor expression on hepatocytes, promoting LDL uptake from the blood.

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20
Q

What is considered a high-intensity statin regimen?

A

A regimen that reduces LDL-C by more than 50%.

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21
Q

What percentage reduction in major vascular events can statins provide?

A

For each 1 mmol/L reduction in LDL-C, statins reduce major vascular events by 22%.

22
Q

When can atorvastatin be taken?

A

Any time of the day.

23
Q

When do simvastatin, pravastatin, and fluvastatin work better?

A

In the evening.

24
Q

Why do you aim for in a full lipid profile?

A

Aiming for >40% reduction in baseline non HDL-C

25
Q

When do you do a liver function test?

A

Ok if transaminases less than 3x upper limit. Repeat within 3 months and again at 12 months.

25
Q

What does a severe renal function cause dose why’s?

A

Dose may need reducing.

26
Q

Why do a Hb1ac test?

A

To diagnose diabetes.

26
Q

Why test for TFTs?

A

To rule out hypothyroidism as a cause of high lipids.

27
Q

How do CK levels affect?

A

If persistent muscle pain prior to starting- if raised but <5x upper limit, start statin at low dose. If ≥5x upper limit, re-measure after 7 days. If levels are still five times the upper limit of normal, do not start statin. If pain while on treatment and CK 5x upper limit stop statin.

28
Q

What are the cautions of statins?

A

Haemorrhagic stroke, risk factors for rhabdomyolysis eg. muscular disorders, elderly, interacting medicines and history of liver diseases or excessive alcohol intake.

29
Q

What are the contraindictions to statins?

A

Acute liver disease, pregnant / breastfeeding or women of child-learning potential not using contraception, certain interacting medicines.

30
Q

What is the gastrointestinal side effect of satin?

A

Constipation, flatulence, dyspepsia, nausea, diarrhoea

31
Q

What is the infectious side effect of satin?

A

Nasopharyngitis (common)

32
Q

What is the musculoskeletal side effect of satin?

A

Myalgia, arthralgia, rhabdomyolysis,necrotising myopathy

33
Q

What is the metabolism side effect of satin?

A

Hyperglycaemia/ hypoglycaemia, weight gain/loss

34
Q

What is the respiratory side effect of satin?

A

Pharyngolaryngeal pain, epistaxis, interstitial lung disease.

35
Q

What is the nervous system side effect of satin?

A

Headache, dizziness, paraesthesia, hypoesthesia, dysgeusia.

36
Q

What is the skin side effect of satin?

A

Urticaria, skin rash, pruritus, alopecia.

37
Q

What is the psychiatric side effect of satin?

A

Insomnia, nightmares (uncommon).

38
Q

How much can ezetimibe reduce LDL-C levels?

A

Around 18.5%.

38
Q

What is the liver side effect of satin?

A

Derranged LFTs, liver failure, T2DM.

39
Q

What is the mechanism of action of ezetimibe?

A

It inhibits the intestinal absorption of dietary and biliary cholesterol - cholesterol absorption inhibitor. Less cholestrol delivered to liver so liver increases LDL receptor expression, remvoing cholestrol from blood

40
Q

Which is more effective: statin or ezetimibe?

A

Statins.

41
Q

What are the cautions and contraindications of ezetimibe?

A

Myopathy and rhabdomyolysis (usually in combination with statins).
Moderate to severe liver impairment.

42
Q

What are the side effects of ezetimibe?

A

Headache, hot flush, hypertension, abdominal pain, diarrhoea, flatulence, myalgia, fatigue, decreased appetite.
ALT and/or ASTincreased (usuallyincombination withstatins).

43
Q

When is bempedoic acid recommended by NICE?

A

For adults with hypercholesterolemia when statins are contraindicated or not tolerated, and ezetimibe alone is insufficient.

44
Q

What are the cautions and contraindications of bempedoic acid?

A

Gout, persistent deranged LFTs on Tx, pregnant or breastfeeding.

45
Q

What are the side effects of bempedoic acid?

A

Anaemia, gout, pain in extremity, myopathy with statins, deranged LFTs, reduction in eGFR.

46
Q

Under what conditions is icosapent ethyl approved by NICE?

A

Triglycerides ≥ 1.7 mmol/L, LDL-C 1.04-2.6 mmol/L, established cardiovascular disease, and on a statin.

47
Q

What are the cautions and contraindications of Icosapent Ethyl?

A

Allergy to fish, hepatic impairment, AF, bleed risk

48
Q

What are the side effects of Icosapent Ethyl?

A

AF, bleeding, peripheral oedema, gout, musculoskeletal pain, constipation

49
Q

How do PCSK9 inhibitors, like evolocumab and alirocumab, work?

A

They prevent PCSK9 from degrading LDL receptors, increasing LDL removal from the blood.

50
Q

Why are PCSK9 inhibitors considered third/fourth-line treatments?

A

Due to their high cost, despite significant reductions in LDL-C.

51
Q
A

Week 1 - Hypertension (4 decks)

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