Chapter 2 - Dyslipidaemia Flashcards Preview

Pharmacy Pre-Reg 2020/2021 > Chapter 2 - Dyslipidaemia > Flashcards

Flashcards in Chapter 2 - Dyslipidaemia Deck (54)
Loading flashcards...
1

What are the causes of hypercholestsrolaemia and hypertriglyceridaemia?

Inherited (familial hypercholestsrolaemia)
Alcohol
Fatty food
Poor glycaemic control
Smoking
Obesity
Medication - corticosteroids, immunosuppressants, antipsychotics

2

What are the aims in hypercholestsrolaemia?

Total cholesterol <5mmol/L
LDL <3mmol/L
HDL >1mmol/L
Triglycerides <2.3mmol/L

3

Give examples of high intensity statins

Atorvastatin 20, 40, 80
Rosuvastatin 10, 20, 40
Simvastatin 80

4

How much do high intensity statins reduce LDL cholesterol by?

>40%

5

Give some examples of medium intensity statins

Atorvastatin 10
Rosuvastatin 5
Simvastatin 20, 40
Fluvastatin 80

6

How much do medium intensity statins reduce LDL cholesterol by?

30-40%

7

Give examples of low intensity statins

Simvastatin 10
Fluvastatin 20, 40
Pravastatin 10, 20, 40

8

How much do low intensity statins reduce LDL cholesterol by?

<30%

9

What is familial hypercholestsrolaemia and when should this be suspected?

This is inherited hypercholestsrolaemia

If should be suspected history
Total cholesterol is >7.5mmol/L
There is a personal or family histrionic of CHD

10

What is the lifestyle advice associated with familial hypercholestsrolaemia?

Stop smoking
Lose weight
Reduce alcohol consumption

This should be given to every patient affected

11

What is the first line treatment for familial hypercholestsrolaemia?

High intensity statin e.g. atorvastatin 20mg

12

What drugs can be considered if a statin is contraindicated, not tolerated or not effective as monotherapy?

Ezetimibe
Fibrates (when TG >10mmol/L)
Lipid modifying drugs

13

In hypercholestsrolaemia, who should primary prevention be given to?

Anyone with familial hypercholestsrolaemia

Anyone with type 1 diabetes

Anyone with CKD

Anyone with a 10 year CVD risk of >10% (QRISK score)

14

What is first line for primary hypercholestsrolaemia?

Atorvastatin 20mg

15

When is secondary prevention given in hypercholestsrolaemia?

In patients with established CVD e.g. MI, angina, stroke, TIA

16

What is the first line drug treatment for secondary hypercholestsrolaemia?

Atorvastatin 80mg

17

What type of cholesterol are statins best at reducing?

LDL-C
They are not as effective at reducing triglycerides

18

What type of cholesterol are fibrates good at reducing?

Triglycerides
They are usually given when TG levels are high (>10mmol/L) even after LDL-C had been reduced

19

What monitoring needs to be done before lipid modifying therapy is started?

TC
HDL-C
Non HDL-C
TG

Creatinine kinase (in patients with an increased risk of myopathy or unexpected muscle pain)
Renal function
LFTs (then measure at 3 and 12 months)
Thyroid function
HbA1c

20

What is rhabdomyolysis?

This is a serious syndrome caused by direct muscle injury

The muscle fibres die and release their contents into the bloodstream

This can lead to serious complications e.g. renal failure

21

What are the symptoms of rhabdomyolysis?

Muscle pain
Muscle weakness of trouble moving
Dare red or brown urine, or decreased urination

22

What is the mechanism of action of statins

They competitively inhibit HMG-CoA reductase
Which controls the synthesis of cholesterol in the liver

23

What are the cautions associated with statins?

Elderly
Liver disease
Increased risk of myopathy

24

What increases the risk of myopathy associated with statins?

High dose
High alcohol consumption
Hypothyroidism
Renal impairment
Personal or family history or muscle disorders

25

What are the side effects of statins?

Common - myalgia, thrombocytopenia

Uncommon - hepatic disorders

Rare - myopathy, rhabdomyolysis, interstitial lung disease

26

Can statins be given in pregnancy?

No

Discontinue statins 3 months before attempting to conceive

The patient should be on adequate contraception during treatment and for 1 month afterwards

27

What patient counselling should be given for statins?

Seek advice if you develop muscle pain, weakness, tenderness or dark urine/less urine (rhabdomyolysis)

Seek advice if you develop difficulty breathing, a cough or weight loss (interstitial lung disease)

Statins have many interactions with food and medications e.g. grapefruit juice

28

What time should to take statins and why?

Simvastatin, pravastatin, fluvastatin
Night - cholesterol synthesis is highest when dietary intake is lowest

Atorvastatin, rosuvastatin
Any time - it has a longer half life

29

When should the dose of rosuvastatin be reduced?

Risk factors for myopathy or rhabdomyolysis

Concurrent use of fibrates, clopidogrel and some antifungals

Patients aged over 70

Patients of an Asian origin

30

What are the main drug interactions of statins?

Amiodarone, verapamil, diltiazem, amlodipine- increased risk of myopathy

Clarithromycin, erythromycin, ciclosporin - temporarily stop the statin during antibiotic treatment

Grapefruit juice - take 12h apart
At johns wort

Fibrates, ezetimibe