Anti-Lipid meds

Question 1

What is Atorvastatin (Lipitor) indicated for?

Answer 1

Statin HMG CoA reductase inhibitor Dyslipidemia/CVD Prevention Reduces risk of MI and stroke

Question 2

What is fenofibrate indicated for?

Answer 2

Fibrate Prescribed either with statins or for statin intolerant patients. Hypertriglyceridemia Hypercholesterolemia

Question 3

What is nicotinic acid indicated for?

Answer 3

Niacin Hypertriglyceridemia Hypercholesterolemia Mixed Dyslipidemia

Question 4

What is ezetimibe indicated for?

Answer 4

Cholesterol absorption inhibitors Dyslipidemia

Question 5

Most common types of dyslipidemias?

Answer 5

elevated LDL (IIa)

Question 6

What is defined as Familial hypercholesterolemia and accounts for ocular signs of xanthelasma and arcus senilis

Answer 6

Type IIa

Question 7

Desired total cholesterol levels

Answer 7

Below 200…. 240 is borderline

Question 8

Desired LDL levels

Answer 8

Below 130… 160 is borderline

Question 9

Desired HDL levels

Answer 9

Above 60… 30 is borderline

Question 10

Lovastatin comes from what natural source?

Answer 10

Red yeast produces it as a secondary metabolite

Question 11

Best selling pharmaseutical in 2003, long lasting statin

Answer 11

Atorvastatin

Question 12

Short acting statin

Answer 12

Simvastatin

Question 13

First statin on the market

Answer 13

Lovastatin

Question 14

These two statins have CNS exposure

Answer 14

Lovastatin & Simvastatin

Question 15

Two best statins for increasing HDL

Answer 15

Pravastatin & simvastatin

Question 16

Two best statins for decreasing LDL

Answer 16

Atrovastatin & rosuvastatin

Question 17

Best statin for reducing serum triglycerol

Answer 17

Atrovastatin

Question 18

Treatment of ocular side effects caused by niacin?

Answer 18

Stop use and symptoms resolve in 2 weeks

Question 19

Combination Drug Vytorin® composition?

Answer 19

ezetimibe + simvastatin

Question 20

What is the mechanism of action for Atorvastatin?

Answer 20

Antidyslipidemic Competitively inhibits HMG-CoA Reductase which is responsible for an early, rate-limiting step in cholesterol biosynthesis Increases hepatic LDL receptors, enhancing catabolism

Question 21

What are the 4 steps in the HMG CoA reductase inhibitor pathway?

Answer 21

Question 22

Atorvastatin side effects

Answer 22

ADVERSE EFFECTS

• Common: nasopharyngitis, myalgia
• Skeletal: myopathy (Creatine Kinase rises 10X)
• Hepatic: impaired function associated w/ elevated serum transaminase levels; jaundice
• CNS: amnesia
• Ocular: diplopia, ptosis, pseudo-CME+ & blurred vision, elevated IOP, intraocular hemorrhage, cataracts (NSC and PSC)

Question 23

Atorvastatin drug interactions

Answer 23

•Cyclosporine, Erythromycin, Azole antifungals (Myopathy exacerbation) and grapefruit juice all inhibit metabolism by P450

Question 24

Contraindications for Atorvastatin

Answer 24

Azole antifungals

Question 25

Indications for Fenofibrate

Answer 25

Hypertriglyceridemia Hypercholesterolemia Given with statins and/or to patients who are statin intolerant

Question 26

Mechanism of action of Fenofibrate

Answer 26

* Fibrates * Stimulates nuclear receptor PPAR which modulates transcription of insulin sensitive genes in liver, muscle and adipose tissue * Enhances HDL production; inhibits triglyceride synthesis and stimulates catabolism of triglyceride-rich lipoproteins

Question 27

Adverse effects of Fenofibrate

Answer 27

ADVERSE EFFECTS •Common: Headache, rhinitis, flu syndrome SERIOUS ADVERSE EFFECTS * Hypersensitivity: SJS, TEN * Hepatic: Hepatitis, cirrhosis * CV: Thromboembolism * Muscular: Myositis, myopathy, **rhabdo**myolysis

Question 28

Drug interactions with Fenofibrate

Answer 28

* Acyclovir, Aminoglycosides, Cyclosporine, Ganciclovir (Impaired renal elimination) * Impaired metabolism of: Sulfonylureas

Question 29

Tryptophan is a precurser of what vitamin?

Answer 29

B3

Question 30

Indications for Niacin (B3)

Answer 30

Hypertriglyceridemia Hypercholesterolemia Mixed Dyslipidemia

Question 31

Most effective drug (?) in increasing HDL levels

Answer 31

Niacin (B3)

Question 32

Mechanism of action for Niacin

Answer 32

* Vitamins/Nutritionals * Inhibits lipolysis in adipose tissue, resulting in reduced hepatic VLDL synthesis and production of LDLs in the plasma 20% reduction in LDL

Question 33

Steps of action for Niacin.

Answer 33

inhibits lipolysis in adipose tissue, resulting in decreased hepatic VLDL synthesis and production of LDLs in the plasma

Question 34

Side effects of Niacin

Answer 34

ADVERSE EFFECTS •Common: Headache, pseudo cystoid macular edema, flushing due to PGD2 production, pruritus, **hyperpigmentation**, **jaundice**, xeroderma, toxic amblyopia, orthostatic hypotension SERIOUS ADVERSE EFFECTS * Hepatic: Hepatotoxicity * CV: Arrhythmias Starting ASA prior to administratoin can decrease PGD2 Ocular side effect go away 2 weeks after discontinuing

Question 35

Niacin drug interactions

Answer 35

Alpha-Blockers and Beta-Blockers have addative effect

Question 36

Contraindications for Niacin

Answer 36

Diabetes because it raises blood sugar Surgery because it has and anti-platelet effect

Question 37

Mechanism of action of Ezetimibe

Answer 37

Cholesterol absorption inhibitor ## Footnote •Inhibits dietary and biliary cholesterol absorption at small intestine brush border

Question 38

Side effects of Ezetimibe

Answer 38

ADVERSE EFFECTS •Common: Sinusitis, influenza, diarrhea SERIOUS ADVERSE EFFECTS * Hypersensitivity: Angioedema, anaphylaxis * Hepatic: Hepatitis * Heme: Thrombocytopenia

Question 39

Drug interactions of Ezetimibe

Answer 39

•Cyclosporine (combo may increase levels of both drugs)

Question 40

Contraindications of Ezetimibe

Answer 40

•Hepatic impairment