Dyslipidemia - Treatment Flashcards
What are primary and secondary disorders?
primary disorders
primary disorders
- are caused by genetic mutations (familial) or a mix of genetic and environmental factors
= familial hypercholesterolaemia, polygenic lipid disorders
secondary disorders
- disorders that occur secondary to other factors such as drug treatment or other diseases
= hypothyroidism, type 2 diabetes, thiazide diuretics
What are primary and secondary interventions?
primary intervention
- prevention of initial cardiovascular events
secondary intervention
- prevention of a secondary cardiovascular event
= are prescribed after the first CV event
What is the purpose of lipid modifying treatments? What are the different types?
they reduce the circulating levels of atherogenic lipids
- triglycerides and lipoproteins
slow, reverse or prevent the development of atherosclerotic lesions (fatty streaks)
reduce the long term risk of CV disease
What are the pathways in which lipid modifying treatments can act?
endogenous pathway
- statins, PCSK9 inhibitors, fibrates
= decrease production and increase uptake into tissues
exogenous pathway
- cholesterol absorption inhibitors
= decrease absorption from dietary sources
What are statins? What is their purpose?
atorvastatin
simvastatin
treatment of
- primary prevention of arterial disease
- secondary prevention of adverse cardiovascular event
- familial hypercholesterolaemia
How do statins act?
act as HMG-CoA reductase inhibitors
- HMG-CoA reductase is an enzyme which is needed in the production of cholesterol
= is the rate limiting step
lowers circulating levels of cholesterol by
- reaching production of cholesterol
- increasing production of LDL receptors
What are the side effects of statins?
advantages and disadvantages
advantages
- improve endothelial function
- reduce vascular inflammation
- reduce platelet aggregation
- anti-thrombotic
disadvantages
- myalgia (muscle pain)
- type II diabetes
- liver damage
What are fibrates? What is their purpose?
bezafibrate
gemfibrozil
treatment of
- mixed dyslipidemia
- severe resistant dyslipidemia
How do fibrates act?
increase the concentration of lipoprotein lipase
- increase breakdown of vLDL and chylomicrons
increased uptake into tissues
enhances expression of LDL receptors
reduced vLDL release
What are PCSK9 inhibitors? What is their purpose?
evolocumab
alirocumab
= are both monoclonal antibodies
treatment of
- familial hypercholesterolaemia
- statin resistant
How do PCSK9 inhibitors work?
inhibits PCSK9 protein
- prevents PCSK9 from binding to LDL receptors therefore stopping LDL receptor degradation
What are cholesterol absorption inhibitors? What is their purpose?
ezetimibe
bile acid binding resins - colestyramine
What are cholesterol absorption inhibitors? How do they act?
ezetimibe
binds to cholesterol transporter in the duodenum
- prevents the uptake of cholesterol from the diet
= is excreted as faeces
What are bile acid binding resins? How do they act?
colestyramine
bind to bile acids in the intestine
- bile acids contain cholesterol
= HDL transports excess cholesterol to the liver
- resins binding means they are excreted as faeces while more bile acids are made from plasma cholesterol
= bile is typically reabsorbed from the blood by the liver
