Anti-hyperlipidaemics - Statins Flashcards

1
Q

Cholesterol is often judged as being all bad. However, there are a number of benefits of cholesterol. Which of the following is NOT one of these benefits?

1 - part of lipid membranes
2 - component of bile
3 - synthesise coagulation factors
4 - steroid synthesis
5 - vitamin D

A

3 - synthesise coagulation factors

  • we need cholesterol in our skins cells to make vitamin D from sunlight.
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2
Q

The liver is able to synthesis cholesterol, or we can consume it in out diets. Once fats and cholesterol have been digested and absorbed they are transported around the body in lipoproteins (contain phospholipids and proteins tags) as they are hydrophobic. As part of the exogenous pathway, what is the 1st lipoprotein they are packaged in?

1 - chylomicrons
2 - LDL
3 - HDL
4 - VLDL

A

1 - chylomicrons

  • largest lipoprotein
  • least dense lipoprotein (essentially they are large and not full, so not dense)
  • uses the portal vein for this
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3
Q

Once lipids and cholesterol have been packaged into chylomicrons, do they enter the circulatory system or lymphatics?

A
  • lymphatics
  • they then enter the circulation at the subclavian vein
  • they can then travel to the liver and adipose tissue
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4
Q

The liver is able to synthesis cholesterol using the mevalonate pathway. What is the rate limiting step in this pathway, that ultimately determines cholesterol synthesis?

1 - fatty acid synthase
2 - 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase
3 - HMG-CoA synthase
4 - acetyl-coA carboxylase

A

2 - 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase

  • this enzyme creates mevalonate, which is the precursor of cholesterol
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5
Q

Once cholesterol has been synthesised in the liver, it is once again packed up into lipoproteins and sent off into the circulation to carry TAGs to the rest of the body as part of the endogenous. Which type of lipoprotein is used 1st?

1 - chylomicrons
2 - LDL
3 - HDL
4 - VLDL

A

4 - VLDL

  • low density refers to the concentration of cholesterol
  • VLDL = high TAGs and low cholesterol
  • LDL = low TAGs and high cholesterol
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6
Q

Once VLDL have been distributed around the body and distributed TAGs they become LDLs (distribute cholesterol around the body as part of the endogenous), and ultimately HDLs. What is the benefit of HDLs?

1 - remove excess TAGs from blood
2 - collect excess cholesterol and return it to the liver
3 - remove cholesterol from plaques
4 - distribute cholesterol around the body

A

2 - collect excess cholesterol and return it to the liver

  • part of the reverse pathway
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7
Q

What receptor is missing in patients with Familial hypercholesterolemia, meaning they are unable to absorb cholesterol?

1 - VLDL receptors
2 - LDL receptors
3 - lipoprotein lipase receptors
4 - GPCR

A

2 - LDL receptors

  • causes very high cholesterol
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8
Q

If these is a lot of LDL, the tissues taking up the cholesterol become saturated. What is a key risk of this in the endothelium of blood vessels?

1 - cause vasodilation
2 - cause damage to endothelium and initiate the coagulation cascade
3 - collect on endothelium and form plaques
4 - all of the above

A

3 - collect on endothelium and form plaques

  • increase risk of strokes, MI and PVD
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9
Q

Which of the 2 drugs below is a anti-hyperlipidaemic statins that we need to be aware of?

1 - Simvastatin
2 - Bisoprolol
3 - Ramipril
4 - Atorvastatin

A

1 - Simvastatin
4 - Atorvastatin

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10
Q

Simvastatin and Atorvastatin are anti-hyperlipidaemics statins. What is the mechanism of action of both of these drugs?

1 - inhibit lipid absorption in the GIT
2 - inhibit HMG-CoA reductase
3 - activates lipoprotein lipase
4 - inhibit HMG-CoA synthase

A

2 - inhibit HMG-CoA reductase

  • less cholesterol is available, so hepatocytes take up LDL from blood to make more cholesterol
  • reduces LDL
  • reduces cholesterol
  • reduces TAG
  • increased HDL
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11
Q

Simvastatin and Atorvastatin are the 2 core anti-hyperlipidaemics that we need to be aware of. Which of the following is NOT an effect of these medications?

1 - reduced cholesterol
2 - reduced LDL
3 - total cholesterol
4 - reduced blood glucose
5 - triglycerides
6 - increased HDL

A

4 - reduced blood glucose

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12
Q

Which of the following is NOT an indication of anti-hyperlipidaemics statins?

