Flashcards in Chapter 2 - Dyslipidaemia Deck (54)
What are the causes of hypercholestsrolaemia and hypertriglyceridaemia?
Inherited (familial hypercholestsrolaemia)
Poor glycaemic control
Medication - corticosteroids, immunosuppressants, antipsychotics
What are the aims in hypercholestsrolaemia?
Total cholesterol <5mmol/L
Give examples of high intensity statins
Atorvastatin 20, 40, 80
Rosuvastatin 10, 20, 40
How much do high intensity statins reduce LDL cholesterol by?
Give some examples of medium intensity statins
Simvastatin 20, 40
How much do medium intensity statins reduce LDL cholesterol by?
Give examples of low intensity statins
Fluvastatin 20, 40
Pravastatin 10, 20, 40
How much do low intensity statins reduce LDL cholesterol by?
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
What is the lifestyle advice associated with familial hypercholestsrolaemia?
Reduce alcohol consumption
This should be given to every patient affected
What is the first line treatment for familial hypercholestsrolaemia?
High intensity statin e.g. atorvastatin 20mg
What drugs can be considered if a statin is contraindicated, not tolerated or not effective as monotherapy?
Fibrates (when TG >10mmol/L)
Lipid modifying drugs
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)
What is first line for primary hypercholestsrolaemia?
When is secondary prevention given in hypercholestsrolaemia?
In patients with established CVD e.g. MI, angina, stroke, TIA
What is the first line drug treatment for secondary hypercholestsrolaemia?
What type of cholesterol are statins best at reducing?
They are not as effective at reducing triglycerides
What type of cholesterol are fibrates good at reducing?
They are usually given when TG levels are high (>10mmol/L) even after LDL-C had been reduced
What monitoring needs to be done before lipid modifying therapy is started?
Creatinine kinase (in patients with an increased risk of myopathy or unexpected muscle pain)
LFTs (then measure at 3 and 12 months)
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
What are the symptoms of rhabdomyolysis?
Muscle weakness of trouble moving
Dare red or brown urine, or decreased urination
What is the mechanism of action of statins
They competitively inhibit HMG-CoA reductase
Which controls the synthesis of cholesterol in the liver
What are the cautions associated with statins?
Increased risk of myopathy
What increases the risk of myopathy associated with statins?
High alcohol consumption
Personal or family history or muscle disorders
What are the side effects of statins?
Common - myalgia, thrombocytopenia
Uncommon - hepatic disorders
Rare - myopathy, rhabdomyolysis, interstitial lung disease
Can statins be given in pregnancy?
Discontinue statins 3 months before attempting to conceive
The patient should be on adequate contraception during treatment and for 1 month afterwards
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
What time should to take statins and why?
Simvastatin, pravastatin, fluvastatin
Night - cholesterol synthesis is highest when dietary intake is lowest
Any time - it has a longer half life
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