Lipid Lowering Drugs

Question 1

Causes of primary lipidaemia

Answer 1

monogenic such as familial hypercholesterolaemia but mostly polygenic causes

Question 2

Causes of secondary hyperlipidaemia

Answer 2

Alcoholism, hypothyroidism, diabetes, diet

Question 3

Examples of statins

Answer 3

Simvastatin, pravastatin, atorvastatin

Question 4

How do statins work

Answer 4

Inhibit HMG-CoA reductase in liver, helps clear plasma LDL cholesterol, decreases TGs and increases HDLs

Question 5

What are statins used for

Answer 5

First line for hypercholesterolaemia to reduce progression of atherosclerosis, primary prevention of MI and stroke

Question 6

Secondary roles of statins

Answer 6

Reduce vascular inflammation and thrombosis, and plaque stability

Question 7

Examples of fibrates

Answer 7

Clofibrate, fenofibrate, gemfibozil

Question 8

Action of fibrates

Answer 8

Inhibit VLDL release and accelerate lipoprotein lipase in tissue capillary, by activating peroxisome proliferator activator receptor alpha.

Question 9

Overall effects of fibrates

Answer 9

Reduces plasma triglycerides, LDLs and increases HDLs

Question 10

What are fibrates used for

Answer 10

First line for high TG (pancreatitis), variable effects on CAD, can be combined with statins

Question 11

Side effects of fibrates

Answer 11

Myositis, flu and gallstones

Question 12

Action of nicotinic acid (Niacin)

Answer 12

Inhibits diaglycerol acyltransferase, reducing TG synthesis and release from liver, lowers plasma TG and LDLs

Question 13

Used of niacin

Answer 13

Combined with fibrates for hypertriglyceridaemia

Question 14

Side effects of niacin

Answer 14

Poorly tolerated, flushing, itching, dizziness, palpitations, gout

Question 15

Anion exchange resin examples

Answer 15

Cholestyramine and colestipol

Question 16

Action, use and side effects of anion exchange resins

Answer 16

Bind to bile acids and reduce lipid absorption, clears plasma LDL and used in combination for severe cases. Gut side effects

Question 17

Eg of lipase inhibitors

Answer 17

Orlistat

Question 18

Role or Orlistat

Answer 18

Breakdown of TG to FA within the gut

Question 19

What are Nutraceuticals

Answer 19

Plant steroids which reduce gut absorption of cholesterol

Question 20

Role of Ezetimibe

Answer 20

Inhibits intestinal cholesterol transporter NPC1L1 which halves cholesterol absorption and reduces plasma LDL-C by 15%.

Question 21

Use of Ezetimibe

Answer 21

Adjuvant to diet and statins