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Pharmacology > Cardio: Drugs Used for Hyperlipidemia > Flashcards

Cardio: Drugs Used for Hyperlipidemia Flashcards

1
Q

MOA of Statins (specifically for lipids)

A

Competitively block HMG-CoA reductase

-means less mevalonate made

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2
Q

What else can statins do, besides lowering lipids?

A

Plaque Stabilization

Reduce Inflammation
-Decrease CRP

Reverse Endothelial Dysfxn
-increase NO and reduce LDL oxidation

Decrease Thrombogenicity
-reduce expression of TF on endothelial cells

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3
Q

Indications of Statins?

A

CV disease-especially if hyperlipidemia

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4
Q

Contrainidcations of Statins?

A

Active Hepatic disease
-statins can increase injury and LFTs

Pregnancy
-teratogenic

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5
Q

Adverse effects of Statins?

A

Myopathy
-see an increase in CK

Diabetes (new onset)

Hepatotoxicity

Possible Neurologic effects (not serious)

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6
Q

Do statins interact with other drugs?

A

Yes, they are metabolized by the CYP450 system (CYP3A4 or CYP2C9)
-drugs that interfere will increase/decrease levels

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7
Q

What groups of people may require a dose reduction of statins?

A

Older people and East Asians

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8
Q

Which statins drugs are metabolized by CYP3A4 and which are CYP2C9?

A

CYP3A4
-Atorvastatin, Simvastatin, Lovastatin

CYP2C9
-Fluvastatin

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9
Q

MOA of Ezetimibe

A

Inhibits PC1L1 protein to impair dietary and biliary cholesterol absorption at brush boarder of the intestine
-decrease LDL

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10
Q

If you are choosing a drug to add to Statins, what is first choice: ezetimibe or PCSK9 inhibitors?

A

Ezetimibe>PCSK9

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11
Q

Indications for Ezetimibe?

A

Hyperlipidemia

-Familial (homozygous) or Acquired

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12
Q

Contraindications of Ezetimibe?

A

Active Hepatic Disease/severe impairment in combo with statins
-Raise in AST/ALT

Pregnancy in combo with Statins

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13
Q

Adverse effects of ezetimibe?

A

Most common: headache, runny nose, sore throat, some body aches

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14
Q

What toxicity is associated with ezetimibe?

A

Skeletal muscle toxicity with concomitant use with statins

-especially if over 65, have hypothyroidism or renal impairment

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15
Q

What are the PCSK9 inhibitors?

A

Alirocumab and Evolocumab

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16
Q

MOA of the PCSK9 inhibitors?

A

Decrease the amount of LDL receptor degredation

-therefore more LDL is taken out of the circulation

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17
Q

Does age, sex, amount of statins or presence of diabetes affect the effect of PCSK9 inhibitors?

A

No.

-page 11

18
Q

Indications for the PCSK9 inhibitors?

A

Pateitns with heterozygous FH or those with CVD due to hyperlipidemia

19
Q

Adverse effects of the PCSK9 inhibitors (both evolocumab and Alirocumab)?

A

Evolocumab
-runny nose, sore throat, cold/flu like symptoms

Alirocumab
-injection site reactions, muscle pain, eye-events

20
Q

MOA of Bile Acid Binding resins?

A

Bind and block the reuptake of bile acids to force liver to make more
-lowers the amount of LDL

21
Q

Indications of the Bile Acid Binding drugs?

A

Hypercholesterolemia

22
Q

Contraindications to Bile Acid Binding drugs/

A

Hypertriglyceridema (>400)
-cause increase in TGs

Dysbetalipoproteinemia

Decreased GI motility or SBO

23
Q

Which of the lipid lowering drugs can cause pancreatitis?

A

Bile Acid Binding drugs

-increase in triglycerides can cause pancreatitis

24
Q

Adverse effects of bile acid binding drugs?

A 
GI upset
Elevated LFTs
Elevated Triglycerides
Fat Soluble vitamin def
-ADEK
25
Q

What metabolic disorder should you be cognizant of when prescribing the bile acid binding drugs?

A

Phenylketonuria

-each packet of Colesevelam contains Phenylalanine

26
Q

MOA of Fibrates

A

Bind and activate PPARa

-increases metabolism of TGs and increase production of HDL

27
Q

What are the indications for the fibrates?

A

Dyslipidemia

Hypertriglyceridemia

28
Q

What drugs are fibrates?

A

Fenofibrate
Fenofibric Acid
Ge fibrozil

29
Q

Contraindications of the fibrates?

A

Severe Kidney disease (increase Creatinine)
Active liver disease
Gallbladder disease
Nursing Mothers

30
Q

Should fibrates be taken with statins?

A

No! Increases the amount of muscle toxicity

31
Q

Other Adverse effects of fibrates?

A

Increase AST, ALT, CPK, and rhinitis

GALLSTONES**

32
Q

Are fibrates safe for nursing mothers?

A

Nope, as they appear in breast milk

33
Q

MOA of Niacin

A

Not completely understood..
-Reduces cholesterol and TG, increases HDL

May increase LPL and release of FFA

34
Q

Indications for Niacin drugs?

A

Reduce total and LDL cholesterol

-can also reduce risk of recurrent nonfatal MI

35
Q

Contraindications of niacin?

A

Liver diease
Active Peptic Ulcers
Arterial bleeding

36
Q

Adverse effects of Niacin?

A

Flushing
-give with NSAIDs

Increase Blood sugar
-diabetics

Increase uric acid
-gout!

Increase AST/ALT
Increase Muscle toxicity (CK)

37
Q

What diseases should niacin not be used in?

A 
Diabetics
Liver disease
Gout
Kidney Disease
PUD
38
Q

Does niacin prolong coagulation?

A

Has been shown to prolong PT

39
Q

What drugs does niacin interact with?

A

Bile Acid binders
Statins
Vitamins can potentiate side effects

40
Q

What should you do with Warfarin in a patient taking statins?

A

May have to decrease the dose

41
Q

What drugs are niacin?

A

Niacor: oral
Niaspan: oral-exended release tablet

Pharmacology (50 decks)

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