Dyslipedemia II

Question 1

Excretion of bezafibrate

Answer 1

94% excreted in the kidneys (40% unchanged

Question 2

Pt counselling point when using Bezafibrate

Answer 2

Take after meals

Question 3

4 drug interactions of bezafibrate

Answer 3

Warfarin – increased anticoagulant effect, reduce warfarin dose by half, then
adjust dose according to INR
* Statins – increased risk of rhabdomyolysis
* Sulphonylureas– increased risk of hypoglycaemia
* Cholestyramine – administer 2 hours apart

Question 4

MOA of cholestyramine

Answer 4

Bind to bile acids in the intestine and
prevent reabsorption and enterohepatic
recircula on → ↓absorp on of exogenous
cholesterol & ↑ metabolism of exogenous
cholesterol into bile acids by the liver

Question 5

Why is systemic toxicity low inn bile acid binging resins?

Answer 5

Because they are not absorbed

Question 6

List the common GI associated symptoms associated with bile acid binding resins (5)

Answer 6

nausea, abdominal
bloating, constipation, diarrhoea =
common + dose related

Question 7

Drug interactions of Bile acid binding resins. How to avoid this interaction?

Answer 7

Interfere with absorption of fat soluble vitamins and drugs; warfarin,
digoxin, chlrorothiazide– take 1 hour
before or 4-6 hours after

Question 8

Which drug is a derivative of Nicotinic acid?

Answer 8

Acipimox

Question 9

MOA of Acipimox

Answer 9

inhibit hepatic TG production & VLDL secretion → (indirect) ↓
LDL & ↑ HDL

Question 10

AE of acipimox at normal doses

Answer 10

normal doses = flushing (produc on of PGD₂; ↓ by taking
Nicotinic acid 30 min after aspirin), palpitations, GI disturbances

Question 11

AE of nicotinic acid at high doses

Answer 11

liver function disorders, impairment of glucose
tolerance & precipitate gout

Question 12

MOA of ezetemibe

Answer 12

inhibits the intestinal absorption of cholesterol and related
plant sterols; ↓ LDL by 15%

Question 13

Explain synergy of ezetemibe with statins

Answer 13

↓ in hepa c cholesterol due to inhibi on of de novo synthesis +
* ↓ delivery of dietary cholesterol to liver = more LDL receptor up
regulation than with statin alone

Question 14

Common adverse effects of ezetimibe (3)

Answer 14

Headache
* Abdominal pain
* Diarrhoea

Question 15

Adverse effects of ezetimibe + statins

Answer 15

Combined with statin:
* Constipation, nausea & flatulence
* ↑ ALT/AST
Myalgia & rhabdomyolysis

Question 16

contraindications of ezetimibe

Answer 16

Moderate to severe hepatic
impairment
* Children < 10 years

Question 17

What are the interventions for people at risk of cardiovascular diseases (e.g. stroke and MI)

Answer 17

lifestyle modification and
* lipid-lowering medicine therapy.

Question 18

Modifiable CVS risk factors (7)

Answer 18

↑TG & LDL
* Hypertension / on
antihypertensives
* Cigarette smoking (10
cigarretes/day for 10 years)
* ↓HDL
* Diabetes
* Obesity (BMI ≥30kg/m² or waist
circ >94 men, >80 women)
* Physical inactivity

Question 19

4 non-modifiable CVS risk factors

Answer 19

Gender
* Age
* Family history of premature CVD
(male <55 years, female <60 years)
* Autoimmune chronic inflammatory
conditions (RA, SLE, psoriasis

Question 20

2 risk calculators to determine 10 year risk for CVD

Answer 20

BMI-based risk assessment
* Framingham risk scores (estimates the 10-year risk of manifesting
clinical CVD)

Question 21

Criteria for very high risk

Answer 21

Established atherosclerotic disease,* i.e.
* Coronary artery disease
* Cerebrovascular disease
* Peripheral arterial disease
* Type 2 diabetes plus one or more other risk factors (smoking,
hypertension, dyslipidaemia) or age >40 years
* Type 1 diabetes with micro-albuminuria or proteinuria
* Genetic dyslipidaemia, e.g. Familial hypercholesterolemia (FH),
dysbetalipoproteinaemia, individuals with total cholesterol (TC) >7.5
mmol/L and/or LDL-C >5 mmol/L
* Severe CKD (GFR <30 mL/min/1.73 m2)
* Asymptomatic individuals with arterial plaque demonstrated on
imaging modalities

Question 22

Criteria for high risk

Answer 22

Markedly elevated BP (systolic BP ≥180 mmHg and/or
diastolic BP ≥110 mmHg)
* Uncomplicated type 1 diabetes and type 2 diabetes aged
<40 years without other risk factors
* Chronic kidney disease (GFR 30 - 59 mL/min/1.73 m2

Question 23

Mx for pt with <10% risk

Answer 23

< 10% risk: lifestyle modification and risk assess patient
every 5 years

Question 24

Mx for pt with 10-20% risk

Answer 24

lifestyle modification and risk assess patient
annually

Question 25

Mx for pt with >20% risk

Answer 25

lifestyle modification and start statin treatment