Lipid Lowering Drugs

Question 1

Name HMG CoA reductase inhibitors

Answer 1

Atorvastatin, Pravastatin, Simvastatin, Lovastatin, Fluvastatin

Question 2

Adverse effect of statins

Answer 2

1. liver: Biomedical abnormalities in liver function
2. Muscle: myopathy and rhabdomyolysis (tea-coloured urine)
3. Contraindications in pregnancy, nursing mothers, children or teenagers: affects neurodevelopment of fetus and child

Question 3

Name PCSK9 inhibitors

Answer 3

Evolocumab, Alirocumab

Question 4

PCSK9 inhibitors use

Answer 4

-Indicated for lowering plasma cholesterol (LDL-C) levels in familial hypercholesterolaemias, especially those intolerant to statins

-Indicated in patients with clinically significant atherosclerotic CVD requiring additional LDL-C lowering after being on diet control and maximally tolerated statin therapy

Question 5

Side effect PCSK9 inhibitors

Answer 5

-Contraindicated in patients who develop hypersensitivity reactions, e.g., hypersensitivity vasculitis or serious allergies requiring hospitalization

-Injection site inflammatory reactions (erythema, itchiness, swelling, pain or tenderness)

-Increased incidence of nasopharyngitis and sinusitis

Question 6

Name fibrates

Answer 6

Gemfibrozil, Fenofibrate

Question 7

Clinical use of fibrates

Answer 7

treatment of hypertriglyceridemias with VLDL elevation, especially for dysbetalipoproteinemia.

Question 8

Side effect of fibrates

Answer 8

Gastrointestinal effects: Nausea Skin rashes gall-stones myositis

Question 9

Clinical use of EPA and DHA ethyl esters

Answer 9

-Used (in conjunction with dietary measures) for Hypertriglycerideaemia (Type IV) monotherapy

-Used for Familial Combined Hyperlipidaemia (Type IIb) in combination with statins (when control of TG is insufficient)

-NOT indicated for Hyperchylamicronaemia (Type I)

Question 10

Side effect of omacor

Answer 10

-Contraindicated in patients who are allergic to fish (derived from fish oil)

-Gastrointestinal symptoms (abdominal distension, pain, constipation, diarrhoea, dyspepsia, flatulence) are the most common adverse effects

-In some patients, DHA may lead to increase of LDL-C (levels need to be monitored e.g., patients with familial hypercholesterolaemias)

-Reduces production of thromboxane A2, may lead to increased bleeding time (special care needed for patients on anticoagulants such as aspirin and warfarin)

Question 11

Clinical use of cholestyramine

Answer 11

treatment of patients with primary hypercholesterolemia (IIa) +Niacin: treat LDL elevations in persons with combined hyperlipidemia (IIb)

Question 12

Side effect of cholestyramine

Answer 12

1. 2. GI effects: constipation, nausea and flatulence impaired absorptions: vitamins A, D, E, K

Question 13

Side effect of ezetimibe

Answer 13

-Common: Diarrhoea, flatulence-Rhabdomyolysis (more common when combined with statins)-Low incidence of reversible hepatotoxicity