Anti- Hyperlipidemics Flashcards
Statins are (A) inhibitors, and are used as the (B) line drugs against (C)
A: HMG-CoA reductase
B: 1st line!
C: primary AND secondary ASCVD
The most potent statin is…
atorvastatin
inhibiting HMG-CoA reductase accomplishes what?
induces expression of LDL receptors which increases LDL removal by inhibiting the synthesis of reductase which breaks down LDL receptors
Statins can be combined with (A) or (B) if they are not effective alone
resins or exetimibe
AE of statins
Myopathy & Rhabdomyolysis
What if myopathy results? Switch to another statin!
Statins are contraindicated in which women?
pregnant or lactating
statins are metabolized by which enzymes?
CYP3A4 and CYP2C9
Bile acid sequestrants are also know as (A) and start with/contain (B)
A-Resins
B- cole/chole
Resins are indicated for what uses? are they safe in pregnancy
- Primary & secondary ASCVD
- Antitoxic for cardiac glycosides
- Hyperlipidemia in pregnant women
- Bile-malabsorption-caused diarrhea
resin/bile sequestrant MOA
increase bile acid excretion
induce LDL receptors
Resins are (A) tolerated. should be avoided in patients with (B) or (C)
A- Well tolerated
B-diverticulitis bc can cause constipation
C- high VLDL bc can increase VLDL
Ezetimibe inhibits (A) absorption by inhibiting (B) and reducing hepatic (C) receptors
A- sterol
B- NPC1L1
C-LDL
Ezetimibe can replace (A) if patients have too many side effects… ie (B)
can replace statins, if patients experience myopathy etc
If statins are at max dosing, you can give injectable (A) inhibitors like (B)
A- PCSK9 inhibitors
B- alirocumab*(praluent)
PCSK9 inhibitors work by …
inhibiting PCKS9 inhibits the body’s natural inhibitor of LDL receptors.. making more LDL receptors available for LDL removal
PCSK9 inhibitors are especially useful in which inherited disorders?
Adjunctive therapy, especially for those with heterozygous or homozygous familial hypercholesterolemia
Fibrates are indicated in …
hyperTRIGLYCeridemia
1st LINE
Fibrates lower (A) by increasing (B) and decreasing (C). They increase (D) by increasing the synthesis of (E)
A) Lower VLDL
by increasing B) LPL expression and decreasing C) liver secretion
D) increase HDL by increasing E) synthesis of apo-a1
Fenofibrate is toxic to …
Kidneys
which fibrate, especially, should not be used with statins? why?
Adverse Effects: If used with a stain, myopathy and rhabdomyolysis are more likely (Gemfibrozil especially)
contraindications for fibrates?
Contraindications:
- Gallstones become more likely with use, don’t use if Hx of biliary tract disease
- Avoid in pts with hepatic or renal dysfunction
Nicotinic acid is used to treat A and B
Hypercholesterolemia (combine with Statin or resin)
Hypertriglyceridemia
Niacin will increase A/B and decrease C/D
increase: HDL, tPA
decrease: VLDL/LDL/Lpa
Niacin should be combined with A or B for treating hypercholesterolemia
Statins or resin (bile acid sequestrants)
niacin should not be used in patients with (A) dysfunction or active (B)
hepatic dysfunction or active PUD
AE of niacin
Adverse Effects:
Flush – due to vasodilation/prostaglandins
Dyspepsia
Liver dysfunction at high doses
Summary
Hypercholesterolemia: statins ezetimibe -coles /resins/bile seques PCSK9 ApoB antisense
Hypertriglyc:
fibrates
BOTH
niacin
