Hyperlipidaemias

Question 1

What are the main classes of lipid lowering drugs?

Answer 1

Statins 
Fibrates
Cholesterol absorption inhibitor
Nicotinic acid
PCSK9 inhibitor

Question 2

What are examples of statins?

Answer 2

Atorvastatin

Simvastatin

Question 3

What is the route of administration of statins?

Answer 3

Oral

Question 4

What is the mechanism of statins?

Answer 4

Competitive inhibition of HMG-CoA reductase

Upregulation of hepatic LDL receptors

Increased clearance of circulating LDL

Question 5

What are side effects of statins?

Answer 5

Myalgia
GI disruption
Nausea
Headache

Question 6

What scoring system is used to assess the need for a statin?

Answer 6

QRISK

Question 7

What is the primary prevention dose of atorvastatin?

Answer 7

20mg OD

Question 8

What is the secondary prevention dose of atorvastatin?

Answer 8

80mg OD

Question 9

What are examples of fibrates?

Answer 9

Fenofibrate

Ciprofibrate

Question 10

What is the indication for fenofibrate?

Answer 10

Hyperlipidaemia where statin is not tolerated

Question 11

What is the route of administration of fenofibrate?

Answer 11

Oral

Question 12

What is the mechanism of fenofibrate?

Answer 12

PPARα activator

• enchanced clearance of triglycerides
• increases fatty acid uptake by liver
• increase LDL affinity for receptor

Question 13

What are the side effects of fenofibrate?

Answer 13

GI upset
Gallstones
Myositis
Abnormal LFTs

Question 14

What are contraindications to fibrates?

Answer 14

Hepatic dysfunction
Renal dysfunction
Gallbladder disease

Question 15

What is an example of nicotinic acid?

Answer 15

Niacin

Question 16

What is the indication for nicotinic acid?

Answer 16

Adjunct to statin

Statin not tolerated

Question 17

What is the route of administration of nicotinic acid?

Answer 17

Oral

Question 18

What is the mechanism of nicotinic acid?

Answer 18

Reduced fatty acid supply
Decreased triglyceride synthesis

Decreased VLDL + LDL
Increased HDL

Question 19

What are the side effects of nicotinic acid?

Answer 19

Flushing
Headache
Hepatotoxicity
GI disturbance

Question 20

When is nicotinic acid contraindicated?

Answer 20

Arterial bleeding

Active peptic ulcer disease

Question 21

What is an example of a cholesterol absorption inhibitor?

Answer 21

Ezetimibe

Question 22

What is the indications for ezetimibe?

Answer 22

Adjunct in hyperlipidaemias

Statin not tolerated

Question 23

What is the route of administration of ezetimibe?

Answer 23

Oral

Question 24

What is the mechanism of ezetimibe?

Answer 24

Inhibits NCPC1L1 transporter in the small intestine

Reduces cholesterol absorption in gut

Hepatic LDL receptor expression decreases

Question 25

What are the side effects of ezetimibe?

Answer 25

Headache Abdominal pain Diarrhoea

Question 26

What are examples of PCSK9 inhibitors?

Answer 26

Alirocumab | Evolocumab

Question 27

What are the indications for PCSK9 inhibitors?

Answer 27

Adjunct in hyperlipidaemia

Question 28

What is the route of administration of PCSK9 inhibitors?

Answer 28

SC

Question 29

What is the mechanism of PCSK9 inhibitors?

Answer 29

Monoclonal antibodies that inhibit PCSK9 PCSK9 binds to LDL receptor Reduction in LDL

Question 30

What are the side effects of PCSK9 inhibitors?

Answer 30

Sore throat Joint pain Nausea Rash