Anti-hyperlipidaemic drugs

Question 1

What enzyme in the cholesterol synthesis pathway do Statins inhibit?

Answer 1

HMG-CoA reductase

Question 2

First line drug for most patients with elevated cholesterol

Answer 2

Statins- Atorvostatin, Simvastatin

Question 3

According to NICE guidelines, which drug is recommended for primary prevention of adverse cardiac events if QRISK2 score is >10%?

a. Ramipril
b. Bispoprolol
c. Verapamil
d. Atorvostatin

Answer 3

d. Atorvostatin

NO OTHER DRUGS are recommended for primary prevention based on estimated risk

Question 4

This drug class has been shown in multiple clinical trials to reduce all cause mortality in MI/stroke patients, CABG, and PCI patients

Answer 4

Statins

Question 5

Common side effects of statins?

Answer 5

Most common side effects include HA, GI upset, and muscle aches.

Can also cause elevated liver enzymes (ALT)

Question 6

Rare, but serious side effect of statins?

Answer 6

Myopathy
Rhabomyolysis
Drug-induced hepatitis

Question 7

For primary prevention of cardiovascular events, a typical starting dose of Simvastatin is ___ mg ON

Answer 7

40

Question 8

For primary prevention of cardiovascular events, a typical starting dose of Atrovostatin is __mg OD

Answer 8

10

Question 9

What is the “high-intensity” Simvastatin dosage for secondary prevention, after a patient has had a cardiovascular event?

Answer 9

80mg OD

Question 10

This drug class helps to lower LDL, total cholesterol and triglycerides, and also increases HDL

Answer 10

Statins

Question 11

First line drug class for patients with very high triglycerides?

Answer 11

Fibrates (Bezafibrate)

Question 12

MOA for Bezafibrate?

Answer 12

Lowers triglycerides and LDL by activation of lipoprotein lipase in the endothelium.
Also acts to raise HDL levels.

Question 13

Side effects of fibrates?

Answer 13

GI disturbance (most common reason for discontinuation)
Myalgia/rhabdomyolysis

Question 14

Which drug class acts as bile salt sequestrants, preventing re-uptake of bile salts in the gut, thereby reducing fat absorption?

Answer 14

Cholestyramine

Question 15

Cholestyramine helps to reduce ____ but actually increases triglycerides

Answer 15

LDL

Question 16

Side effects of Cholestyramine?

Answer 16

GI disturbance
Decreases absorption of fat-soluble vitamins

Question 17

Name two anti-hyperlipidaemic drugs that could be used as alternatives to Statins

Answer 17

Ezetimibe, Cholestyramine

Question 18

Which drug acts to selectively inhibit the absorption of cholesterol by the small intestine? Has a mild effect on lowering LDL

Answer 18

Ezetimibe

Question 19

This drug can be used as an add-on to statin therapy to mildly lower LDL’s, or can be used as an alternative in statin-intolerant patients

Answer 19

Ezetimibe

Question 20

This substance helps to reduce VLDL synthesis by the liver, and also reduces triglycerides

Answer 20

Fish oil

Question 21

This substance inhibits lipase enzymes in adipose tissue, helping to (mildly) reduce LDL/TG. Helps to markedly raise HDL. Used for patients with very high Lp-a levels

Answer 21

Niacin/Nicotinic acid

(s/e: facial flushing)