Anti-hyperlipidemia drugs

Question 1

Plasma Lipoproteins

Answer 1

• VLDLs (triglycerides
• LDLs (greatest contributor to CHD)
• HDLs (normal cholesterol)

Question 2

Recommended levels of Cholesterol

Answer 2

• HDL (less than 40 is undesirable, should be around 50-70)
• LDL (less than 100 is desirable)
• triglycerides (higher than 150 is undesirable)

Question 3

HMG-CoA Reductase Inhibitors (Statins)

Answer 3

• most effective drugs in lowering LDLs
• can also elevate HDL and reduce triglycerides (although not by much)
• promotes plaque stability, reduce the risk of CV events, and increase bone formation
• Used to treat high cholesterol, prevention of CV events, Post MI therapy, and Diabetes
• includes lovastatin, rosuvastatin, simvastatin. atorvastatin,

Question 4

Drug interactions and adverse effects of statins

Answer 4

• common adverse effects include headache, rash, and gi distrubancs, complaints of normal joint and muscle pain
• rare adverse effects include myopathy/rhabdomyolysis (SEVERE muscle and joint pain) and hepatotoxicity
• interacts with other lipid lowering drugs (not bile acid sequestrants), DO NOT USE IN PREGNANCY DEAR GOD
• give once daily in the evening as that is when they have the greatest impact

Question 5

Nicotinic Acid (Niacin)

Answer 5

• reduces LDL and TG levels and increases HDL levels more effectively than any other drug
• adverse effects include skin flushing and itching, as well as GI, hepatotoxicity, gout

Question 6

Bile Acid Sequestrants

Answer 6

• binds bile acids in GI tract and prevents absorption and promotes their excretion
• primarily used as adjuncts to statins
• drug that need to know is Cholestyramine
• reduces LDL and can cause constipation

Question 7

Ezetimibe

Answer 7

• inhibits the absorption of cholesterol
• used to reduce total cholesterol, LDL, and apolipoprotein B
• approved for monotherapy and combined use with statins
• adverse effects include myopathy, rhabdomyolysis, hep, pancreatitis, thrombocytopenia
• negative reaction with cyclosporines

Question 8

Fibrates

Answer 8

• most effective drugs available for lowering triglycerides, can also raise HDL levels, but has little to no effect on LDL
• CAN INCREASE RISK OF BLEEDING IN PATIENTS TAKING WARFARIN
• CAN INCREASE RISK OF RHABDOMYOLYSIS IN PATIENTS TAKING STATINS
• drug to focus on is Gemifibrozil

Question 9

Colesevelam

Answer 9

• bile acid sequestrant
• does not decrease the uptake of fat soluble vitamins like other bile acid sequestrants
• has the same effects as other bile acid sequestrants otherwise

Question 10

Gemfibrozil

Answer 10

• fibrate
• can displace warfarin from the plasma albumin so measre the INR frequently
• STOP DRUG IMMEDIATELY IN CASES OF ABDOMINAL PAIN
• used to reduce triglycerides but is reservered for those who have not responded to diet
• adverse effects include rashes, GI problems, myopathy, and hepatotoxicity

Question 11

Common Drug Combinations

Answer 11

• niacin and lovastatin
• simvistatin and one of niacin or ezetimibe
• Pravastatin and aspirin
• atorvastatin and amlopidine