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Lipids (Statins (Side effects
muscle pain, myopathy, rhabdomylosis, dose…
Lipids
Statins
Side effects
- muscle pain, myopathy, rhabdomylosis, dose related
- 0.25% increased risk of diabetes = risks outweigh benefits
- either: stop statin, reduce dose, change to lower intensity statin
Mode of action
- inhibits HMG-CoA (cholesterol synthesis in liver)
- can also raise HDL
Interactions
- more an issue with simvastatin than ator
- a lot of antibiotics, heart meds, grapefruit
Before starting a statin
- smoking
- alcohol
- BP
- BMI
- lipid levels
- HbA1c
- renal and eGFR
- ALT/AST baseline less than 3x ULN
- TSH
- interactions
- muscle plain and creatinine kinase
Other drugs
Antiplatelets
- not for primary prevention
- 2ndary:
- HTN+elderly+10yr risk
- HTN+eGFR less than 45
- clopidogrel for people who cant tol aspirin
Ezetimibe
- inhibits dietary abs, 1ry hyperchol
- can be used with statin, increased risk of myopathy
Fibrates
- act by decreasing TGL, can cause muscle tox and renal failure if given with statins
- monitor liver function and creatinine kinase if given
- don't offer to px treated for prim or sec prev, CKD, D1 or 2
About
-
-
LDL: major transporters in blood, encourage deposit in arteries (bad cholesterol)
Diagnosis
QRISK2
use for:
- primary prevention up to 84
- DM2
DON'T USE FOR:
- DM1
- eGFR <60 or albuminuria
- established CVD
- hypercholesterolaemia
LIPIDS
full lipid profile:
- total cholesterol - >9
- HDL
- non-HDL - >7.5
- triglycerides - >20
- unless due to alcohol/glycaemic
- if 10-20 repeat with fasting test within 2wks
Primary prevention
- diabetes 1&2, CKD
- 20mg daily
- D1: over 40, had for 10 year, kidney issues or other risks
- D2: 10% 10yr risk of CVD
- CKD: always offer, increase dose if eGFR is over 30
Secondary prevention
- 80mg
- interaction or specific patient factors may lead to reduced drug dose or different drug
- 40% reduction in non-HDL needed in 3mo.
- increase dose, lifestyle, check adherence