Anti-hyperlipidemia Agents

Question 1

What are lipoproteins?

Answer 1

Serve as carriers to transport lipids (cholesterol, triglycerides) in the blood

Question 2

What is the role of Apolipoprotein?

Answer 2

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

Question 3

Where is VLDL secreted and where it is then transported?

Answer 3

Secreted by the liver and export triglycerides to peripheral tissues

Question 4

Where is HDL produced?

Answer 4

Liver and intestine

Question 5

What is the role of HDL?

Answer 5

Act as scavengers to take up cholesterol from peripheral tissues and triglycerides from degradation of VLDL

Question 6

Cholesterol is insoluable in water, so what must it be bound to for transportation

Answer 6

Lipoproteins

Question 7

Where are triglycerides primarily stored?

Answer 7

In adipocytes

Question 8

What patients are high risk for heart attack and should be on statin therapy?

Answer 8

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%

Question 9

When are HMG Competitive reductase inhibitors usually taken?

Answer 9

At night

Question 10

What are the contraindications of HMG CoA reductase inhibitors?

Answer 10

Pregnancy
Lactation
Active or chronic liver disease (LFTs before starting)
Ready yeast rice (can be nephrotoxic)

Question 11

What lab should be ordered prior to starting a statin therapy?

Answer 11

Liver function tests

Question 12

What are the adverse effects of HMG CoA reductase inhibitors?

Answer 12

Elevated LFT
Myopathy and rhabdomyolysis
Photosensitivity
May increase affect of warfarin
GI upset

Question 13

What are the effects of a HMG CoA reductase inhibitor

Answer 13

Reduces cholesterol synthesis and upregulates LDL receptors on hepatocytes

Modest reduction in triglycerides

Question 14

What are the side effects of nicotinic acid?

Answer 14

Intense cutaneous flush (warmth and pruritis)
Nausea
Abdominal Pain
Hyperuricemia and gout
Impaired glucose tolerance
Hepatotoxicity
Hypotension

Question 15

What are Niacin’s effects?

Answer 15

Increases HDL (most effective agent)
Decreases lipoportein (a)
Decreases LDL
Lowers triglycerides by 20-30%

Question 16

What are the effects of Fibric Acids?

Answer 16

Decreases secretion of VLDL
Increases lipoprotein lipase activity
Increase HDL

Question 17

What are the indications for Fibric Acids?

Answer 17

Hypertriglycerides
Treatment in type III hyperlipidemia
Low HDL

Question 18

When Gemfibrozil (Lopid) is used with statins what risks are increased?

Answer 18

Higher risk for myopathy and rhabdomyolysis

Question 19

What are the indications for Bile Acid Sequestrates?

Answer 19

Type IIA and Type IIB hyperlipidemias
Elevated LDL
Digitalis toxicity
Chronic pruritis

Question 20

What are the top three contraindications for Bile Acid Sequestrates?

Answer 20

Biliary cirrhosis, biliary obstruction
Gallstones (cholelithiasis)
Hypertriglyceridemia

Question 21

What is the MOA of HMG CoA Reductase Inhibitors (Statins)

Answer 21

Inhibit HMG-Co A reductase

Question 22

Nicotinic Acid MOA

Answer 22

Inhibits lipolysis in adipose tissue, reduces VLDL secretion from liver

Question 23

Bile Acid Sequestrants MOA

Answer 23

Binds bile-acids in gut, prevents reabsorption, increased cholesterol

Question 24

Fibric Acid MOA

Answer 24

Inhibit cholesterol synthesis

Question 25

Cholesterol Absorption Inhibitor MOA

Answer 25

Inhibits reabsorption of cholesterol excreted in bile; Decreased LDL and phytosterols

Question 26

Omega 3 Fatty Acid MOA

Answer 26

Inhibit VLDL and triglyceride synthesis in liver