4.1 Hyperlipidaemias Flashcards
explain how statins work
competitive inhibitor of HMG-CoA reductase, less cholesterol made so up regulation of LDL receptors, so increased LDL clearance from blood
simvastatin vs atrovatstatin
simvastatin has a shorter half life (2 hours) so given at night, also is a prodrug activated by first pass metabolism
atorvatstatin is active, longer half life so can be given morning or night. helps adherence
other meds to consider when thinking about prescribing a statin
inhibitors of CYP3A4 as they can increase plasma statin conc e.g. amiodarone, macrlides…
also grapefruit juice
statin doses
primary prevention: 20mg
secondary prevention: 80mg
nocebo effect
treatment has a negative effect due to negative patient expectations e.g. patient experiences symptoms of muscle pain from statin, because they know its possible
important drug reactions of fibrates
warfarin, can increase coagulation
example of cholesterol absorption inhibitors
ezetimibe
contraindications for ezetimibe
hepatic failure, can mean drugs not metabolised
important drug reaction for ezetimibe
rhabdomyolysis possible with statin
PCSK9 inhibitor examples and how they work
alirocumab
less LDL receptors internalised so LDL can still bind to them and be internalised
inclisiran
PCSK9 prodcution prevented
do plant sterols work with ezetimibe?
no known therapeutic benefit
could alcohol be used for hypercholesteraemia?
no, increases HDL but also increases TAG
