Antihyperlipidemics

Question 1

HMG CoA reductase inhibitors

Answer 1

atorvastatin

rosuvastatin

Question 2

decrease liver cholesterol
increase LDL receptors
decrease plasma LDL
decrease VLDL synthesis: decrease tags

Answer 2

HMG CoA inhibitors “statins”

Question 3

myalgia
myopathy
rhabdomyolysis
hepatotoxicity

Answer 3

SE of HMG CoA inhibitors

Question 4

drug interactions with HMG CoA inhibitors

Answer 4

Gemfibrozil
cytochrome p450 inhibitors enhance toxicity of statin
avoid in chronic alcohol drinkers and hepatitis pts

Question 5

what enzyme is decreased?

that decreases ATP and leads to myocyte damage

Answer 5

CoQ

Question 6

statin contraindications

Answer 6

pregnant and lactating women
kids under 8
because the need cholesterol

Question 7

increase bile acid synthesis

Answer 7

resin

Question 8

Bile Acid sequestrants

Answer 8

cholestyramine

colestipol

Question 9

decrease recirculation of bile salts
increase synthesis of new bile salts
decrease liver cholesterol
increase LDL receptors
decrease blood LDL

Answer 9

Bile acid sequestrants

Question 10

decrease blood cholesterol by 50-65%

Answer 10

Statins

Question 11

decrease cholesterol by 20%

Answer 11

bile acid sequestrants

Question 12

increase VLDL and tags
increase cholesterol in gall bladder = gall stones
constipation
Malabsorption of lipid soluble vitamins (A,D,E,K & folic acid)

Answer 12

bile acid sequestrants

Question 13

drug interaction with bile acid sequestrants

Answer 13

orally administered drugs (warfarin, thiazides, digoxin, etc)

Question 14

hypertriglyceridemia

Answer 14

Contraindication of bile acid sequestrants

Question 15

inhibits VLDL synthesis 
decreases plasma VLDL 
decreased plasma LDL (20-30%)
increase plasma HDL (30-40%)
decreases lipoprotein (a)

Answer 15

Niacin (B3)

Question 16

flushing
pruritus 
burning pain
hepatotoxicity 
hyperglycemia

Answer 16

SE of niacin

can take aspirin to avoid increase in PG

Question 17

bind to PPARa and increase expression of lipoprotein lipases

Answer 17

Gemfibrozil

Fenofibrate (Fibrates)

Question 18

decrease VLDL (35%) and IDL
modest decrease LDL (10%)
increased HDL (10%)

Answer 18

gemfibrozil

fenofibrate

Question 19

used in hypertriglyceridemia

Answer 19

gemfibrozil

fenofibrate

Question 20

gallstones
myositis
myopathy

Answer 20

gemfibrozil

fenofibrate

Question 21

most effect at increasing HDL

Answer 21

niacin

Question 22

removing cholesterol from fatty streak in blood vessels and activates LCAT to esterize cholesterol (transferred to IDL and LDL by CETP)

Answer 22

increasing Apo A1 and A2

Question 23

directly blocks NPC1L1 receptor - increases LDL receptor - decreasing LDL in blood stream

Answer 23

Ezetimibe

Question 24

GIT distress

Answer 24

SE of Ezetimibe

Question 25

decreases cytosolic cholesterol and increases HDL 4-9%

Answer 25

Ezetimibe

Question 26

weight loss drug

Answer 26

orlistat

Question 27

inhibits pancreatic lipase - decreasing tags breakdown in intestine

Answer 27

orlistat

Question 28

oily stool
diarrhea
decrease absorption of lipid soluble vitamins

Answer 28

orlistat

Question 29

PCSK9 inhibitors

Answer 29

alirocumab

evolocumab

Question 30

decrease hepatic tags synthesis and increase tags clearance

Answer 30

omega 3 fatty acid

Question 31

indication: hypertriglyceridemia
Contraindications: fish allergy

Answer 31

omega 3 fatty acid

Question 32

are monoclonal antibody - bind to PCSK9 to inhibit LDL receptor degradation and increase LDL receptors; decreasing LDL (48-71%) and APO B (42-55%) in blood stream

Answer 32

PCSK 9 inhibitors

Question 33

Indications

1) heterozygous familial hypercholesterolemia
2) clinical atherosclerotic cardiovascular disease

Answer 33

PCSK 9 inhibitors

Question 34

ADR: allergy, nasopharyngitis, injection site reaction

Answer 34

PCSK 9 inhibitors