Dyslipedemia II Flashcards
Excretion of bezafibrate
94% excreted in the kidneys (40% unchanged
Pt counselling point when using Bezafibrate
Take after meals
4 drug interactions of bezafibrate
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
MOA of cholestyramine
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
Why is systemic toxicity low inn bile acid binging resins?
Because they are not absorbed
List the common GI associated symptoms associated with bile acid binding resins (5)
nausea, abdominal
bloating, constipation, diarrhoea =
common + dose related
Drug interactions of Bile acid binding resins. How to avoid this interaction?
Interfere with absorption of fat soluble vitamins and drugs; warfarin,
digoxin, chlrorothiazide– take 1 hour
before or 4-6 hours after
Which drug is a derivative of Nicotinic acid?
Acipimox
MOA of Acipimox
inhibit hepatic TG production & VLDL secretion → (indirect) ↓
LDL & ↑ HDL
AE of acipimox at normal doses
normal doses = flushing (produc on of PGD₂; ↓ by taking
Nicotinic acid 30 min after aspirin), palpitations, GI disturbances
AE of nicotinic acid at high doses
liver function disorders, impairment of glucose
tolerance & precipitate gout
MOA of ezetemibe
inhibits the intestinal absorption of cholesterol and related
plant sterols; ↓ LDL by 15%
Explain synergy of ezetemibe with statins
↓ 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
Common adverse effects of ezetimibe (3)
Headache
* Abdominal pain
* Diarrhoea
Adverse effects of ezetimibe + statins
Combined with statin:
* Constipation, nausea & flatulence
* ↑ ALT/AST
Myalgia & rhabdomyolysis
contraindications of ezetimibe
Moderate to severe hepatic
impairment
* Children < 10 years
What are the interventions for people at risk of cardiovascular diseases (e.g. stroke and MI)
lifestyle modification and
* lipid-lowering medicine therapy.
Modifiable CVS risk factors (7)
↑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
4 non-modifiable CVS risk factors
Gender
* Age
* Family history of premature CVD
(male <55 years, female <60 years)
* Autoimmune chronic inflammatory
conditions (RA, SLE, psoriasis
2 risk calculators to determine 10 year risk for CVD
BMI-based risk assessment
* Framingham risk scores (estimates the 10-year risk of manifesting
clinical CVD)
Criteria for very high risk
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
Criteria for high risk
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
Mx for pt with <10% risk
< 10% risk: lifestyle modification and risk assess patient
every 5 years
Mx for pt with 10-20% risk
lifestyle modification and risk assess patient
annually
Mx for pt with >20% risk
lifestyle modification and start statin treatment
