Hyperlipidaemias Flashcards
What are the main classes of lipid lowering drugs?
Statins Fibrates Cholesterol absorption inhibitor Nicotinic acid PCSK9 inhibitor
What are examples of statins?
Atorvastatin
Simvastatin
What is the route of administration of statins?
Oral
What is the mechanism of statins?
Competitive inhibition of HMG-CoA reductase
Upregulation of hepatic LDL receptors
Increased clearance of circulating LDL
What are side effects of statins?
Myalgia
GI disruption
Nausea
Headache
What scoring system is used to assess the need for a statin?
QRISK
What is the primary prevention dose of atorvastatin?
20mg OD
What is the secondary prevention dose of atorvastatin?
80mg OD
What are examples of fibrates?
Fenofibrate
Ciprofibrate
What is the indication for fenofibrate?
Hyperlipidaemia where statin is not tolerated
What is the route of administration of fenofibrate?
Oral
What is the mechanism of fenofibrate?
PPARα activator
- enchanced clearance of triglycerides
- increases fatty acid uptake by liver
- increase LDL affinity for receptor
What are the side effects of fenofibrate?
GI upset
Gallstones
Myositis
Abnormal LFTs
What are contraindications to fibrates?
Hepatic dysfunction
Renal dysfunction
Gallbladder disease
What is an example of nicotinic acid?
Niacin
What is the indication for nicotinic acid?
Adjunct to statin
Statin not tolerated
What is the route of administration of nicotinic acid?
Oral
What is the mechanism of nicotinic acid?
Reduced fatty acid supply
Decreased triglyceride synthesis
Decreased VLDL + LDL
Increased HDL
What are the side effects of nicotinic acid?
Flushing
Headache
Hepatotoxicity
GI disturbance
When is nicotinic acid contraindicated?
Arterial bleeding
Active peptic ulcer disease
What is an example of a cholesterol absorption inhibitor?
Ezetimibe
What is the indications for ezetimibe?
Adjunct in hyperlipidaemias
Statin not tolerated
What is the route of administration of ezetimibe?
Oral
What is the mechanism of ezetimibe?
Inhibits NCPC1L1 transporter in the small intestine
Reduces cholesterol absorption in gut
Hepatic LDL receptor expression decreases
What are the side effects of ezetimibe?
Headache
Abdominal pain
Diarrhoea
What are examples of PCSK9 inhibitors?
Alirocumab
Evolocumab
What are the indications for PCSK9 inhibitors?
Adjunct in hyperlipidaemia
What is the route of administration of PCSK9 inhibitors?
SC
What is the mechanism of PCSK9 inhibitors?
Monoclonal antibodies that inhibit PCSK9
PCSK9 binds to LDL receptor
Reduction in LDL
What are the side effects of PCSK9 inhibitors?
Sore throat
Joint pain
Nausea
Rash
