Hyperlipidemia

Question 1

When might you use Gemfibrozil?

Answer 1

• When other drugs haven’t worked.
• For patients who have low HDL levels and high triglycerides

Question 2

What can you combine statins with?

Answer 2

Ezetimibe

Niacin

Bile-binding resins (Gemfibrozil)

Question 3

statins MOA

Answer 3

HMG-CoA reductase inhibitors

Question 4

What does niacin and fibrates both have in common?

Answer 4

both equally good at reducing triglycerides.

Question 5

MOA for fibrates

Answer 5

regulates gene transcription.

Lowers triglycerides by affecting (reducing activity of) an enzyme that removes triglycerides from VLDL

Question 6

What are statins really good at?

Answer 6

<<<< LDLs (20-50%)

Question 7

whats the good thing about ezetimibe?

Answer 7

can be combined with statins to << LDLs without needing a large dose of statin.

(synergistic)

Question 8

Niacin causes flushing. What other symptoms?

Answer 8

pruritus

hyperglycaemia (but only if diabetes is controlled)

Question 9

Why do you need to be careful combined NSAIDs with fluvastatin?

Answer 9

use same CYP2C9 pathway

Question 10

Drug interactions are important with cholestyramine & colestripol, why?

Answer 10

need 2 hour gap between taking medications because they bind to digoxin, thyroxin, warfarin.

Question 11

what did the 4000 px statins study show?

Answer 11

Reduced death, MI, stroke with statins.

Question 12

two representative drugs of bile acid-binding resins

Answer 12

1. Cholestyramine
2. Colestripol
   3.

Question 13

What is strongly associated with atheromas?

Answer 13

Raised serum cholesterol is a risk factor for atherosclerosis, especially when associated with a low value of HDL

Question 14

Common adverise effects of Gemfibrozil?

Answer 14

• myalgia
• GI disturbances

(best not to combine with statins)

Question 15

Why would you use cholestyramine & colestripol?

Answer 15

good for hypercholesterolemia and for patients who don’t tolerate other drugs.

Question 16

MOA Ezetimibe?

Answer 16

inhibits absorption of both biliary and dietary cholesterol.

Question 18

What’s the function of VLDL?

Answer 18

major carrier of plasma triglyerides

and the precursor to LDL.

Question 19

Prophylasis solution to flushing from niacin?

Answer 19

aspirin

Question 20

Fibrate representative drug

Answer 20

Gemfibrozil

Question 21

Commone adverse effects of statins?

Answer 21

myalgia

GI problems

myositis

hepatotoxicty

rhabdomyolysis (monitor liver enzyme if >> muscle pains)

Question 22

other names for niacin?

Answer 22

B3, nicotinic acid

Question 23

MOA of niacin?

Answer 23

Reduces the supply of free fatty acids that the liver uses to incorporate into VLDL.

• does this by inhibiting lipolysis in adipose tissue

Question 24

adverse effects of ezetimibe?

Answer 24

well tolerated.

maybe diarrhoea

occassionally headaches

Question 25

statins and warfarin? what’s the score?

Answer 25

statins slightly inhibit warfarin metabolism

Question 26

What is Niacin good for?

Answer 26

BIGGEST effect on increasing HDLs!!

Question 27

Adverse effects of cholestyramine & colestripol?

Answer 27

GI disturbances, occasionally perianal pruritis and skin rash

Question 28

What is the target value of serum cholesterol?

Answer 28

< 5.0 mmol/l

Question 29

What is the risk of CAD directly related to?

Answer 29

serum cholesterol levels

Question 30

What are the main effects of Gemfibrozil?

Answer 30

• Lowers triglycerides

increases HDL

Question 32

When would you use Niacin?

Answer 32

to increase HDL levels

to reduce risk of pancreatitis (like fibrates, niacin reduces triglyercide levels)

ONLY drug that can reduce lipoprotein (a)!!!

Question 33

What’s the MOA of cholestyramine & colestripol?

Answer 33

prevents uptake of bile in the GI tract.

• therefore liver has to use more cholesterol to synthesis new bile.

ALSO - Up regulates Liver LDL receptors and more cholesterol is delivered to the liver.

Question 34

Which drugs inhibit CYP3A4 pathway?

Answer 34

erthromycin

itraconazole

ritonavir

Question 35

statins have important drug interactions, which pathway does atorvastin, lovastain and simvastin use?

Answer 35

CYP3A4