1 - primary prevention of adverse cardiovascular (CV) event
2 - dyslipidaemia
3 - hypertension
4 - secondary prevention of adverse cardiovascular (CV) event

A

3 - hypertension

  • secondary CV relates to those with IHD, PVD or previous strokes
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13
Q

Anti-hyperlipidaemics statins, atorvastain and simvastatin are indicated in the primary prevention of adverse cardiovascular (CV) event. This relates to individuals >40 y/o who have not had a CV event, but are at risk of having one (stroke, MI etc..). Using a validated scoring tool such as the Q-risk, what is the 10 year cut off risk to begin using statins?

1 - >1%
2 - >10%
3 - >20%
4 - >40%

A

2 - >10%

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14
Q

There are 3 common adverse events of statin use. Which of the following is NOT a common adverse event?

1 - headache
2 - rhabdomyolysis
3 - GI upset
4 - muscle aches

A

2 - rhabdomyolysis

  • can occur but this is rare
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15
Q

Although rare, which 2 of the following can statins cause in the liver?

1 - NAFLD
2 - fibrosis
3 - drug induced hepatitis
4 - increased liver enzymes

A

3 - drug induced hepatitis
4 - increased liver enzymes

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16
Q

Which 2 of the following should the prescription of statins be used with caution?

1 - hepatic impairment
2 - GU ischaemia
3 - splenomegaly
4 - renal impairment

A

1 - hepatic impairment
- statins metabolised by cytochrome P450 (CYP)
- CYP, mostly in liver

4 - renal impairment
- statins eliminated by kidneys.
- can be used but dosage should be reduced

17
Q

Which 2 of the following are statins contraindicated in?

1 - renal impairment
2 - hepatic impairment
3 - pregnant women
4 - women breastfeeding

A

3 - pregnant women
- cholesterol is essential in foetal development

4 - women breastfeeding
- may pass into breast milk

18
Q

Stains, atorvastatin and simvastain are both metabolised by cytochrome P450 (CYP). What effect would a CYP inhibitors have on statins?

A
  • statins will not be metabolised, so they can accumulate
  • increases risk of adverse events
19
Q

Knowing which drugs/ drug classes interact with cytochrome P450 (CYP) in the liver is important, as statins are metabolised by CYP. Which of the following is NOT a CYP minhibitor?

1 - amiodarone
2 - benzodiazepines
3 - diltiazem
4 - macrolids
5 - protease inhibitors
6 - grapefruit juice

A

2 - benzodiazepines

  • amiodarone and diltiazem= Ca2+ channel blocker
  • macrolids = antibiotics
  • protease inhibitors
20
Q

What dose of atorvastain would be prescribed in a patient with CVD as a primary preventative?

1 - 1mg daily
2 - 5mg daily
3 - 10mg daily
4 - 40mg daily

A

3 - 10mg daily

21
Q

What dose of simvastatin would be prescribed in a patient with CVD as a primary preventative?

1 - 1mg daily
2 - 5mg daily
3 - 10mg daily
4 - 40mg daily

A

4 - 40mg daily

  • baseline lipid profile
  • 3 month lipid profile
22
Q

What dose of simvastatin would be prescribed in a patient as a primary preventative?

1 - 1mg daily
2 - 5mg daily
3 - 40mg daily
4 - 80mg daily

A

4 - 80mg daily

  • monitor liver enzymes at 3 and 12 months
23
Q

Statins are generally encouraged to be taken in the evenings, why is this?

1 - hypotension
2 - drowsiness
3 - cholesterol synthesis is highest in mornings
4 - all of the above

A

3 - cholesterol synthesis is highest in mornings

24
Q

Once statins are started, how long will the patient normally take them for primary and secondary prevention?

1 - 6 months
2 - 1 years
3 - 6 years
4 - indefinitely

A

4 - indefinitely

25
Q

When patients are prescribed statins as part of primary prevention, what is the aim to reduce LDL by within 3 months?

1 - 4%
2 - 14%
3 - 40%
4 - 80%

A

3 - 40%

26
Q

Prior to starting statins, what conditions should be rules out?

1 - hypertension
2 - hypothyroidism
3 - CHF
4 - CKD

A

2 - hypothyroidism

  • reversible cause of hyperlipidaemia and increases the risk of myositis
27
Q

In patients <80 y/o with hypertension, what are the NICE guidelines for BP?

1 - 130/85
2 - 140/90
3 - 150/90
4 - 160/90

A

2 - 140/90
- 130/85 in diabetes
- 150/90 in >80 y/o