Statins Flashcards

1
Q

What do statins inhibit?

A

HMG-CoA reductase

(enzyme that limits hepatic choelsterol synthesis)

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2
Q

What are some adverse side effects of statins?

A
  1. Myopathy (Myalgia, myositis, rhabdomyolysis and raised CK)
  2. Liver impairment - check LFTS 3 and 12 months.
  3. Intracerebral haemorrhage if previously had a stroke.
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3
Q

In what type of statins is myopathy more common with?

A

Lipophilic statins (simvastatin or atorvastatin)

Not so much with hydrophilic statins (rosuvastatin, pravastatin or fluvastatin)

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4
Q

When should statins be stopped regarding serum transaminases and liver impairment?

A

If ALT or AST rise to 3 times the upper limit of the reference range.

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5
Q

What are some risk factors that can cause people to develop myopathy with statin use?

A
  • Female sex
  • Advanced age
  • Low BMI
  • Multisystem disease like DM.
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6
Q

Who does the Royal College of Physicians recommend avoiding statins in and why?

A

People with a history of intracerebral haemorrhage because of the increased risk of intracerebral haemorrhage in patients who have previously had a stroke.

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7
Q

Are intracerebral haemorrhages seen in patient who are being treated for primary prevention?

A

No

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8
Q

Who should receive a statin?

A
  • All people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
  • NICE recommend anyone with a 10-year cardiovascular risk >= 10%
  • Patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
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9
Q

When should statins be taken and why?

A

At night because this is when the majority of cholesterol synthesis occurs.

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10
Q

NICe don’t have any targets for cholesterol and LDL levels. What do the Joint British Societies recommend we lower it to?

A

Total cholesterol <4.0 mmol/l

LDL cholesterol <2.0 mmol/l

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