Lipid lowering drugs Flashcards
How do statins work?
Statins inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.
What are the adverse effects of statins?
- myopathy
-liver impairment
What are the contraindications of statins?
macrolides (e.g. erythromycin, clarithromycin) are an important interaction. Statins should be stopped until patients complete the course
pregnancy
Who should get a statin?
all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10%
patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy
How does Ezetimibe work?
Ezetimibe is a lipid-lowering drug which inhibits cholesterol receptors on enterocytes, decreasing cholesterol absorption in the small intestine.
who receives Ezetimibe ?
Ezetimibe monotherapy is recommended as an option for treating primary hypercholesterolaemia in adults in whom initial statin therapy is contraindicated or who cannot tolerate statin therapy
What is nicotinic acid used for?
Nicotinic acid (niacin) is used in the treatment of patients with hyperlipidaemia, although its use is limited by side-effects. As well as lowering cholesterol and triglyceride concentrations it also raises HDL levels.
What are the adverse effects of nicotinic acid?
flushing: mediated by prostaglandins
impaired glucose tolerance
myositis
What are fibrates used for and how do they work?
Fibrates are used in the management of hyperlipidaemia, particularly raised triglycerides.
Fibrates work through activating PPAR alpha receptors resulting in an increase in LPL activity reducing triglyceride levels.
What are the adverse effects of fibrates?
gastrointestinal side-effects are common
increased risk of thromboembolism
What is cholestyramine and how does it work?
Cholestyramine is a bile acid sequestrant used in the management of hyperlipidaemia. It decreases bile acid reabsorption in the small intestine, therefore upregulating the amount of cholesterol that is converted to bile acid. The main effect it has on the lipid profile is to reduce LDL cholesterol
What are the adverse effects of Cholestyramine
abdominal cramps and constipation
decreases absorption of fat-soluble vitamins
cholesterol gallstones
may raise level of triglycerides
