Cardiology Lipid Lowering Agents

Question 1

Statins

Answer 1

HMG-CoA Reductase Inhibitors - stop conversion of HMG-CoA to mevalonate (cholesterol precursor)
Super decrease LDL, increase HDL, decrease TG’s
CU: decrease MORTALITY in CAD pt’s
AE: Hepatotoxicity (increase LFT’s), myopathy (esp w/fibrates or niacin)

Question 2

Best LDL lowering drug

Answer 2

Statins

Question 3

Cholestyramine, Colestipol, Colesevelam

Answer 3

Bile Acid Resins - prevent intestine reabsorption of bile acids - forces liver to use cholesterol to make more
Decrease LDL, slight increase of HDL and TG’s
AE: GI upset (pooping out fat), decreased drug and fat-soluble vitamin absorption

Question 4

Ezetimibe

Answer 4

Prevents cholesterol absorption at small intestine brush border.
Decreases LDL. No effect on HDL/TG’s
AE: diarrhea, rarely increased LFT’s

Question 5

Gemfibrozil, Bezafibrate, Fenofibrate

Answer 5

Fibrates - upregulate LPL to increase TG clearance AND activate PPAR-alpha to induce HDL synthesis.
decrease LDL, increase HDL, super decrease TG’s
AE: myopathy (increase w/statins), cholesterol gallstones

Question 6

Best TG lowering drug

Answer 6

Fibrates (gemfibrozil, bezafibrate, fenofibrate)

Question 7

Niacin (Vit B3)

Answer 7

Inhibits hormone sensitive lipase lipolysis in adipose tissue to decrease release of free fatty acids and reduces hepatic VLDL synthesis
Decreases LDL, super increases HDL, decreases TG’s
AE: red/flushed face (decreased w/NSAIDs or long-term use), hyperglycemia, hyperuricemia

Question 8

Best HDL increasing drug

Answer 8

Niacin (Vit B3)