Lipid Lowering Drugs

Question 1

What is the target cholesterol?

Answer 1

less than or equal to 4 mmol/L - 5mmol/l when you have CVD risk
non-HDL - less than or equal to 2.5 mmol/L
HDL - less than or equal to 1.8 mmol/L

Question 2

What is the role of lipid lowering drugs?

Answer 2

Target levels of cholesterol and lipids in patients with a high CV risk

Question 3

Examples of lipid-lowering drugs

Answer 3

Statins
Ezetimide
Fibrates
Bile acid-binding resins
Nicotinic acid
Omega-3-acid ethyl esters (fish oil derivatives)

Question 4

What is the main lipid-lowering effects?

Answer 4

Reduction of circulating LDL
Modest increases in plasma HDL

Question 5

Name the fungal derived statins (type 1)

Answer 5

Pravastatin, Simvastatin

Question 6

Name the synthetically derived statins (type 2)

Answer 6

Atorvastatin, Rosuvastatin, Fluvastatin

Question 7

Describe the clinical uses of statins

Answer 7

Secondary prevention of CHD
Primary prevention of CHD in patents with other risk factors:
- diabetes
- chronic kidney disease

in familiar hypercholesterolaemia

Question 8

What should statins be cautioned/contraindicated?

Answer 8

Caution in patients with:
- Liver disease
- Hypothyrodism

Contradictions - pregnancy as cholesterol is important in the formation of the baby

Question 9

Name some CV benefits of statins

Answer 9

Improvement of endothelial function
Anti-inflammatory - inhibition of prenylation of small GTPase like Rha,Rac, cdc42
Anti-thrombotic and Antiplatelets effects
Increase in vasodilation - inhibition of RhoA-ROCK pathway by preventing post-translation prenylation of RhoA
Increase in neovascularization of ischaemic tissue (e.g. coronary circulation)

Question 10

Name the common ADRs with statins

Answer 10

Asthenia - physical weakness
Muscle pain (myalgia)
Nausea, dizziness, headache
Constipation, diarrhoea
Flatulence and GI discomfort
Thrombocytopenia - reduced number of white blood cells

Question 11

Name the RARE and VERY RARE side effects

Answer 11

Rare:
Myopathies
- Myositis - muscle inflammation
- Rhabdomyolysis - muscle breakdown

Very Rare:
Hepatitis
Intestinal Lung Disease

Question 12

Name the RARE and VERY RARE side effects

Answer 12

Rare:
Myopathies
- Myositis - muscle inflammation
- Rhabdomyolysis - muscle breakdown

Very Rare:
Hepatitis
Intestinal Lung Disease

Question 13

Name which drugs which inhibit CYP3A4 leading to increased statin levels

Answer 13

Anti-fungal (itraconazole)
Antibiotics (erythromycin, clarithromycin)
CCBs (verapamil, dilitazem)
Immunosuppressants (cyclosporins)
Grapefruit juice