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CPT > 4. Hyperlipidaemia > Flashcards

4. Hyperlipidaemia Flashcards

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1
Q

What is the mechanism of action of statins?

A

Competitive inhibition of HMG-CoA reductase - rate controlling enzyme in HMG-CoA to mevalonate pathway

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2
Q

What is the function of statins?

A

Increased clearance of circulating LDL

Reduce cholesterol

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3
Q

What are the 2 main statins prescribed?

A

Atorvastatin

Simvastatin

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4
Q

What are the additional benefits of statin therapy?

A 
Improved vascular endothelial function 
Stabilisation of atherosclerotic plaque
Improved haemostasis
Anti-inflammatory
Antioxidant
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5
Q

What are the adverse effects of statins?

A

GI disruption, nausea, headache
Myalgia
Increased liver enzymes
Rarely rhabdomyolysis

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6
Q

What are the contraindications of statins?

A

Renal or hepatic impairment

Pregnancy and breastfeeding

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7
Q

What are the important drug interactions with statins?

A

CYP3A4 - amiodarone, diltiazem, macrolides all increase [plasma] statin
Amlodipine also increases [plasma] statin

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8
Q

What is the NICE guidelines for primary prevention of high cholesterol levels?

A

20mg atorvastatin once daily

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9
Q

What is the NICE guidelines for secondary prevention of high cholesterol?

A

80mg atorvastatin once daily

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10
Q

What must be obtained before prescribing statins?

A

Full lipid profile including HDL, non-HDL and triglycerides

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11
Q

What do fibrates do?

A

Activation of nuclear transcription factor - PPARalpha
Increase triglycerides from lipoprotein in plasma
Increase fatty acid uptake by the liver
Increase levels of HDL
Increase LDL affinity for receptor

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12
Q

What is the role of PPARalpha?

A

Regulate expression of genes that control lipoprotein metabolism - increase production of lipoprotein lipase

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13
Q

Give an example of a fibrate

A

Fenofibrate

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14
Q

What are some adverse effects of fibrates?

A

Cholelithiasis
GI upset
Myositis

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15
Q

What re some contraindications of fibrates?

A

Photosensitivity

Gallbladder disease

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16
Q

What are some important drug reactions with fibrates?

A

Warfarin - increase anti coagulation

17
Q

What is the role of cholesterol absorption inhibitors?

A

Inhibit NPC1L1 transporter at brush border
Reduces absorption of cholesterol by the gut
Hepatic LDL receptor expression increases
Decreases cholesterol and LDL

18
Q

Name a cholesterol absorption inhibitor

A

Ezetimibe

19
Q

What are some adverse effects of ezetimibe?

A

Abdominal pain

GI upset

20
Q

What is a contraindication of ezetimibe?

A

Hepatic failure

21
Q

What is an important drug reaction with ezetimibe?

A

Mindful if prescribed with statin - theoretical risk of rhabdomyolysis

22
Q

What is the mechanism of action of alirocumab?

A

PCSK9 inhibitors - reduction in LDL cholesterol

CPT (30 decks)

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