Hypolipidaemic Drugs

Question 1

How many classes of drugs

Answer 1

5

Question 2

Which are they

Answer 2

HMG-CoA reductase inhibitors/statins
Lipoprotein lipase activators/fibrates
Sterol absorption inhibitor
Lipase and triglyceride synthesis inhibitor
Bile acid sequestrants

Question 3

Examples of HMG-COA reductase inhibitors

Answer 3

High efficacy: Rosuvastatin, Atorvastatin
Low efficacy: Lovastatin, simvastatin

Question 4

Examples of Fibrates

Answer 4

Gemfibrozil
Bezafibrate

Question 5

Example of sterol uptake inhibitor

Answer 5

Ezetimibe

Question 6

Example of bile acid sequestrants

Answer 6

Colestipol
Cholestyramine

Question 7

Example of lipase and triglyceride synthesis inhibitor

Answer 7

Nicotinic acid

Question 8

MOA of statins

Answer 8

HMG-CoA converted to mevolonate by HMG-COA reductase
Statins inhibit HMG COA reductase

Question 9

ADR of statins

Answer 9

Most common: muscle aches
Can cause myopathy
GIT complaints, headache, rashes, sleep disturbances uncommon
Liver damage very rare

Question 10

Uses of statins

Answer 10

1. Primary and secondary hyperlipidemias
2. In ASCVD patients (angina, MI, ACS)
3. Secondary Prophylaxis of MI
4. Prevent thromboembolism

Question 11

MOA of bile acid sesquestrants

Answer 11

Bind bile acids in the intestine and interrupt enterohepatic circulation. Hence faecal excretion of both bile and CH increased

Question 12

MOA of fibrates

Answer 12

Activate key enzyme for degradation of VLDL - lipoprotein lipase
Results in lowering of circulating TGs
Effect achieved by effect on PPAR-alpha receptor which enhances lipoprotein lipase synthesis and fatty acid oxidation

Question 13

What is PPAR-alpha

Answer 13

Peroxisome proliferator activator receptor alpha

Question 14

ADR of fibrates

Answer 14

Epigastric pain, diarrhea
Skin rashes body ache
Myopathy and hepatitis uncommon

Question 15

Why is gemfibrozil and statins not given together

Answer 15

Increases risk of myopathy

Question 16

MOA of nicotinic acid

Answer 16

Inhibits intracellular lipolysis by lipase in adipocytes and decrease flow of FFA from adipose tissue to liver which reduces FFA availability for synthesis of TGs and VLDL

Question 17

Actions of Nicotinic acid

Answer 17

Decreases TG, VLDL
Modest fall in LDL-CH
Increases HDL-CH

Question 18

ADR of Nicotinic acid

Answer 18

Cutaneous vasodilation hence causes marked flushing, heat, itching due to release of PGD2
Dyspepsia and can lead to ulcer
Hyperglycemia and DM
Dryness and hyperpigmentation
Hyperuricemias
Arrhythmias

Question 19

Uses of Nicotinic acid

Answer 19

Lower VLDL and raise HDL
Control acute pancreatitis associated with severe hyper triglyceridemias

Question 20

MOA of ezetimibe

Answer 20

Inhibits intestinal absorption of dietary and intestinal CH absorption by interfering with CH transport protein called NPC1L1

Question 21

Life style modifications for hyperlipidemia

Answer 21

Low fat low carb diet
Limitation of saturated and trans fat
Exercise
Weight control
Smoking cessation
No alcohol

Question 22

High intensity, moderate and low intensity therapy

Answer 22

Rosuvastatin and Atorvastatin high intensity
Rozat: 10-40mg high 5-10mg moderate no low