CVR 15 hyperlipidaemia

Question 1

what is the absolute benefit of statin therapy

Answer 1

lowering LDL by 2mmol for 5 years in 10 thousand prevent major vascular event in 1000 10%

Question 2

Should we use tredaptive which is a combination of nicotinic acid and laropiprant?

Answer 2

No in 2012 25000 patents saw a worse effect and was recalled in 2013

Question 3

How are bile acid binding resins used

Answer 3

in conjunction with statin if patient fails to repsond. 13% decrease in cholesterol

Question 4

What are the side effects of bile acid binding resin

Answer 4

bloating and dyspepsia and can interfere with drug absorbitoion

Question 5

What does bile acid do

Answer 5

Very safe and not absorbed in gut. They increase LDL receptor activity

Question 6

What do fibrates do?

Answer 6

Clofibrate, fenofibrate, Bexafibrate, gemfibrozil incrase activity of peripheral lipoprotein lipase which reduces VLDL producition and uptake of LDL. Decreases TG and mild increase in HDL

Question 7

Whats an adverse effect of combining gemfibrozil and statin

Answer 7

GI disturbance
Myotoxicity
elevated liver enzyme

Question 8

How do fibrates work

Answer 8

probably ivovled PPAR transcription factor which regulates lipid metabolism

Question 9

What drugs interfere with statin oxidation

Answer 9

Those metabolised by CYP3A4
Gemfibrozil
macrolide antibiotic (erythromycin)
Azole antifungals
cyclosporine
Amioderone
HIVE protease inhibitor

Question 10

What are the proven adverse effects of statins

Answer 10

myopathy
diabetes 100/10000
strokes 10/10000

Question 11

What is myopathy

Answer 11

muscle pain and wekaness due to blood increase of CK

Question 12

What are the most potent drugs at reducing LDL cholestoerl

Answer 12

HMG CoA reductase inhibitors

ACE

Question 13

Whats the best drug at raising HDL

Answer 13

nicotinic acid

Question 14

What is most effective at lowering triglycerides

Answer 14

Fibrates

Question 15

What are the secondary causes of hyperlipidemia

Answer 15

DM
hypothyroid
obesity
alchohol
Renal
Liver
Drugs - thiazides steroids

Question 16

How do we classify hyperlipdeamia

Answer 16

frederickson - which protein is increased

Primary and Secondary

Question 17

How are triglycerides assosiated with CHD events

Answer 17

related to low HDL and high athergenic LDLD

Question 18

When to use bariatric and drugs

Answer 18

drugs bmi over 30 and 1 assosiated comorbid condition

surgery - above 40 bmii and have not responded to drugs

obesity is over 30

Question 19

Risks of obesity

Answer 19

hypertension dslipidemia DM type 2 CHD stroke gall baldder osteoarthritis apnea cancer

Question 20

What are the 4 statin benefit groups

Answer 20

1 = ASCVD
2= LDL over 4.9
3 = 40-75 yrs with diabetes and LDLC 1.8-4.8
4 = ASCVD or diabetes 40-75 with 10 year ASCVD risk of 7.5% or more

Question 21

What drugs rais HDL and whats the problem

Answer 21

Torcetrapib japanese island. May raise `bp

CETP chelsterol ester transfer prtoent

Question 22

How do we classify lipoprotiens

Answer 22

Density
chylomicron
VLDL
IDL
LDL
HDL

Question 23

Structure of lipoproteins

Answer 23

They are made up of a central hydrophobic lipid core (TG and cholesterol esters) encased in a hydrophilic coat (phospholipids, free cholesterol and apolipoproteins)

Water insoluble lipids are core components, Water soluble components etc on outside.

Question 24

What do lipoproteins do

Answer 24

transport triglycerides and cholesterol.

Central hydrophobic lipd co