6. Drugs used for lipid disorders, heart failure and hypertension

Question 1

Which groups benefit from statins?

Answer 1

Those with atherosclerotic CV disease
Those with high LDL
Those with diabetes and slightly elevated LDL
No current atherosclerotic CV disease but estimated 10 year risk of 7.5% or more

Question 2

What are the causes of secondary hyperlipidaemia?

Answer 2

Diabetes
Obesity
Hypothyroidism
Alcohol, liver disease, renal disease
Drugs

Question 3

Which drugs can cause hyperlipidaemia?

Answer 3

OCP
Thiazide
Steroids

Question 4

What drugs are used in the treatment of hyperlipidaemia?

Answer 4

Statins
Bile acid binding resins
Fibrates
Nicotinic acid

Question 5

What are statins also known as?

Answer 5

HMG-CoA reductase inhibitors

Question 6

How do statins work?

Answer 6

Reduce LDL cholesterol

Question 7

How does nicotinic acid work?

Answer 7

Increases HDL cholesterol

Question 8

How do fibrates work?

Answer 8

Reduce TAGs

Increase the activity of peripheral LPL

Question 9

What are the adverse effects of statins?

Answer 9

Myopathy
Diabetes
Increased risk haemorrhagic stroke
‘Nocebo’ effect

Question 10

Which drugs interact with statins?

Answer 10

Most commonly gemfibrozil

Any other drug that interacts with CYP3A4: macrolides, azoles and cyclosporine

Question 11

Name a fibrate

Answer 11

Gemfibrozil

Question 12

What are the side effects of fibrates?

Answer 12

GI disturbance

Increases liver enzymes

Question 13

Name a bile acid sequestrant

Answer 13

Cholestyramine

Question 14

Why are bile acid sequestrants useful in children with congenital dyslipidaemia?

Answer 14

It isn’t absorbed from the gut

Question 15

What instruction is important to give when prescribing bile acid sequestrants?

Answer 15

Take other drugs one hour before or 4 hours after as it prevents other drugs from being absorbed

Question 16

What are the side effects associated with bile acid sequestrants?

Answer 16

Abdominal bloating

Dispepsia

Question 17

What positive inotropes are used in the short term treatment of heart failure?

Answer 17

Phosphodiesterase inhibitors
B1-blockers
Both increase contractability and cardiac output

Question 18

Name a cardiac glycoside which is used in the long-term treatment of heart failure

Answer 18

Digoxin

Question 19

What effects does digoxin have on the heart?

Answer 19

Increases contractability by increasing intracellular calcium
increase activity in the vagal nerve (slow firing in SA node and conduction in AV)

Question 20

Why should an ECG be done when a patient gets nauseous on digoxin?

Answer 20

It has a narrow therapeutic range and can cause arrhythmias

Question 21

Name an ACE inhibitor

Answer 21

Captopril

Question 22

How do ACE inhibitors work in the treatment of heart failure

Answer 22

Reduce angiotensin 2: reduce peripheral resistance
Reduce aldosterone: reduce water retention
Reduce sympathetic activity

Question 23

What side effects are associated with ACE inhibitors?

Answer 23

Hypotension
Renal dysfunction and hyperkalaemia
Cough

Question 24

Which type of diuretic is most potent?

Answer 24

Loop diuretics

Question 25

How do loop diuretics work?

Answer 25

Act on the thick ascending loop of henle to inhibit the reabsorption of NaCl
also increase capacity of veins to reduce BP

Question 26

What side effects are associated with loop diuretics?

Answer 26

Hypo Na, K, Mg, Ca
ototoxicity, deafness, tinnitus, vertigo
Increase uric acid, LDL, glucose

Question 27

Where do thiazide diuretics work?

Answer 27

Distal tubule, prevent NaCl transport

Question 28

What side effects are associated with thiazide diuretics?

Answer 28

Hypo Na, K, Mg
Increase uric acid and cholesterol
Impotence and pancreatitis

Question 29

Name an aldosterone antagonist

Answer 29

Spironolactone

Question 30

What side effects are associated with spironolactone?

Answer 30

Hyper K

Gynaecomastia