OTHER LIPID MODIFYING DRUGS

Question 1

Ezetimibe - MOA

Answer 1

inhibits the intestinal absorption of cholesterol

Question 2

Is Ezetimibe effective on its own?

Answer 2

• If used alone it has a modest effect on lowering LDL
  concentration
• It has little effect on other lipoproteins (e.g. Triglycerides)

Question 3

What is the dose of Ezetimibe?

Answer 3

10mg OD

Question 4

What are the indications for Ezetimibe?

Answer 4

• Adjunct to dietary measurements and statins in primary hypercholesterolaemia
• Primary hypercholesterolaemia (if statins are not tolerated/ contraindicated)
• Heterozygous familial hypercholesterolaemia

Question 5

What are the common side-effects of Ezetimibe?

Answer 5

• Gl disorders
• Diarrhoea

Question 6

What are Alirocumab and Evolocumab used for?

Answer 6

• Licensed for treatment of primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed
  dyslipidaemia as an adjunct to dietary measures

Question 7

Can Alirocumab or
Evolocumab be used in combination with other lipid-modifying drugs?

Answer 7

• Yes, it statins are not tolerated

Question 8

How do Bile acid sequestrants work?

Answer 8

• Binds to and sequesters bile acids.
• Liver then produces more bile acids to replace those lost.
• Body uses cholesterol to make bile acids = reduced LDL cholesterol circulating in the blood.

Question 9

Bile Acid Sequestrants - examples

Answer 9

Colesevelam
Colestipol
Colestyramine

Question 10

Bile Acid Sequestrants - administration counselling points

Answer 10

Take other drugs 1 hour before (4 hours for colesevelam) or 4 hours after bile sequestrant.

Question 11

Bile Acid Sequestrants - interactions

Answer 11

• Impairs absorption of fat-soluble vitamins (ADEK and folic acid) and other drugs

Question 12

Impairs absorption of fat-soluble vitamins (ADEK) and other drugs

Answer 12

Impairs absorption of fat-soluble vitamins (ADEK) and other drugs

Question 13

Fibrates - examples

Answer 13

• Bezafibrate
• Ciprofibrate
• Fenofibrate
• Gemfibrozil

Question 14

Fibrates - MOA

Answer 14

• They act by decreasing serum triglycerides
• They have a variable effect on LDL-cholesterol

Question 15

When are fibrates mainly used?

Answer 15

• In those with a serum-triglyceride concentration of greater than 10mmol/L
• Or in those who cannot tolerate statin (specialist use)

Question 16

What is a common side-effect of Fibrates?

Answer 16

• Gl disorders
• Myotoxicity in renal impairment

Question 17

Can fibrates be used in renal impairment?

Answer 17

Dose adjustment required

Question 18

Statin + Fibrates =

Answer 18

increased risk of muscle related side-effects
rhabdomyolysis
* Statin + gemfibrozil (do not use together)

Question 19

Nictoinic acid - examples

Answer 19

Acipimox
Nicotinic acid
Omega-3 fatty acid

Question 20

Nicotinic acid - indication

Answer 20

Adjunct to statin OR alone if statin not tolerated

Question 21

Nicotinic acid - MOA

Answer 21

Lowers cholesterol and triglyceride concentrations by inhibiting synthesis.
Increases HDL cholesterol

Question 22

Nicotinic acid - CI

Answer 22

Active peptic ulcer disease
Arterial bleeding

Question 23

What is a common side-effect of nicotinic acid which limits its use?

Answer 23

• Vasodilation (e.g. flushing)

Question 24

Omega-3 Fatty Acids - Indication

Answer 24

• Used in adjunct to statin/diet.
• Not be used alone
• No evidence for use

Question 25

Omega-3 Fatty Acids - cautions

Answer 25

Anticoagulant treatment
Haemorrhagic disorders
- Has natural anticoagulant properties so can thin the blood

Question 26

Omega-3 Fatty Acids - side effects

Answer 26

AF
Burping
Constipation
GI distubrances
N + V