Lipid Lowering Drug

Question 1

Dyslipidaemia range of TT, LDL, HDL

Answer 1

TT 1

Question 2

Tx Range of TT LDL HDL TG in CVD

Answer 2

TT 1

TG

Question 3

What happens if you do not fast for at least 10hours??

Answer 3

TG will be higher so smaller LDL is calculated unless direct measurement of LDL is done

Question 4

Does dyslipidaemia Tx need monitoring?

Answer 4

Yes, 4-6 weeks initially, 6-12mths for maintenance, more frequently in post MI LT

Question 5

When is the lab test for the cholesterol low?

Answer 5

When standing, in vessels, in the morning, in chronic illness, MI within 24hrs or 3 mths post, some drugs

Question 6

What does statin do?

Answer 6

Inhibit the reductase to reduce cholesterol synthesis and to increase hepatic uptake of cholesterol
IT DECREASES LDL TG AND INCREASES HDL

Question 7

Which drugs are effective in morning and which are at night?

Answer 7

Atorva rosuvastatin - at night

Simva fluva prava - in the evening

Question 8

What are myoglobin sand why are they bad in statin ADE?

Answer 8

Released substance from the muscle by rhabdomyolysis

It is sticky so it can get into kidney tubules and block it

Question 9

When should you stop statin therapy??

Answer 9

When ALT level becomes higher than 3x of normal

When CK level becomes higher than 10x of normal

Question 10

What statin should you avoid with warfarin?

Answer 10

Simva fluva rosuvastatin as it increases INR

Question 11

What do enzyme 3A4 metabolise?

Answer 11

Simva and atorva

So avoid antibiotics or carbamazepine or St. John’s wort

Question 12

What are examples of resins?

Answer 12

Cholestyramine, colestipol sachets

Question 13

What do resins do?

Answer 13

Bind bile acids in intestine that are produced using cholesterol
So that more cholesterol is used to make more bile salts

Question 14

What is bad thing about resins?

Answer 14

It increases TG

Question 15

Why do we need to be careful about taking other drugs when taking resins?

Answer 15

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

Question 16

What are examples of fibrates?

Answer 16

Gemfibrozil fenofibrate

Question 17

What do fibrates do?

Answer 17

Work on PPAR associated with metabolism
It decreases lipoprotein production and TG
It increases clearance of lipoproteins

Question 18

What does fibrates work well on?

Answer 18

Huge effect on TG

But less effect on LDL

Question 19

What are some odd ADE of fibrates?

Answer 19

Photosensitivity, dyspepsia

Question 20

What should fibrates be avoided with?

Answer 20

With warfarin (increased anticoagulation)
With statin (increased rhabdo, myopathy)

Question 21

What does nicotinic acid do?

Answer 21

Inhibit peripheral fat breakdown which travels back to the liver
Inhibit hepatic TG and VLDL production

Question 22

What are some adverse effects of nicotinic acid?

Answer 22

Flushing, itching (due to prostaglandin), headache

Question 23

When should you NOT use nicotinic acid?

Answer 23

After recent MI (increased CV risk)

Question 24

What does ezetimibe do?

Answer 24

Decrease absorption of dietary and biliary cholesterol

MAINLY AFFECR LDL

Question 25

What are good combinations and bad combinations with ezetimibe?

Answer 25

Bad combo with fenofibrate due to increased risk of gall bladder disease
Good combo with simva/ atorva due to higher effect on LDL

Question 26

What is an odd ADE of ezetimibe??

Answer 26

Depression

Question 27

What does fish oil decrease?

Answer 27

It decreases TG

Question 28

What can you add to statin in pt with predominantly high LDL?

Answer 28

Ezetimibe, resin, FAD/NA

Question 29

what do you use as a first line for pt with mainly high TG?

Answer 29

FAD or add fish oil if very high TG

Or NA but poor tolerability

Question 30

At what level of TG in mixed hyperlipidaemia should we give FAD instead of statin as first line?

Answer 30

When the TG level exceeds 4mmol/L (high TG)