4.2: Cholesterol

Question 1

How do statins work?

Answer 1

Inhibit HMG-CoA reductase in hepatocytes to inhibit cholesterol synthesis

Also decreases production of LDL, and increases its clearance by upregulating its receptors

Question 2

Why are LFTs carried out on a px before and after commencing statin therapy?

Answer 2

As statins raise transaminase levels

Question 3

What are some ADRs of statins?

Answer 3

Raised transaminase levels
Generalised myopathy (may cause raised creatine kinase levels)
Headache
Arthralgia
GI complaints

Question 4

Which enzyme do fibrates upregulate and what does this do?

Answer 4

Upregulates lipoprotein lipase

So more TAGs are broken down into glycerol and fatty acids which can be taken up by cells

Question 5

Which cholesterol lower agent is primarily used for hypertriglyceridaemias?

Answer 5

Fibrates

Question 6

Which cholesterol lowering agent is best to raise HDLs and how does it work?

Answer 6

Nicotinic acid, by inhibiting lipoprotein a synthesis

Question 7

Which cholesterol lowering agent can activate a peptic ulcer?

Answer 7

Nicotinic acid

Question 8

When is nicotinic acid contraindicated?

Answer 8

In liver disease or peptic ulcer disease

Question 9

How does ezetimide lower cholesterol?

Answer 9

Inhibits cholesterol absorption in the intestines so less is delivered to the liver

Question 10

Which class of drugs are best to lower LDL cholesterol and which class are best to lower TAG concentration?

Answer 10

Statins best to lower LDL

Fibrates best to lower TAG

Question 11

Who should be on statins?

Answer 11

All adults with history of CVD
Those with diabetes and any risk factors
Adults up to 84 years old with a 10 year risk of CVD of 10% or more