20. CIS Lipid Drugs

Question 1

Drugs ending in pril are ACE inhibitors. Pt has high LDL and high cholesterol, male with HTN. What mechanism of action of drug is most appropriate?

Answer 1

Statin!!

inhibits rate limiting enzyme in cholesterol synthesis

Question 2

Fibrates are good for increasing HDL and most importantly lowering?

Answer 2

TG

Question 3

Niacin is good for decreasing TGs but most importantly, increasing?

Answer 3

HDL

Question 4

Statins are effective in lowering plamsa cholesterol in all types of hyperlipidemias, useful in combination with resins, niacin or?

Answer 4

***ezetimibe

Question 5

Atorvastatin and rosuvastatin are the most potent HMG-CoA reductase inhibitors and fluvastatin is the weakest, what is the cheapest generic?

Answer 5

Simvastatin

Question 6

besides for inhibiting HMGCoA, what is an added benefit of statins?

Answer 6

increased expression of LDL receptors

Question 7

What is the most common/ hallmark adverse effects of statins?

Answer 7

Myopathy/ muscle pain so you would see increased Creatine kinase (can see elevated aminotransferase activity)

Question 8

Statins are contraindication in women who are?

Answer 8

pregnant, lactating or about to become pregnant

Question 9

Statings mainly use CYP450 for biotransformation except for what two drugs, which should be given to avoid processing in the liver or inducers/inhibitors like grapefruit juice?

Answer 9

Pitavastatin

Pravastatin

Question 10

Pt had high LDL, TGs, and low HDL. An agent is prescribed with simvastatin that will increase risk of myopathy, which is it?

Answer 10

Gemfibrozil (fibrates cause myopathy)

Question 11

Fibrates (gemfibrozil and fenofibrate) are agonist for PPARalpha receptor which induce expression of what, which is MOST important for lipolysis of TGs and decreasing its plasma concentration?

Answer 11

increased expression of lipoprotein lipase in muscle vascular beds via PPAR alpha agonism

Question 12

Side effects of fibrates includ GI disturbances (most common), gall stones myopathy and

Answer 12

rhabdomyolysis

Question 13

Which cholesterol absorption inhibitor can be prescribed in comb with simvastatin to FURTHER decrease LDL?

Answer 13

Ezetimibe (only cholesterol absorption inhibitor at intestinal level via NPC1L1)

Question 14

Woman w high total cholesterol, low hdl, and extremely high TGs most likely have a genetic mutation where?

Answer 14

Lipoprotein lipase (tx heterozygous mutation with fibrates)

Question 15

Skin flushing/rash is a common side effect of what medicine that occurs shortly after taking it and can be prevented with premedicated aspirin?

Answer 15

Niacin

can also see acanthosis nicrigans, cant give to people with liver dz or peptic ulcers

Question 16

Niacin mainly inhibits hormone sensitive lipase in ADIPOSE tissue, dec. FFA, dec TG syn in liver, dec. VLDL causing dec. cholesterol delivery to peripheral cells, causing inc. cholesterol removal resulting in?

Answer 16

increased HDL levels