Cholesterol Pharmacology Flashcards
Why is cholesterol management important
Cholesterol and LDL levels are major risk factors for CVD
What are indications for cholesterol pharmacological therapy
Primary prevention
Secondary prevention
Of cardiovascular disease
Who require statin therapy for primary prevention
10yr CV risk >10% on QRISK2 assessment
CKD with eGFR <60
T1DM with: >40yo, >10yrs diabetic, established nephropathy, other CVD risk factors
What treatment is given for primary prevention
Artorvastatin 20mg
How do you screen for hyperlipidaemia
Full lipid profile: Total cholesterol HDL Non-HDL cholesterol TAG
Who require treatment for secondary prevention
Anyone with established CVD:
IHD
Stroke
Peripheral arterial dienes
What treatment is given for secondary prevention
80mg artorvastatin
What is mechanism of action of statins
Inhibit HMG-CoA reductase
Inhibit cholesterol synthesis at hepatocytes
Reduce LDL synthesis
Increase LDL uptake (low cholesterol in hepatocytes causes increased LDLR expression)
Thus lower serum cholesterol
What are secondary benefits of statins
Anti inflammatory
Reduce plaque formation
Improve endothelial function
What are side effects of statins
GI disturbance
Myopathy: Muscle aches, myositis, rhabdomyolysis, raised CK
Liver impairment: raised transaminases
What are PK properties of statins
30-80% absorption
5-30% systemic availability
CYP450 metabolism (some types)
Taken at night: time of cholesterol synthesis
What monitoring is required for statins
LFTs
Baseline, 3 monthly, 12 monthly
What is mechanism of action of fibrates
PPAR alpha agonist Stimulate lipoprotein lipase Significant Decrease in TAG levels Mild decrease in LDL Mild increase in HDL
Give examples of fibrates
Bezafibrate
What are indications of fibrates
Mixed hyperlipidaemia:
Hyperlipidaemia with low HDL
Hypertriglyceridaemia
Combination with statins
