Statins

Question 1

Simvastatin, atorvastatin:
- class + mech action
- SE
- Containd
- indic
- monitoring

Answer 1

Simvastatin, atorvastatin:
- class + mech action: hmg coa reductase inhibitor which means less hmg coa —> mevalonate causing inc LDL receptors on liver inc uptake hence clearance from blood. also antiinflamm, antox and stabilises atherosclerotic plaques - take at night
- SE: gi upset, myalgia, rhabdomyolysis
- Containd: preg, renal/hepatic impairment, CYP3A4 inhib (amlodipine, grapefruit juice, macrolides), intracerebral haemorrhage
- indications: secondary prev 80mg (PAD, tia, stroke, IHD), primary 20mg (qrisk >10% or t1dm or ckd efr <60)
- monitoring; lfts baseline + 3 months + 12 months (discont if concs inc >3x), non HDL should be reduced >40%

Question 2

Ezetimibe:
- class + mech
- SE

Answer 2

Ezetimibe:
- class + mech: cholesterol absorption inhibitor, inhibits npc11l1 transporter in si, given alongside statin if can’t tolerate high dose
- SE: rhabdomyolysis, angiooedema

Question 3

Fenofibrate:
- class + mech
- SE
- contraind

Answer 3

Fenofibrate:
- class + mech: fibric acid derivative, activates ppar which increases lipoprotein lipase LPL which inc TAG removal and FA uptake to liver
- SE: cholelithiasis, myositis
- contraind: photosensitivity, gb disease

Question 4

Inclisiran, alirocumab, evolocumab
- definition

Answer 4

Inclisiran, alirocumab, evolocumab
- definition: pcsk9 inhibitor, pcsk9 internalises ldl so more present to cause chol clearance
injection