Cardiovascular Drugs

Question 1

Statins

Answer 1

MOA: HMG CoA Reductase Inhibitor

1. Decrease LDL*****
2. Slightly raise HDL
3. Slightly decrease TGs

SE: Hepatotoxicity (LFTs), Myopathy (esp. when used with Fibrates or Niacin), TERATOGENIC

Question 2

Cholestyramine, Colestipol, Colesevelam

Answer 2

MOA: Prevent reabsorption of bile acids
SAFE FOR PREGNANT WOMEN! (all others not safe)

1. Decrease LDL*
2. Slightly raise HDL
3. Slightly raise TGs
4. Weakly stimulate VLDL synthesis - offset with statin

SE: GI upset, Fat soluble vitamin deficiencies, Decrease absorption of other drugs

Question 3

Ezetimibe

Answer 3

MOA: Inhibit enterocyte NPC1 cholesterol transporter
Good for statin intolerant patients

1. Decrease LDL**

SE: Rare, increased LFTs, Diarrhea

Question 4

Fibrates

Answer 4

Gemfibrozil, Bezafibrate, Fenofibrate

MOA: Upregulate LPL, Activate PPAR-alpha to induce HDL synthesis

1. Decrease TGs**
2. Slightly decrease LDL and raise HDL

SE: Myopathy (w/ statins), Gallstones

Question 5

Niacin

Answer 5

MOA: Inhibits lipolysis (HSL - Gi pathway) in adipose
Reduces hepatic VLDL synthesis

1. Increase HDL*** (#1 at raising HDL)
2. Decrease LDL*
3. Decrease TGs

SE: Red flushed face (tx - NSAIDs), Hyperglycemia, Hyperuricemia (reactivate GOUT)

Question 6

PCSK9 Inhibitors

Answer 6

MOA: Inactivate LDL receptor degradation, increase amount of LDL removed from bloodstream

1. Reduce LDL**
2. Slightly increase HDL and decrease TGs

SE: Myalgias, Delirium, Dementia, other neurocognitive effects

Question 7

Best choice for increasing HDL in patients with high TGs

Answer 7

Fibrates

Question 8

Atorvastatin

Answer 8

Worst at increasing HDL

Good at decreasing TGs

Question 9

Rosuvastatin

Answer 9

BEST at increasing HDL and

Decreasing TGs

Question 10

Fluvastatin

Answer 10

Lowest risk of myopathy

Question 11

Statin Drug Interactions

Answer 11

Cyclosporine - may potentiate statin

Gemfibrozil - myopathy

Question 12

Fish Oil

Answer 12

Decrease TGs and VLDL (by 25% - good supplement)

Decreases ApoB

Question 13

CETP Inhibitors

Answer 13

Torcetrapib, Dalcetrapib
MOA: Prevent cholesteryl ester transfer from HDL to LDL

1. Increase HDL
2. Decrease LDL

Question 14

1. Decrease LDL*****
2. Slightly raise HDL
3. Slightly decrease TGs

SE: Hepatotoxicity (LFTs), Myopathy (esp. when used with Fibrates or Niacin), TERATOGENIC

Answer 14

Statins

Question 15

SAFE FOR PREGNANT WOMEN! (all others not safe)

1. Decrease LDL*
2. Slightly raise HDL
3. Slightly raise TGs
4. Weakly stimulate VLDL synthesis - offset with statin

SE: GI upset, Fat soluble vitamin deficiencies, Decrease absorption of other drugs

Answer 15

Bile Acid Sequestrants

Question 16

MOA: Inhibit enterocyte NPC1 cholesterol transporter
Good for statin intolerant patients

1. Decrease LDL**

SE: Rare, increased LFTs, Diarrhea

Answer 16

Ezetimibe

Question 17

MOA: Upregulate LPL, Activate PPAR-alpha to induce HDL synthesis

1. Decrease TGs**
2. Slightly decrease LDL and raise HDL

SE: Myopathy (w/ statins), Gallstones

Answer 17

Fibrates

Question 18

MOA: Inhibits lipolysis (HSL - Gi pathway) in adipose
Reduces hepatic VLDL synthesis

1. Increase HDL*** (#1 at raising HDL)
2. Decrease LDL*
3. Decrease TGs

SE: Red flushed face (tx - NSAIDs), Hyperglycemia, Hyperuricemia (reactivate GOUT)

Answer 18

Niacin

Question 19

MOA: Inactivate LDL receptor degradation, increase amount of LDL removed from bloodstream

1. Reduce LDL**
2. Slightly increase HDL and decrease TGs

SE: Myalgias, Delirium, Dementia, other neurocognitive effects

Answer 19

PCSK9 Inhibitors - Evolocumab

Question 20

MOA: Prevent cholesteryl ester transfer from HDL to LDL

1. Increase HDL
2. Decrease LDL

Answer 20

CETP Inhibitors - Torcetrapib, Dalcetrapib