Antilipidemics

Question 1

Pathophysiology EXOGENOUS PATHWAY

Answer 1

fat and cholesterol converted into TRIGLYCERIDES and HDL

Question 2

Pathophysiology ENDOGENOUS PATHWAY

Answer 2

VLDL synthesized and converted into LDL

Question 3

Aims of Therapy: EXOGENOUS PATHWAY

Answer 3

TLCs
drugs that affect absorption from intestine (bile-acid sequestrants & ezetimibe)
drugs that INC lipolysis of TG (fibric-acid derivatives)

Question 4

Aims of therapy ENDOGENOUS PATHWAY

Answer 4

INC LDL receptors in liver (bile acid binding resins & statins)
inhibit production of VLDL (niacin, fibric-acid derivatives)

Question 5

Niacin MOA

Answer 5

drugs for TG and HDL

inhibit VLDL = DEC LDL; DEC TG 20-80%; INC HDL

reduces circulating fibrinogen = DEC thrombus formation

Question 6

Niacin side/adverse effects & contraindications/precautions

Answer 6

SE: flushing

Contraindications/precautions:
active liver disease
renal impairment
ASA allergy
PUD
NO lactation

Question 7

Niacin Interactions & medication administration

Answer 7

Interactions: fibric-acid derivatives, azoles, statins

med admin: INC dose gradually to reduce flushing, take ASA/NSAIDs 30 min prior

Question 8

fibric-acid derivatives (fenofibrate, gemfibrozil) MOA

Answer 8

drug for TG and HDL

MOA: reduces TG 50T% or more
INC HDL 15-25%
DEC LDL 15-20%

Question 9

fibric-acid derivatives side/adverse effects

Answer 9

GI symptoms:
dyspepsia, abd pain, diarrhea
cholelithiasis

Question 10

fibric acid derivatives contraindications/precautions & interactions

Answer 10

contraindications/precautions: active liver disease, renal impairment, NO lactation

interactions:
warfarin
statins
niacin
bile-acid sequestrants
azoles

Question 11

fibric acid derivatives med admin/patient education

Answer 11

med admin: D/C if gallstones present

patient education: may initially DEC Hgb, Hct, WBC but resolves w/ continued use

Question 12

Bile-acid sequestrants (cholestyramine) MOA

Answer 12

Drugs for LDL

MOA: DEC LDL 10-30%
enhances conversion of cholesterol into bile acids in liver; INC bile acid excretion

Question 13

Bile acid sequestrants side/adverse effects

Answer 13

CONSTIPATION - older adults
flatulence, N/V, abd pain
HA
DEC folate levels
burnt odor in urine

Question 14

bile acid sequestrants contraindications/precautions

Answer 14

INC liver enzymes + hepatitis = hx liver disease
ETOH
constipation
NO lactation

Question 15

bile acid sequestrants interactions

Answer 15

warfarin
fibric-acid derivatives
azoles

Question 16

bile acid sequestrants patient education

Answer 16

Tx constipation - use laxative/stool softener
folic acid supplement

Question 17

Statins MOA

Answer 17

Drugs for LDL

MOA: block production of cholesterol in liver; INC LDL receptors in liver
DEC LDL 25-65%
DEC TG 12-43%

Question 18

Statins side/adverse effects

Answer 18

INC BS = concentration/memory issues
mild HA
**MYALGIA – RHABDOMYOLYSIS w/ renal dysfunction

Question 19

Statins Contraindications/precautions

Answer 19

active liver disease
pregnancy cat x
NO lactation

Question 20

Statins interactions

Answer 20

warfarin
INC digoxin levels
Propranolol DEC statin levels
azoles
niacin, erythromycin, cyclosporine INC rhabdo
fibric-acid derivatives
grapefruit juice

Question 21

Statin med admin/education

Answer 21

monitor for MYALGIA, MUSCLE TENDERNESS/WEAKNESS
evaluate CK levels

benefit: reduce CV risk