Atherosclerosis and lipid lowering drugs

Question 1

Drug induced dyslipidaemia may be caused by

Answer 1

• BB
• Thiazides
• Corticosteroids
• Retinoids - Monitor
• OC
• Anti-HIV

Question 2

Statins MOA

Answer 2

HMG-CoA Reductase inhibitors

• Reduce plasma cholesterol; upregelation of heptic LDL receptoors, promoting LDL uptake

Question 3

Statins are less effective in:

Answer 3

Homozygous familial hypercholesterolaemia. Can not make LDL receptors. Not a problem in heterozygous disease

Atorvastatin may be effective

Question 4

When to take statins

Answer 4

At night, offsets a nocturnal increase in cholestereol synthsis

except atorastatin

Question 5

When and how to prescribe atorvastatin

Answer 5

PRIMARY

>10% risk of CV over next 10 years (Qrisk)

• 20mg atorvastatin. Low intensity

SECONDARY/PTS with CVD

• 80mg atorvastatin

Question 6

Considerations in statin presscription

Answer 6

MOnitor liver function

May cause Rabdo, increased risk by use of fibrates

Question 7

Contraindicatiosn for Sim astatin

Answer 7

Macrolides

INteraction with amlodipine, veramipril, diltiazem

or amlodipine plus statin: PREVASTATIN

Question 8

Fibrates MOA

Answer 8

Activate: PPAR-a to alter liprotein metabolism

• Promote VLDL breakdown
• Recude TGs, so can be used with statins when TGs raised
• Decrease glucose, use in DM
• Reduce IHD, but not mortality

SE: RHABDO

Question 9

Cholesterol Absorption inhibitors

Answer 9

Ezetimibe

For use on top of statin

Question 10

Use of Fish oils

Answer 10

• For Hypertriglyceridaemia
• But INCREASE LDL
• Eicosapentaenoic acid compeotes with arachidonic acid for COX

Question 11

Dyslipidaemia management steps

Answer 11