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Who should take lipid-lowering drugs?
At risk groups for cardiovascular disease, e.g. familial hypercholesterolaemia, diabetics over 40, HTN.
Q-risk >20%
For primary and secondary prevention of cardiovascular disease
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What conservative measures should be advised when trying to lower lipid levels?
Diet, exercise, smoking cessation, reduced alcohol consumption and weight management
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What other drugs should be considered when prescribing lipid-lowering drugs?
Low dose aspirin
Anti-hypertensives
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What options are there for lowering lipid levels?
- Statins
- Fibrates
- Bile acid sequestrant
- Nicotinic acid
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What are the cholesterol targets when prescribing lipid-lowering drugs?
Total cholesterol <4mmol/l
LDL cholesterol <2mmol/l
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How do statins work?
Competitively inhibits HMG CoA in the liver (cholesterol synthesis pathway)
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When should you be cautious when prescribing statins?
Ensure hypothyroidism is well-managed
History of liver disease or alcoholism (measure LFTs at 3/12 and 12/12)
Risj of myopathy or rhabdomyolysis
Pregnancy and breast-feeding
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What are the side effects of statins?
Myalgia, Myopathy, Myositis, Rhabdomyolysis
Rarely: hepatitis, jaundice, pancreatitis and liver failure
GI disturbance, Sleep affected, headaches, dizziness
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What counsel should you give a patient before they start statins?
To report unexplained muscle pain, tenderness or weakness promptly
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Give examples of statins
Atorvastatin (lipitor)
Simvastatin
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