Hyperlipidaemia

Question 1

Target total cholesterol

Answer 1

5 or below

Question 2

Target HDL

Answer 2

1 or above

Question 3

Target LDL

Answer 3

3 or below

Question 4

Target non-HDL

Answer 4

4 or below

Question 5

Target triglycerides

Answer 5

2.3 or below (most dangerous)

Question 6

What percentage reduction in non-HDL cholesterol should you aim for after starting lipid-lowering therapy?

Answer 6

> 40%

Question 7

When should you offer a lipid-lowering agent to a patient?

Answer 7

Patients under 85 with a 10 year risk of CVD greater than 10%
Patients with T2DM with a greater than 10% risk of CVD in next 10 years
All T1DM with:
- Age over 40
- Diabetes for over 10 years
- Established nephropathy
Patients with CKD
Patients with familial hypercholesterolaemia presenting with high cholesterol

Question 8

What is offered if the maximum tolerate dose of statin fails to control cholesterol levels?

Answer 8

Combination with ezetimibe
OR alternative statin

Question 9

What is offered if statins and ezetimibe are not tolerated?

Answer 9

Fibrates or bile acid sequestrants (colestyramine, or colestipol hydrochloride) under specialist advice

Question 10

Side effect of using a statin and fibrate in combination?

Answer 10

Rhabdomyolysis

Question 11

Which statins are to be taken at night?

Answer 11

Simvastatin, Pravastatin, Fluvastatin

Question 12

Which statins are to be taken at any time of the day?

Answer 12

Atorvastatin and rosuvastatin

Question 13

Which disorder should be managed prior to commencing a statin?

Answer 13

Hypothyroidism

Question 14

Monitoring requirement for patients at high risk of diabetes before starting statin

Answer 14

HbA1c and repeat at 3 months

Question 15

Maximum dose of simvastatin when used with amiodarone

Answer 15

20mg

Question 16

Maximum dose of simvastatin when used with amlodipine

Answer 16

20mg

Question 17

Maximum dose of simvastatin when used with RL-CCB

Answer 17

20mg

Question 18

Maximum dose of simvastatin when used with ticagrelor

Answer 18

40mg

Question 19

Maximum dose of atorvastatin when used with ciclosporin

Answer 19

10mg

Question 20

Maximum dose of atorvastatin when used with tipranavir

Answer 20

10mg

Question 21

Monitoring requirements before starting a statin

Answer 21

Full lipid profile
Thyroid function
Renal function
LFTs

Question 22

How often are the monitoring requirements for statins repeated?

Answer 22

3 months after starting
Annually

Question 23

When to discontinue statin if liver enzymes are abnormal?

Answer 23

When serum transaminases are raised by more than 3 times the upper limit

Question 24

When to measure creatine kinase levels?

Answer 24

Measured in patients who have previously had persistent muscle aches prior to initiating statin

Question 25

Management if creatine kinase is 5 times the upper limit?

Answer 25

Remeasure in 7 days

Question 26

Management if CK is still higher than 5 times the upper limit

Answer 26

Do not initiate statin

Question 27

Management if levels are raised but below 5 times the upper limit

Answer 27

Start statin at low dose

Question 28

Side effects of statins

Answer 28

Myopathy and rhabdomyolysis o Muscle toxicity: seek medical advice if they develop muscle symptoms (pain, tenderness or weakness) Interstitial lung disease o Seek medical attention if patient develops dyspnoea, cough and weight loss Teratogenic o Statins should be avoided in pregnancy (discontinue 3 months before conceiving) Hyperglycaemia

Question 29

Statin interactions

Answer 29

CYP450 enzyme inducers: reduces the concentration of statin CYP450 enzyme inhibitors: increases the concentration of statin therefore increased risk of rhabdomyolysis Macrolides: stop taking their statin during treatment Grapefruit juice ORAL Fusidic acid: stop statin during treatment and restart 7 days after last dose

Question 30

Examples of fibrates

Answer 30

Bezafibrate, ciprofibrate, fenofibrate, gemfibrozil

Question 31

Monitoring requirements of fibrates

Answer 31

LFTs every 3 months for the first year

Question 32

Side effect of fibrate when used in renal impairment

Answer 32

Myotoxicity

Question 33

Maximum dose of Rosuvastatin with Clopidogrel

Answer 33

20mg

Question 34

Maximum dose of Rosuvastatin with Clopidogrel

Answer 34

20mg