Chapter 27: Dyslipidemia

Question 1

Red Yeast Rice

Answer 1

Yeast grown on rice that contains naturally occurring HMG-CoA reductase inhibitors in low amounts

Question 2

Cholesterol lowering drugs that cause liver damage

Answer 2

• niacin
• fibrates
• potentially statins and ezetimibe

These drugs should not be used if ALT or AST is >3x ULN

Question 3

Statin MOA

Answer 3

Inhibit the enzyme HMG-CoA reductase, which prevents the conversion of HMG-CoA to mevalonate. This is the rate limiting step in cholesterol synthesis.

Question 4

High Intensity Statins

Answer 4

Atorvastatin 40-80mg

Rosuvastatin 20-40mg

Question 5

Low Intensity Statins

Answer 5

"She Probably Loves Fore Play"
S- simvastatin 10mg
P- pravastatin 10-20mg
L- lovastatin 20mg
F- fluvastatin 20-4mg
P- pitavastatin 1mg

Question 6

Ezetimibe MOA

Answer 6

Inhibits absorption of cholesterol in the small intestine

-Monitor LFTS, avoid use in active liver disease

Question 7

PCSK-9 inhibitors

Answer 7

Block the ability of PCSK9 to bind to the LDL receptor . PCSK9 is an enzyme that increases LDL receptor degradation, LDL receptor clears circulating LDL. PCSK9 inhibitors decrease LDL dramatically.

Question 8

Bile Acid Sequestrants/Bile Acid Binding Resins MOA

Answer 8

Work by binding bile acids in the intestines, forming a complex that is excreted in the feces. This non-systemic action results in a partial removal of the bile-acids from the enterohepatic circulation, preventing their reabsorption.

-CI in TG>500

Question 9

Fibrates MOA

Answer 9

Peroxisome proliferate receptor alpha (PPARA) activators, which upregulate the expression of apoC-II and apoA-I.
ApoC-II increases lipoprotein lipase activity leading to catabolism of VLDL.
Can lead to increased LDL

Question 10

Gemfibrozil CI

Answer 10

Do not use with repaglinide (can increase hypoglycemia)

Should not be given with ezetimibe or statins

Question 11

Niacin MOA

Answer 11

Decreases the rate of hepatic synthesis of VLDL (decreases TG) and LDL. Also alters the binding of HDL particles to scavenger receptor B-1 in the liver.

-Also know as nicotinic acid or B-3

Question 12

Fish Oil MOA

Answer 12

• not completely understood
• Indicated for TG >500 as an adjunct to diet
• Lovaza can increase LDL

Question 13

Juxtapid (lomitapide) MOA

Answer 13

• REMS
• decreases apoB, the main component of LDL and VLDL. Binds to and inhibits microsomal triglyceride transfer protein (MTP) which prevents the assembly of apoB containing lipoproteins.
• approved for homozygous familial hypercholesterolemia (HoFH)