L 23. Hyperlipidaemia 2

Question 1

Patients with a … CV risk will have the …. from lifestyle modifications and what are they?

Answer 1

Patients with a high CV risk have the GREATEST benefits from lifestyle modifications.
Healthy diet, Regular exercise, weight management, Smoking cessation.

Question 2

Reduction in body weight: what will improve ?

Answer 2

improves lipid profile

Question 3

Overweight patients have an increased risk of developing?

Answer 3

Atherosclerosis

Question 4

What type of fats need to be reduced for CV patients?

Answer 4

Transfats and saturated fats, needs to be reduced

Question 5

Exercise per day and per week?

Answer 5

30 mins/day

2.5 hours/week

Question 6

For high CV risk patients the DIET and exercise alone will be adequate?

Answer 6

Diet and exercise alone will not be adequate to achieve the necessary improvements in lipid profile

Question 7

What is the primary prevention for hyperlipidaemia impact?

Answer 7

Only has sole elevated cholesterol. And the Patients with no evidence of CHD or other atherosclerotic disease.

Question 8

Who does secondary prevention for hyperlipidemia impact?

Answer 8

Patients who have conditions alongside elevated cholesterol (e.g angina, MI patients, coronary artery bypass patients etc)

Question 9

What is the first-line drug for lipid-lowering therapy?

Answer 9

STATINS!!!!

Question 10

What are the 5 main classes of drug for CV patients which can lower the lipid?

Answer 10

1. Statins
2. Fibrates
3. Bile acid binding agents
4. Cholesterol absorption inhibitors
5. Nicotinic acid derivatives

Question 11

What is the drug class of statins?

Answer 11

HMG-CoA reductase inhibitors.

Question 12

What is the mechanism of statin work?

Answer 12

Statins work by inhibiting the conversion of HMG-CoA to mevalonic acid and later to cholesterol, therefore they are effective in lowering LDL().

Question 13

What proportion of concentration will we achieve within 2 weeks of statins administration?

Answer 13

25 to 62%

Question 14

We will receive full effect within how many weeks of statin administration?

Answer 14

4 weeks

Question 15

Doubling the statin dose achieves an extra… reduction in LDL

Answer 15

6% (only a small added reduction)

Question 16

Inhibiting the cholesterol pathway, what will also inhibit?

Answer 16

Production of byproducts in the cholesterol pathway

Question 17

Which statin is first line for most patients?

Answer 17

Atorvastatin.

Question 18

What are the other Statin Options? What do we do if a patient is not tolerated after atorvastatin in?

Answer 18

Atorvastatin, rosuvastatin, pravastatin, simvastatin

Will use simvastatin and rosuvastatin

Question 19

When does cholesterol synthesis peak?
Therefore when are statins recommended to be taken?
Which statin doesn’t need to adhere to this?

Answer 19

Statins recommended to be taken at night. But no evidence best taken at night.
Atorvastatin has a longer half life so dosing time doesn’t matter (just consistency and adherence does)

Question 20

What are some examples of statin interactions? What happens?

Answer 20

CYP3A4 inhibitors increase statin concentration

e.g azoles, macrolides, antidepressants, grapefruit juice.

Question 21

What is the ADRs of statins?

Answer 21

Elevated liver enzymes, myopathy, rhabdomyolysis

Myopathy vs rhabdomyolysis

Question 22

What is rhabdomyolysis? What patient may feel?

Answer 22

Rhabdo= started
Myo= Muscle
Lysis= Breakdown
Patients may feel muscle necrosis

Question 23

Myopathy: muscle pain with creatinine kinase 10x normal

Answer 23

Rhabdomyolysis: muscle necrosis and release of intracellular muscle constituents in the bloodstream (myopathy + brown urine + myoglobinuria)

Question 24

Statins in pregnancy and breastfeeding?

Answer 24

NOT to be used in pregnancy or breastfeeding.

Question 25

How fibrates are used for CV patients?

Answer 25

Fibrates are used along with statins. They do not use it alone.

Question 26

How do fibrates work?

Answer 26

Increase some apoproteins and decrease others to reduce triglyceride rich lipoproteins, causing a decrease in LDL.

Question 27

Common side effects from fibrates

Answer 27

Well tolerated
GI disturbances: Dyspepsia, abdo pain, diarrhoea, flatulence, rash, muscle pain, fatigue.
Myopathy + rhabdomyolysis can occur with statin use.

Question 28

Fibrates in pregnancy and breastfeeding?

Answer 28

NOT in preg and breastfeeding

Question 29

What do you need to check before starting fibrates?

Answer 29

Creatinine kinase (CK) levels

Question 30

Bile acid binding agent what are they? Give an examples

Answer 30

Cholestryamine and colestipol

Question 31

How do bile acid-binding agents work? What effect does this have?

Answer 31

Binds to bile acids produced from cholesterol, then this complex (resin-bile acid) is excreted in faeces.
Causes hepatic cholesterol to be converted into bile to replace lost bile = decreased stored cholesterol

Question 32

What are the Bile acid-binding agent’s side effects? How do you minimize this?

Answer 32

GI (constipation, bloating, flatulence).

Minimize by increasing fluid intake.

Question 33

Are bile acid binding agents all good in pregnancy and breastfeeding?

Answer 33

NOT, avoid in pregnancy and breastfeeding

Question 34

Cholesterol absorption inhibitor example

Answer 34

Ezetimibe

Question 35

How do cholesterol absorption inhibitors work?

Answer 35

They interact with a cholesterol transporter in the intestinal brush border to stop cholesterol reabsorption in GI.

Question 36

Cholesterol absorption inhibitors should be prescribed…

Answer 36

With a statin, fibrate, or nicotinic acid derivative

Question 37

Are cholesterol absorption inhibitors safe in preg/bfeeding?

Answer 37

Not safe, avoid in pregnancy and breastfeeding

Question 38

Nicotinic acids and derivatives are ….

Answer 38

No longer recommended as monotherapy or in conjunction with other lipid-lowering drugs.

Question 39

What is the Monitoring for statins?

Answer 39

Non-fasting lipid levels every 12 months.

CK if symptoms of muscle pain (if too high will decrease/discontinue statin use)

Question 40

Steps for high cholesterol treatment?

Answer 40

Lifestyle modifications + statins