AntiLipidDrugs

Question 1

If patients have myalgia as a side effect on one statin can try the patient on another statin?

Answer 1

Yes. myalgia does not rule out the class altogether. Patients may tolerate a different statin – if failed multiple statins, change drug class

Question 2

MOA of statins

Answer 2

Inhibits HMG-CoA reductase, reducing cholesterol synthesis.

Question 3

Fibric acid derivatives MOA

Answer 3

Activates PPAR-alpha, increasing lipolysis and elimination of triglyceride-rich particles.

increase lipolysis of triglycerides via lipoprotein lipase, resulting in a decrease of 50% or more in triglyceride levels.

Question 4

Bile acid sequestrants MOA

Answer 4

exchange chloride ions for negatively charged bile acids, promoting a 10-fold increase in bile-acid excretion.
Binds bile acids in the intestine, preventing their reabsorption
Increased clearance results in enhanced conversion of cholesterol to bile acids by the liver.

Question 5

Bile acid sequestrants drugs

Answer 5

Cholestyramine (Questran), Colestipol (Colestid)

Question 6

Fibric acid derivatives drugs

Answer 6

Gemfibrozil (Lopid), Fenofibrate (TriCor)

Question 7

What class is Ezetimibe (Zetia), what is its MOA?

Answer 7

Inhibits absorption of cholesterol at the brush border of the small intestine.

Question 8

Active liver disease is a contraindication for all antilipidemics except ?

Answer 8

the bile-acid sequestrants
Cholestyramine (Questran), Colestipol (Colestid).

Question 9

Cholestyramine(Questran) can do what to Amio?

Answer 9

Decrease amio levels

Question 10

How are bile acid sequestrants absorbed and distributed?

Answer 10

Cholestyramine and colestipol are not absorbed at all and have no distribution. Their action is entirely related to binding bile acids in the gut

Question 11

Contrainidcation of Cholestyramine(Questran) and a caution for bile acid sequestrants

Answer 11

Cautious use of the bile-acid sequestrants is suggested for patients with a history of constipation. Phenylketonuria (PKU) is a contraindication.

Question 12

Indication for Bile Acid Sequestrants

Answer 12

HLD

Question 13

Cholestyramine(Questran) comes in what form

Answer 13

powder

Question 14

bile-acid sequestrants’ major side effects are

Answer 14

Side Effects: Gastrointestinal disturbances (constipation, bloating).

Question 15

Plasma half life of statins are generally short except

Answer 15

Atorvastatin half-life of which is 14 hours

Question 16

Statins, particularly atorvastatin, do what to digoxin levels?

Answer 16

Increase!

Question 17

Grapefruit ingestion should be avoided with which statins

Answer 17

simvastatin, lovastatin, and atorvastatin

Question 18

Most potent statin drug?

Answer 18

Rosuvastatin,
atorvastatin second most potent

Question 19

Rosuvastatin and others in the class, could cause an increase in the likelihood of developing.

Answer 19

Diabetes. risk for CV event greater, so shouldn’t be stopped

Question 20

Rosuvastatin, more or less, likely to have myalgias

Answer 20

Less

Question 21

All HMG-CoAReductaseInhibitors(statins) are contraindicated in?

Answer 21

in pregnancy or active hepatic disease

Question 22

Gemfibrozil(Lopid) is contraindicated with concurrent use of which drugs

Answer 22

DDI w/statins (contraindicated with lovastatin
and simvastatin)

Question 23

Gemfibrozil(Lopid) is what class of drug

Answer 23

Fibric acid derivatives

Question 24

Gemfibrozil excreted?

Answer 24

Mostly unchanged in urine, so monitor impaired renal functoin

Question 25

Avoid concurrent use of Gemfibrozil and?

Answer 25

Atorvastatin - increased myopathy and rhabdomyolysis risk

Question 26

Side Effects of Gemfibrozil

Answer 26

dyspepsia, abdominal pain, and diarrhea. They may also produce cholelithiasis secondary to their increased cholesterol excretion into the bile. They are discontinued if gallstones are found.

Question 27

most potent triglyceride-lowering agents because of their effect on VLDL?

Answer 27

Fenofibrate and gemfibrozil

aka fibric acid derivatives

Question 28

Best meds to increase HDL

Answer 28

Gemfibrozil and fenofibrate are the next best at increasing HDL, followed by some reductase inhibitors.

Question 29

Is Ezetimibe absrobed?

Answer 29

No, works in the gut

Question 30

True or False, Ezetimibe can be used with statins or solo if statin not tolerated.

Answer 30

True. Ezetimibe (Zetia) is approved for combination of these statins for added effect or for solo use in HF if statins are not tolerated

Question 31

When is Evolocumab used?

Answer 31

PCSK9 inhibitors are used in conjunction with high-dose statins and other lipid-lowering medications when desired outcomes are not met in very high-risk CV patients

Question 32

What drug class is Evolocumab and Alirocumab

Answer 32

PCSK9 Inhibitors

Question 33

PCSK9 inhibitors MOA (evolocumab and alirocumab)

Answer 33

monoclonal antibodies that alter the activity of a protein that transports LDL into the liver for recycling into the system. Consequently, there are more lipoprotein receptors on the liver for removal, which results in lower LDL levels in the serum.

Question 34

How are PCSK9 inhibitors given

Answer 34

PCSK9 inhibitors are given every 2 weeks or only once a month using a single-dose pen–like device.