Anti-hyperlipidemia Agents Flashcards
What are lipoproteins?
Serve as carriers to transport lipids (cholesterol, triglycerides) in the blood
What is the role of Apolipoprotein?
Apolipoprotein B100 plays a role in moving cholesterol around your body. It is a form of LDL and mutations in it can cause a familial hypercholesterolemia
Where is VLDL secreted and where it is then transported?
Secreted by the liver and export triglycerides to peripheral tissues
Where is HDL produced?
Liver and intestine
What is the role of HDL?
Act as scavengers to take up cholesterol from peripheral tissues and triglycerides from degradation of VLDL
Cholesterol is insoluable in water, so what must it be bound to for transportation
Lipoproteins
Where are triglycerides primarily stored?
In adipocytes
What patients are high risk for heart attack and should be on statin therapy?
Patients with any form of ASCVD (TIA, stroke, etc.)
Patients with Primary LDL-C > 190 mg/dL
Patients with DM (40-75 years old)
Patients with estimated 10-year ASCVD risk >7.5%
When are HMG Competitive reductase inhibitors usually taken?
At night
What are the contraindications of HMG CoA reductase inhibitors?
Pregnancy
Lactation
Active or chronic liver disease (LFTs before starting)
Ready yeast rice (can be nephrotoxic)
What lab should be ordered prior to starting a statin therapy?
Liver function tests
What are the adverse effects of HMG CoA reductase inhibitors?
Elevated LFT
Myopathy and rhabdomyolysis
Photosensitivity
May increase affect of warfarin
GI upset
What are the effects of a HMG CoA reductase inhibitor
Reduces cholesterol synthesis and upregulates LDL receptors on hepatocytes
Modest reduction in triglycerides
What are the side effects of nicotinic acid?
Intense cutaneous flush (warmth and pruritis)
Nausea
Abdominal Pain
Hyperuricemia and gout
Impaired glucose tolerance
Hepatotoxicity
Hypotension
What are Niacin’s effects?
Increases HDL (most effective agent)
Decreases lipoportein (a)
Decreases LDL
Lowers triglycerides by 20-30%
What are the effects of Fibric Acids?
Decreases secretion of VLDL
Increases lipoprotein lipase activity
Increase HDL
What are the indications for Fibric Acids?
Hypertriglycerides
Treatment in type III hyperlipidemia
Low HDL
When Gemfibrozil (Lopid) is used with statins what risks are increased?
Higher risk for myopathy and rhabdomyolysis
What are the indications for Bile Acid Sequestrates?
Type IIA and Type IIB hyperlipidemias
Elevated LDL
Digitalis toxicity
Chronic pruritis
What are the top three contraindications for Bile Acid Sequestrates?
Biliary cirrhosis, biliary obstruction
Gallstones (cholelithiasis)
Hypertriglyceridemia
What is the MOA of HMG CoA Reductase Inhibitors (Statins)
Inhibit HMG-Co A reductase
Nicotinic Acid MOA
Inhibits lipolysis in adipose tissue, reduces VLDL secretion from liver
Bile Acid Sequestrants MOA
Binds bile-acids in gut, prevents reabsorption, increased cholesterol
Fibric Acid MOA
Inhibit cholesterol synthesis
Cholesterol Absorption Inhibitor MOA
Inhibits reabsorption of cholesterol excreted in bile; Decreased LDL and phytosterols
Omega 3 Fatty Acid MOA
Inhibit VLDL and triglyceride synthesis in liver
