Cholesterol

Question 1

What do Bile Acid Sequestrants do?

Answer 1

• Reduce cholesterol by binding bile acids in gut.

- Increase fecal loss of bile salt bound LDL cholesterol

Question 2

Are there drug interactions with bile acid sequestrants?

Answer 2

They bind drugs in the GI tract

Question 3

Preparations of Bile acid sequestrants

Answer 3

1. Cholestyramine resin
2. Colesevelan
3. Solestipol

Question 4

What does Nicotinic acid do?

Answer 4

• Decreases liver triacylglycerol synthesis necessary for VLDL production
• Decreased VLDLs decreases plasma LDLs
• Can reverse some endothelial cell dysfunction leading to thrombosis caused by high cholesterol and atherosclerosis

Question 5

Which drug is the least expensive out of all the drugs stated in connection with high cholesterol

Answer 5

Nicotinic acid (niacin)

Question 6

Side effect of Nicotinic acid

Answer 6

facial flushing

Question 7

What do Fibric Acids do?

Answer 7

• Lower plasma triglycerides
• Increases HDLs
• Inhibit cholesterol synthesis in liver

Question 8

Name the preparations for fibric acids

Answer 8

1. Clofibrate
   
   2. Fenofibrate
   3. Gemfibrozil
      
      • (look for fiber)

Question 9

What are the leading cholesterol-lowering medications?

Answer 9

HMG CoA Reductase Inhibitors

Question 10

How is the HMG CoA Reductase Inhibitor associated with cholesterol?

Answer 10

It is the rate limiting step in the synthesis of cholesterol

Question 11

Drugs lower cholesterol by what 2 methods?

Answer 11

1. Decreases synthesis of cholesterol in liver

2. Increases LDL breakdown (decreases existing bad cholesterol)

Question 12

T or F, New evidence shows that statins have anti-inflammatory activity and may also increase HDLs in some individuals

Answer 12

True

Question 13

In what clinical scenario is a patient not able to take HMG CoA reducatse Inhibitors?

Answer 13

Cannot take if liver disease

Question 14

What are the side effects of statin drugs?

Answer 14

1. Drugs may alter liver function because that is their target
   2. Myalgias (disintegration of muscle tissue)

Question 15

Avoid use of statin drugs in conjunction with what other drugs?

Answer 15

• Avoid use of macrolide antibiotics (erythromycin) and systemic (azole) antifungal medifications in statin users. Promotes rhabomlis
• Red flag drugs!!!

Question 16

What is ezetimibe?

Answer 16

• A combination drug taken with statins

- Decresases intestinal cholesterol absorption

Question 17

Statin (simvastatin) + ezetimibe (Zetia) = ?

Answer 17

Vytorin

Question 18

Statin (atorvastatin) + ezetimibe (Zetia) = ?

Answer 18

Liptruzet

Question 19

ACC/AHA guidelines for statin therapy

Answer 19

1. Patients without CVD who are 40 to 75 and have a 7.5% or higher risk for having a heart attack or stroke within 10 years.
   
   2. History of a CV event
   3. 21 years and older who have a very high level of bad cholesterol
      
      4. With type 1 or type 2 diabetes who are 40 to 75 years old

Question 20

It is no longer a guideline to prescribe what if patients don’t reach targets with statins alone?

Answer 20

• Don’t prescribe additional cholesterol-lowering drugs such as fibrates and niacin
  - These drugs have not been shown to reduce heart attack or stroke risk

Question 21

Oral Care considerations with lipid lowering agents

Answer 21

1. Multiple drug interactions: look up each medication before prescribing dental meds
   
   2. Assess risk for increased bleeding
   3. Avoid azole antifungals and macrolide antibiotics with HMG CoA Reductase Inhibitors
      
      4. Assess changes in cholesterol lowering medications at each visit