Lipid Lowering Drug Flashcards
Dyslipidaemia range of TT, LDL, HDL
TT 1
Tx Range of TT LDL HDL TG in CVD
TT 1
TG
What happens if you do not fast for at least 10hours??
TG will be higher so smaller LDL is calculated unless direct measurement of LDL is done
Does dyslipidaemia Tx need monitoring?
Yes, 4-6 weeks initially, 6-12mths for maintenance, more frequently in post MI LT
When is the lab test for the cholesterol low?
When standing, in vessels, in the morning, in chronic illness, MI within 24hrs or 3 mths post, some drugs
What does statin do?
Inhibit the reductase to reduce cholesterol synthesis and to increase hepatic uptake of cholesterol
IT DECREASES LDL TG AND INCREASES HDL
Which drugs are effective in morning and which are at night?
Atorva rosuvastatin - at night
Simva fluva prava - in the evening
What are myoglobin sand why are they bad in statin ADE?
Released substance from the muscle by rhabdomyolysis
It is sticky so it can get into kidney tubules and block it
When should you stop statin therapy??
When ALT level becomes higher than 3x of normal
When CK level becomes higher than 10x of normal
What statin should you avoid with warfarin?
Simva fluva rosuvastatin as it increases INR
What do enzyme 3A4 metabolise?
Simva and atorva
So avoid antibiotics or carbamazepine or St. John’s wort
What are examples of resins?
Cholestyramine, colestipol sachets
What do resins do?
Bind bile acids in intestine that are produced using cholesterol
So that more cholesterol is used to make more bile salts
What is bad thing about resins?
It increases TG
Why do we need to be careful about taking other drugs when taking resins?
Because resins bind to other drugs so you need to take other drugs one hour before and 4-6hrs after resins
Consider vitamin A D E K supplements
What are examples of fibrates?
Gemfibrozil fenofibrate
What do fibrates do?
Work on PPAR associated with metabolism
It decreases lipoprotein production and TG
It increases clearance of lipoproteins
What does fibrates work well on?
Huge effect on TG
But less effect on LDL
What are some odd ADE of fibrates?
Photosensitivity, dyspepsia
What should fibrates be avoided with?
With warfarin (increased anticoagulation) With statin (increased rhabdo, myopathy)
What does nicotinic acid do?
Inhibit peripheral fat breakdown which travels back to the liver
Inhibit hepatic TG and VLDL production
What are some adverse effects of nicotinic acid?
Flushing, itching (due to prostaglandin), headache
When should you NOT use nicotinic acid?
After recent MI (increased CV risk)
What does ezetimibe do?
Decrease absorption of dietary and biliary cholesterol
MAINLY AFFECR LDL
What are good combinations and bad combinations with ezetimibe?
Bad combo with fenofibrate due to increased risk of gall bladder disease
Good combo with simva/ atorva due to higher effect on LDL
What is an odd ADE of ezetimibe??
Depression
What does fish oil decrease?
It decreases TG
What can you add to statin in pt with predominantly high LDL?
Ezetimibe, resin, FAD/NA
what do you use as a first line for pt with mainly high TG?
FAD or add fish oil if very high TG
Or NA but poor tolerability
At what level of TG in mixed hyperlipidaemia should we give FAD instead of statin as first line?
When the TG level exceeds 4mmol/L (high TG)
