B - 21. Agents used in dyslipidemias

Question 1

Pharmacological treatment outcome difference between primary and secondary dyslipidemia

Answer 1

Primary (genetic) is often well treated, while secondary is not.

Question 2

Statins; main effect, names and indication

Answer 2

HMG-CoA reductase inhibitors - reduces LDL and TG, increases HDL

Simvastatin
Atorvastatin
Rosuvastatin (not metabolized in liver)

Indications

• hypercholesterolemia
• prevention of cardiovascular complications

Question 3

Statins; other good effects and SE

Answer 3

Good:

• can stabilize plaques
• improve peripheral circulation

SE:

• Most tolerate statins well
• Rare - progressive rhabdomyolysis in certain predispositioned patients
• hepatotoxic, nephrotoxic

Question 4

Fibrates; names, indication, effect, SE

Answer 4

PPAR alpha agonists - stimulate LPL -> increased clearance of VLDL

Fenofibrate

Indicated in hypertriglyceridemia

SE:

• bilestone risk
• myopathy in combo with statins

Question 5

Intestinal cholesterol transporter inhibitors

Answer 5

Ezetimibe

NPC1L1 receptor inhibitor - critical mediator of cholesterol absorption

Used in combination with statins for up to 25% reduced cholesterol

Well tolerated, but can give diarrhea (probably steatorrhea)

Question 6

Bile acid sequestants

Answer 6

Colesevelam

Exchanges ions like Cl- for bile acids, sequestering them and lovering lipid uptake

Used in hyperlipidemias, mainly lowers LDL

Causes GI problems, but no systemic SE