Session 5 - Group Work Flashcards
Indicate whether the drug increases, decreases or does not affect: LDL-Chol, HDL-Chol, TGs
Statin
LDL-Chol, HDL-Chol, TGs
Decrease, Increase, Decrease
Indicate whether the drug increases, decreases or does not affect: LDL-Chol, HDL-Chol, TGs
Ezetimibe
LDL-Chol, HDL-Chol, TGs
Decrease, Increase, Decrease
Indicate whether the drug increases, decreases or does not affect: LDL-Chol, HDL-Chol, TGs
Nicotinic acid
LDL-Chol, HDL-Chol, TGs
Decrease, Increase, Decrease
Indicate whether the drug increases, decreases or does not affect: LDL-Chol, HDL-Chol, TGs
Cholestyramine
LDL-Chol, HDL-Chol, TGs
Decrease, Increase, Increase
Indicate whether the drug increases, decreases or does not affect: LDL-Chol, HDL-Chol, TGs
Omega 3 FA
LDL-Chol, HDL-Chol, TGs
Increase, Increase, Decrease
Indicate whether the drug increases, decreases or does not affect: LDL-Chol, HDL-Chol, TGs
Fibrates
LDL-Chol, HDL-Chol, TGs
Decrease, Increase, Decrease
1) A 63-year-old man was admitted to CCU with an acute anterior MI. He received the usual treatment with thrombolysis, aspirin, beta blocker and ACE inhibitor.
His total cholesterol was found to be 7mmol/L with TG of 1.1 mmol/L.
a) What is the evidence that lowering cholesterol is likely to be beneficial to this patient?
For every 1 mmol/L you drop it you have 20% reduced risk of CVD.
1) A 63-year-old man was admitted to CCU with an acute anterior MI. He received the usual treatment with thrombolysis, aspirin, beta blocker and ACE inhibitor.
His total cholesterol was found to be 7mmol/L with TG of 1.1 mmol/L.
b) The patient is prescribed a lipid-lowering drug.
What different agents could be used?
Statin Ezetimibe Nicotinic acid Cholestyramine(?) Fibrates
1) A 63-year-old man was admitted to CCU with an acute anterior MI. He received the usual treatment with thrombolysis, aspirin, beta blocker and ACE inhibitor.
His total cholesterol was found to be 7mmol/L with TG of 1.1 mmol/L.
c) Atorvastatin is prescribed.
What is the mechanism of action of this group of drugs and where to they predominantly act?
Competitive inhibition of HMG-CoA reductase – rate controlling enzyme in mevalonate pathway
Upregulation of hepatic LDL receptors
Increased clearance of circulating LDL
1) A 63-year-old man was admitted to CCU with an acute anterior MI. He received the usual treatment with thrombolysis, aspirin, beta blocker and ACE inhibitor.
His total cholesterol was found to be 7mmol/L with TG of 1.1 mmol/L.
d) What advice should the patient receive about statin therapy and explain why it is recommended to be taken NOCTE?
Avoid grapefruit juice (or grapefruit) because it affects CYP 3A4 and take it at night because the circadian rhythm upregulates LDL receptors so it has highest efficacy here
1) A 63-year-old man was admitted to CCU with an acute anterior MI. He received the usual treatment with thrombolysis, aspirin, beta blocker and ACE inhibitor.
His total cholesterol was found to be 7mmol/L with TG of 1.1 mmol/L.
e) Would the absolute level of cholesterol affect the decision to use a lipid-lowering agent?
Yes, full lipid profile should be done and QRISK.
1) A 63-year-old man was admitted to CCU with an acute anterior MI. He received the usual treatment with thrombolysis, aspirin, beta blocker and ACE inhibitor.
His total cholesterol was found to be 7mmol/L with TG of 1.1 mmol/L.
f) Once the treatment is initiated, what is the target cholesterol value?
LDL level should be <2.0 mmol/L and total cholesterol should be <4.0 mmol/L
2) A 25-year-old gentleman presented with vague aches and pains in his arms. Two years before, he was diagnosed with Familial Hypercholesterolemia and had received treatment.
a) What could be the cause of his symptoms?
Adverse drug reaction to the statins - myalgia and rhabdomyolysis
2) A 25-year-old gentleman presented with vague aches and pains in his arms. Two years before, he was diagnosed with Familial Hypercholesterolemia and had received treatment.
b) How would the diagnosis be confirmed?
Take him off the statins and give him an alternative e.g. fibrates or nicotinic acid - check symptoms disappear
If not then serum transaminase and CK levels. K levels LFT and U&E’s.
2) A 25-year-old gentleman presented with vague aches and pains in his arms. Two years before, he was diagnosed with Familial Hypercholesterolemia and had received treatment.
c) What alternative therapy could be used to treat his condition?
Fibrates
Nicotinic acid
Ezetimibe