Hyperlipidemia

Question 1

Atorvastatin and simvastatin

Answer 1

Competitive inhibition of HMG CoA reductase. Upregulation of hepatic LDL receptors. Increase clearance of circulating LDL

Question 2

Benefits of statin therapy

Answer 2

Improve vascular endothelial function- Increase NO
Stabilize plaque- Increase collagen
Improve haemostasis- increase fibrinolysis
Anti Inflammatory and antioxidant

Question 3

Considerations with Statin prescribing

Answer 3

It’s a prodrug
Renal and hepatic impairment
Pregnancy
CPY3A4 (increased by amlodipine and amiodarone)

Question 4

ADR statins

Answer 4

muscle pain and stomach upset

Question 5

Fenofibrate

Answer 5

Fibric acid derivatives- activation of nuclear transcription factor PPARa. Increase production of lipoprotein lipase = increase levels HDL and increase LDL affinity for receptor

Question 6

ADR fenofibrate

Answer 6

Cholelithiasis, GI upset, myositis, increases anticoagulation

Question 7

Ezetimibe

Answer 7

Cholesterol absorption inhibitor- NPC1L11 in brush border. Increase hepatic LDL receptor expression

Question 8

ADR ezetimibe

Answer 8

Abdominal pain, GI upset, increase risk of rhabdomyolysis

Question 9

Alirocumab

Answer 9

PCSK9 inhibitor = reduction of LDL as degradation of LDL receptor once internalised

Question 10

Plant sterols

Answer 10

LDL lowering. Alcohol increases HDL but also TAG.