Atherosclerosis and lipid lowering drugs Flashcards
Drug induced dyslipidaemia may be caused by
- BB
- Thiazides
- Corticosteroids
- Retinoids - Monitor
- OC
- Anti-HIV
Statins MOA
HMG-CoA Reductase inhibitors
- Reduce plasma cholesterol; upregelation of heptic LDL receptoors, promoting LDL uptake
Statins are less effective in:
Homozygous familial hypercholesterolaemia. Can not make LDL receptors. Not a problem in heterozygous disease
Atorvastatin may be effective
When to take statins
At night, offsets a nocturnal increase in cholestereol synthsis
except atorastatin
When and how to prescribe atorvastatin
PRIMARY
>10% risk of CV over next 10 years (Qrisk)
- 20mg atorvastatin. Low intensity
SECONDARY/PTS with CVD
- 80mg atorvastatin
Considerations in statin presscription
MOnitor liver function
May cause Rabdo, increased risk by use of fibrates
Contraindicatiosn for Sim astatin
Macrolides
INteraction with amlodipine, veramipril, diltiazem
or amlodipine plus statin: PREVASTATIN
Fibrates MOA
Activate: PPAR-a to alter liprotein metabolism
- Promote VLDL breakdown
- Recude TGs, so can be used with statins when TGs raised
- Decrease glucose, use in DM
- Reduce IHD, but not mortality
SE: RHABDO
Cholesterol Absorption inhibitors
Ezetimibe
For use on top of statin
Use of Fish oils
- For Hypertriglyceridaemia
- But INCREASE LDL
- Eicosapentaenoic acid compeotes with arachidonic acid for COX
Dyslipidaemia management steps