Dyslipidaemia

Question 1

Atorvastatin (Lipitor)
Fluvastatin (Lescol XL)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)

Answer 1

A) HMG-CoA Reductase Inhibitors

B)
ALL:
1. HyperCHOLESTEROLaemia
ATOR, PRAV, SIMV:
2. Mixed HyperLIPIDaemia
ROSU, SIMV:
2. High Risk of Cardiovascular Disease
PRAV:
3. Post MI
4. Unstable ANGINA

C)
ATOR: 10 - 80 mg ONCE daily
PRAV: 10 - 80 mg NOCTE
SIMV: 10 - 80 mg NOCTE

FLUV: 80 mg ONCE daily

ROSU: 5 - 40 mg ONCE daily

D)

1. AMINOTRASNFERASE (elevated)**
2. CREATINE KINASE (CK)**
3. MYOPATHY and RHABDOMYOLYSIS**
4. LDL, HDL and TRIGLYCERIDES**
5. DIET and LIFESTYLE
6. HEPATIC**
7. RENAL (impairment increases risk of rhabdo)

E)
Labels:
(18) - ATOR, SIMV
#To reduce risk of HEART DISEASE, do regular exercise and follow a healthy diet low in saturated fats
**DR - URINE dark brown or if you have any MUSCLE PAIN, Tenderness or Weakness
S/E
*GIT (mild transient GI symptoms)
*CNS (headache, sleep disturbances, dizziness)

Question 2

Cholestyramine (Questran Lite)

Answer 2

A) Bile Acid Binding Resins

B)

1. HyperCHOLESTEROLaemia
2. Mixed HyperLIPIDaemia
3. ITCH (assoc. with Partial Biliary Tract obstruction)
4. Diarrhoea (following ileal resection or diease)

C)
4g BD - 36 g (2 or 3 doses)

D)

1. Drug INTERACTIONS** (reduce effect of some meds)
2. LIPIDS
3. FAT-SOLUBLE VITAMINS (A,D,E,K)

E)
#This medicine can REDUCE the effect of a number of other medicines. The best way to avoid a problem is to take other medicines AT LEAST 1 hr BEFORE or 4-6 hrs AFTER this medicine
#MIX with WATER, JUICE or HIGHLY FLUID foods such as soup
#Reduce the gritty texture by mixing dose and standing it in the FRIDGE for at least 4 hrs or overnight

Question 3

Colestipol (Colestid)

Answer 3

A) Bile Acid Binding Resins

B)
1. HyperCHOLESTEROLaemia

C)
5 - 30 g (1-4 doses)

D)

1. Drug INTERACTIONS** (reduce effect of some meds)
2. LIPIDS
3. FAT-SOLUBLE VITAMINS (A,D,E,K)

E)
#This medicine can REDUCE the effect of a number of other medicines. The best way to avoid a problem is to take other medicines AT LEAST 1 hr BEFORE or 4-6 hrs AFTER this medicine
#Mix with MILK, JUICE or HIGHLY FLUID foods such as soup

Question 4

Fenofibrate (Lipidil)

Answer 4

A) Fibrate

B)

1. Severe HyperTRIGLYCERIDaemia
2. DysLIPIDaemia (assoc. T2DM)
3. HyperCHOLESTEROLaemia (2nd line)
4. Reduction in Progression of Pre-existing DIABETIC RETINOPATHY (assoc. T2DM)

C)
48 - 145 mg ONCE daily

D)

1. Hepatic AMINOTRANSFERASE***(elevated - stop tx if >3times ULN)
2. LIPIDS
3. Complete BLOOD COUNT (rare leucopenia)
4. HEPATIC (contraindicated in impairment, gall diseases etc)
5. RENAL (reduce dose)

E)
Labels: 8
#Avoid exposure of skin to SUN, wear protective clothing and use sunscreen
#Regular EXERCISE and Healthy DIET to reduce risk of Heart Disease
**DR - (rhabdo) - muscle pain, tenderness or weakness
**DR - (gallstone) - dark brown urine
S/E
*GIT (dyspepsia, abdo pain)

Question 5

Gemfibrozil (Lipigem)

Answer 5

A) Fibrate

B)

1. Severe HyperTRIGLYCERIDaemia with risk of PANCREATITS
2. Mixed HyperLIPIDaemia and DysLIPIDaemia (assoc. with diabetes)
3. HyperCHOLESTEROLaemia

C)
600 mg TWICE daily

D)

1. LIPIDS
2. Complete BLOOD COUNT (rare leucopenia)
3. HEPATIC (contraindicated in impairment, gall diseases etc)
4. RENAL (reduce dose)

E)
Labels: 3b, 5
#Best absorbed if you take it half an hour BEFORE FOOD. However, if it upsets your stomach, take it with meals
#Regular EXERCISE and Healthy DIET to reduce risk of Heart Disease
**DR - (rhabdo) - muscle pain, tenderness or weakness
**DR - (gallstone) - dark brown urine
S/E
Dry mouth, Headache, Muscle pain

Question 6

Ezetimibe (Ezetrol)

Answer 6

A) Cholesterol Intestinal Absorption Inhibitor

B)

1. HyperCHOLESTEROLaemia
2. HOMOZYGOUS SISTEROLAEMI

C)
10 mg ONCE daily

D)

1. LFTS** (raised ALT/AST >3 times ULN)
2. LIPIDS** (reduced LDL levels)
3. MOOD (APF says may cause depression)
4. Diet and Exercise

E)
#Regular EXERCISE and Healthy DIET to reduce risk of Heart Disease
**DR - (myalgia) new or unusual muscle pain, tenderness or weakness
S/E
*Headache and Diarrhoea

Question 7

Nicotinic Acid OR Niacin OR Vit. B3

Answer 7

A) Vitamin B3

B)

1. HyperCHOLESTEROLaemia
2. Mixed HyperLIPIDaemia
3. Severe HyperTRIGLYCERIDaemia
4. Pellagra

C)
15 - 50 mg daily
250 - 1000 mg TDS

D)

1. LIVER function
2. Blood GLUCOSE (increase)
3. FLUSHING (induced by prostaglandins)
4. Blood Pressure (contraindicated in symptomatic hypotension)
5. RENAL (dose reduce)
6. HEPATIC (exacerbate hepatic impairment)

E)
Labels: B (take WITH FOOD)
#Take with FOOD to reduce stomach upset
#FLUSHING and STOMACH upsets usually stop after 2-6 weeks but if you miss a number of doses in a row they may reappear when you start taking the tablets again.
**DR - (hepatic failure) muscle pain, tenderness or weakness
S/E
*VASODILATION (face and neck flushing, hypotension)
*GIT (dyspepsia, diarrhoea, nausea and vomiting)
*SKIN (hyperpigmentation)