Atherosclerosis and lipoprotein Rx Flashcards
HMG coa inhibitors name s
statins
statins moa
nhibits 3-hydroxy-3methylglutaryl coenzyme A
(HMG-CoA), the rate- limiting step in cholesterol
synthesis.
Resulting in a compensatory increase in the expression of LDL receptors in the live
statin adrs
Myopathy (myositis orrhabdomyolysis)
Hepatotoxicity
New onset diabetes-reported in primary prevention trials
Memory loss- rare
statin dental
Muscle weakness may
present as difficulty
brushing teeth or
weakness with chewing
fibrates
Fenofibrate Available: PO
Fenofibric acid Available: PO
Gemfibrozil Available: PO
fibrates moa
Agonist of peroxisome proliferator-activated receptor-α (PPARα) nuclear receptor. Increases transcription of lipoprotein lipase, resulting in reduction in VLDL and triglycerides, also increases LDL update and HDL synthesis
fibrates adrs
Myopathy (more common in combo with statins)
Blurred vision
Hepatotoxicity
GI distress (abdominal pain)
finbrates dental
Semisupine chair position
may help with GI distress
May cause dry mouth
Avoid dental light in
patient’s eyes if having
visual effects
BABAs
Cholestyramine Available: PO (powder)
Colesevelam Available: PO
Colestipol Available: PO
BABAs moa
Bind to bile in the intestine,
preventing resorption of bile
acid. Results in increased
uptake of LDL by liver to make
more bile acid
BABAs ADRs
Significant GI distress- constipation, abdominal pain, nausea, dyspepsia
Elevations in triglycerides
BABAs dental
semisupine for GI
Absorption inhibitor
Ezetimibe
Absorption inhibitor MOA
Blocks cholesterol absorption
in the intestine (duodenum)
by blocking transport protein
NPC1L1 in the brush border of
the enterocytes
Ezetimibe ADRs
Side effects are rare
Diarrhea (4%)
Back pain (3%
Ezetimibe dental
none
niacin moa
Inhibits hepatic VLDL secretion.
Lowers serum Triglycerides and LDL and increases serum HDL
niacin ADRs
Flushing
GI Distress
Hepatotoxicity
Impaired glucose tolerance
Elevations in uric acid levels (worsen gout)
niacin dental
May prolong clotting
time, increasing the
risk of bleeding.
May cause dizziness so
use caution as patient
stands u
ATP-citrate lyase (ACL) inhibitor
Bempedoic acid
Available: PO
bempedoic acid moa
Inhibits ATP-citrate lyase
(ACL), two steps upstream of
HMG CoA reductase
bempedoic acid adr
Hyperuricemia (gout)
Muscle spasms
Elevated liver enzymes
bempedoic acid dental
none
Proprotein subtilisin kexin type 9 (PCSK9) inhibitors
Alirocumab
Evolcumab
Available: SQ
Alirocumab/ Evolcumab moa
Block the action of PCSK9
PCSK-9 promotes the degradation of LDL receptors.
Inhibition of PCSK-9 results in more active LDL receptors and lower serum LDL
Alirocumab/ Evolcumab adrs
Side effects are rare
Injection site reaction (7-17%)
Diarrhea (5%)
Decreasing LDL too low (< 25mg/dL)
Alirocumab/ Evolcumab dental
none
