Chapter 8 - Dyslipidemia

Question 1

atorvastatin (Lipitor)

Answer 1

Class: HMG-CoA Reductase Inhibitors (Statins)

• MOA: act by inhibiting HMG-CoA reductase, as liver produces less cholesterol it responds by making more LDL receptors on the surface of liver cells; the more LDL receptor sites results in an increase in the amount of LDL from the blood
• Admin: takes 2 weeks for maximum therapeutic effect, give with food to decrease GI, pregnancy category X
• AE: headache, GI complaints, liver damage can occur in a small amount of patients – liver function should be monitored for the first few months of therapy. Rhabdomyolysis (patients get breakdown of RBCs/tissue of muscle, goes to kidney, can cause renal failure. Most common S/S: muscle aches/muscle pain during muscle damage) is the most serious AE
• Food interactions: grapefruit juice inhibits the metabolism of statins, allowing them to reach toxic levels

Question 2

cholestyramine (Questran)

Answer 2

Class: Bile Acid Sequestrants

• MOA: binds bile acids in intestinal lumen, causes bile acids to be excreted in feces
• Use: primarily lowers LDL
• Admin: powder form, do not take with other meds -take one hour before other meds
• AE: not systemically absorbed – mostly GI effects (abdominal fullness, flatulence , diarrhea, constipation)

Question 3

fenofibrate (TriCor)

Answer 3

Class: Fibrates

• MOA: decrease hepatic production of triglycerides, VLDL and increase HDL
• Use: most effective in reducing triglycerides and increasing HDL
• AE: GI discomfort, diarrhea, gallstones

Question 4

ezetimibe (Zetia)

Answer 4

Class: Cholesterol Absorption Inhibitor

• MOA: blocks biliary and dietary cholesterol absorption in intestine
• Use: primary dyslipidemia
• Admin: take same time every day
• AE: headache, diarrhea, rash, nausea

Question 5

niacin (Nicotinic Acid)

Answer 5

Class: Vitamin

• MOA: reduces total LDL, VLDL, and triglyceride levels; increases HDL
• Use: most effective in increasing HDL, use with statin lowers LDL more than any other drug alone
• AE: flushing, pruritus, gastric irritation
• Admin: reduce flushing by taking ASA 325 mg – 30 minutes prior to niacin or ibuprofen 200 mg – 60 minutes before niacin. Take with cold water
• Other: Sold OTC – one form, nicotinamide, does NOT have lipid-lowering effects – educate your patients