Anti Lipid Drugs and Clinical Component Flashcards
what is the most commonly used anti lipid drugs?
class I statins
what is the mechanism of the class I statins?
HMG CoA reductase inhibitor…and increasing level of LDL receptors on the hepatocytes
what are four other roles that class I statins have?
increase NO productions
stabilize plaques
reduce inflammation in atherogenesis
reduce platelet activation and risk of VTE (most profound)
name the fiveclass I statins
atorvastatin rosuvastatin simvastatin pravastatin lovastatin
what must we be aware of when prescribing statins?
different drugs have different levels of effects…so pay attention to chart and how much you wanna lower LDL
when does the liver do the most cholesterol synthesis?
between 12 am and 2 am
should you give statins during pregnancy?
NO…category X
which two statins should be given at night?
lovastatin and simvastatin
what are the two main toxicities of statins?
myopathy and hepatotoxicity
which statins are metabolized by CYP3a4
lovastatin simvastatin and atorvastatin
what is risk of taking statin that is metabolized by CYP3A4 ?
some drugs inhibit CYP3A4 so will lead to increased levels of the statin that is metabolized there
what is the mechanism of class II anti lipids?
bile acid binding agents…so they bind the bile acid and you reduce the cholesterol in liver and then they make more LDL receptors
name the class II anti lipid drug
colestipol
what is a good alternate to statins during pregnancy?
class II bile acid bindings
are class II anti lipids absorbed? what is the effect of this?
they are not absorbed so they do not cause systemic toxicity but do cause GI toxicities
what is the class III anti lipid drug?
Niacin or vitamin B3
what is the mechanism of niacin?
reduces packaging of lipids in the liver and the release of VLDL into system
what is niacins biggest toxicity?
insulin resistance leading to type II diabetes
what is the mechanism of the class IV anti lipid drugs?
they increase the expression of LDL receptors
and they decrease activity of the lipoprotein lipase
and they increase break down of free fatty acids to rid of potentially harmful LDL
name the two class IV anti lipid drugs
gemfibrozil
fenofibrate
what is a well known risky drug interaction with class IV anti lipids?
they increase the myopathy when given with statins because they inhibit the uptake of statins
what is another drug toxicity/interaction of class IV anti lipids?
can cause less uptake of warfarin and lead to more bleeding
what is the mechanism of class five anti lipid drugs?
inhibit the NPC1 receptor that is in charge of uptaking the cholesterol in the liver…leading to low levels in liver and increased LDL receptors on the liver
name the class five anti lipid drug?
ezetimibe
what is vytorin anti lipid drug and how does it work?
it is a combination of ezetimibe and a statin…statin inhibits production in liver and ezetimibe inhibits uptake of cholesterol in liver so together they have a greater effect on lowering LDL
what is the mechanism of class six anti lipid drugs?
monoclonal antibodies that bind the pCSK9 inhibitors that are usually in charge of recycling the LDL receptors on hepatocytes…so they decrease the recycling of the LDL receptors and then have more LDL receptors on the surface to lower LDL levels
name the class 6 anti lipid drug
alirocumab
is it common for anti lipid drugs to be combined?
oh yeah…sometimes patients with genetic disorder dyslipidemias they can be on up to four different classes of anti lipids
what are three drugs that inhibit the CYP3A4 molecule in liver and therefore increase toxicity risk in statins?
gemfibrozil
amlodipine
warfarin
