hyperlipidemia drugs

Question 1

Pro-atherogenic effects of Ox-LDL

Answer 1

Inhibits macrophage motility

• Induces T-cell activation and VSMC division /

differentiation

• Toxic to endothelial cells
• Enhances platelet aggregation

Question 2

Old Classes of Lipid Lowering Drugs

Answer 2

● Statins - simvastatin

● Cholesterol lipase inhibitors - ezetimibe

● Nicotinic acid / niacin

● Fibrates – fenofibrate

● Resins - colestyramine

● Omega-3 fatty acids - omacor

● ? Plant sterols

Question 3

which drug class doesnt have much of systemic effects and why?

Answer 3

Ezetimibe and its active glucuronide metabolite

bc they circulate enterohepatically

• Delivers agent back to the site of action

• Limits systemic exposure

Question 4

Statins

Answer 4

Question 5

Mechansim of action of statins

Answer 5

Question 6

Adverse Drug Reactions of Statins

Answer 6

• Increased transaminase levels
• 0.1%-2.5% of treated patients develop increases of >

3 x upper-normal limit, especially at higher doses

• Rapidly reversible, no evidence of chronic liver disease

• Myopathy

• Diffuse muscle pain and CPK > 10 x upper-normal limit
• Primarily seen when higher doses of statins are used in combination with cyclosporine, gemfibrozil, and occasionally erythromycin and niacin

• Miscellaneous

• Gastrointestinal complaints, arthralgias, and headaches

Question 7

Some secondary benefits of Statin treatment

Answer 7

Anti-inflammatory
●Plaque reduction
● Improved endothelial cell function

● Reduced thrombotic risk

decreases endothelin>> which causes vasoconstriction

Question 8

Statin therapy is recommended as part of the management strategy for who?

Answer 8

for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD.

Question 9

which statin is now withdrawn from the market?

Answer 9

Cerivastatin >> causes drug0drug interaction due to reports of fatal rhabdomyolysis.

Question 10

Mechanism of action of fibric acids and side effects

Answer 10

mainly to reduce TAG!

SE:

GI upset (8%), cholelithiasis, myositis,

AbnormL LFTs

Question 11

changing ur diet has a greater impact on which lipids in the body?

Answer 11

TAG is modified much more easily than cholestrol!

Question 12

Fibric Acid Derivatives

Indications, Efficacy , Side Effects, Contraindications:

Answer 12

Question 13

Nicotinic Acid

• Adverse effects,
• Contraindications

indication

Answer 13

Question 14

how do we reduce side effects of niacin>> Flushing, itching, headache ?

Answer 14

reduced by immediate-release, Niaspan® or combination with low-dose aspirin

Question 15

Ezetimibe: Mechanism of Action

Answer 15

Question 16

what is the main class of lipid therapy?

Answer 16

statins

Question 17

when would u wanna use combination therapy?

like statins and smth else?

Answer 17

for those who cant tolerate statins or have a specific need for, (ex: having high TAG levels)

Question 18

which drug, when combined with statins, is thought to impair glucuronidation of statins ?

Answer 18

Gemfibrozil

Question 19

which drug has a much better effect when combined with statins?

(combination statin therapy)

Answer 19

Ezetimibe

Question 20

which drug class has flushing and itching as ADR?

Answer 20

Nictonic acid

Question 21

what is the best drug to increase HDL?

Question 22

those who have hypercholestermia and statin drugs don’t work well, what do we give them instead?

Answer 22

Evolocumab >> PSCK9 Inhibitor

reating adults with primary hypercholesterolaemia (heterozygous-familial and non-familial) or mixed dyslipidaemia

Question 23

non-drug dietary approaches to lipid lowering

Answer 23

– Fish oils

– Fibre
– Vitamin C / E

– Alcohol increses (HDL)

– plant sterols (instead of butter)

Question 24

some ppl will still have cholestrol levels of 7 or 8 mmol/L even w/ a good diet, why?

Answer 24

bc vast majority of cholestrol is under genetic control!

Question 25

Learn how to undertake a CV Risk Assessment

Answer 25

Qrsik calculator

-ask age, ethnicity, postcode ( could asscess poverty)

Question 26

describe the NICE guidance relating to lipid-lowering drug prescribing

Answer 26

Question 27

function of omega-3 fatty acids

Answer 27

decrease TAG

Question 28

which drug increases the most HDL?

Answer 28

nicotinic acid

(hawraa likes smoking lol)

Question 29

which drug has a more effect in decreasing TAG?

Answer 29

fibrates

Question 30

what and how much is gibven for piramry prevention of ppl with HIGH RSIK of CVD event >10%

Answer 30

low dose>> 20mg atrovastatin