Cholesterol Drugs

Question 1

Statin Examples

Answer 1

1. Atorvastatin (Lipitor)
2. Simvastatin (Zocor)
3. Pravastatin (Pravachol)

Question 2

Statin MOA

Answer 2

HMG-CoA reductase (mediates first step of cholesterol synthesis) inhibitors –> decrease LDL

Question 3

Statin Indications

Answer 3

Hyperlipidemia (first line)

Question 4

Statin CIs

Answer 4

1. Pregnancy - under no circumstances
2. liver disease, hx alcoholism
3. caution in pts who take red yeast rice supplements

Question 5

Statin S/Es

Answer 5

1. myalgias, muscle weakness
2. myositis, rhabdomyolysis (brown urine, check CPK)
3. hepatotoxicity
4. depletion of coenzyme Q10
5. photosensitivity

Question 6

How long does it take to see effect of statins

Answer 6

4 weeks to see peak effects

Question 7

patient ed for Statin regarding food

Answer 7

don’t drink grapefruit juice

Question 8

Statin Drug interactions

Answer 8

1. Fibrates
2. Niacin
3. Erythromycin

Question 9

What do you have to check before starting statins

Answer 9

LFTs initially and then every 3-6 months

Question 10

Cholesterol Absorption Inhibitor example

Answer 10

Ezetimibe (Zetia)

Question 11

Cholesterol Absorption Inhibitor MOA

Answer 11

inhibits cholesterol absorption in small intestine

Question 12

Cholesterol Absorption Inhibitor Indications

Answer 12

add-on therapy for hyperlipidemia (add to statin)

Question 13

Cholesterol Absorption Inhibitor CIs

Answer 13

liver disease if given in addition to statin

Question 14

Cholesterol Absorption Inhibitor S/E

Answer 14

1. abdominal pain
2. diarrhea
3. arthralgia
4. fatigue
5. Serious: angioedema, increased LFTs, drug-induced myopathy, rhabdomyolysis

Question 15

Cholesterol Absorption Inhibitor drug interactsion

Answer 15

1. bile acid sequestrants
2. cyclosporine (cancer drug)
3. fibrates

Question 16

Bile Acid Sequestrants Example

Answer 16

Cholestyramine (Questran/Prevalite)

Question 17

Bile Acid Sequestrants MOA

Answer 17

binds to bile acids and makes them insoluble so they are excreted in feces, lowers LDL but not as effectively as statin

Question 18

Bile Acid Sequestrants indications

Answer 18

hyperlipidemia

Question 19

Bile Acid Sequestrants CIs

Answer 19

hypertriglyceridemia
liver disease
hx of bowel obstruction or severe constipation

Question 20

Bile Acid Sequestrants S/E

Answer 20

1. constipation
2. bloatin
3. gas
4. nausea
5. upper abdominal pain
6. increase LFTs
7. can cause Vitamin A, D, E, K deficiencies (fat soluble vitamins)

Question 21

Bile Acid Sequestrants prevent the absorption of…..

and when can you give these other medications in relation to Bile Acid Sequestrants

Answer 21

1. thiazide diuretics
2. furosemide/lasix
3. propranolol
4. digoxin
5. warfarin
6. fat-soluble vitamins
   - -> other drugs must be administered one hour before or 4 hours after giving medication

Question 22

Fibrates Indications

Answer 22

Hypertriglyceridemia

Question 23

Fibrates Examples

Answer 23

Gemfibrozil (Lopid)

Fenofibrate (Tricor)

Question 24

Fibrates MOA

Answer 24

inhibit peripheral lipolysis, inhibit LDL secretion

Question 25

Fibrates CIs

Answer 25

renal disease | gallbladder disease

Question 26

Fibrates S/E

Answer 26

Cholelithiasis (diarrhea, nausea) pancreatitis myopathy

Question 27

Niacin MOA

Answer 27

precursor of coenzyme that is used in lipid metabolism

Question 28

Niacin indications

Answer 28

hypercholesterolemia | low HDL

Question 29

Niacin contraindications

Answer 29

flushing liver dysfunction orthostatic hypotension can worsen gout

Question 30

what can be given with niacin to prevent flushing?

Answer 30

aspirin or flush-free niacin

Question 31

Evolocumab (Repatha) drug class

Answer 31

monoclonal antibody inhibitor

Question 32

Evolocumab (Repatha) MOA

Answer 32

increase LDL clearance from blood

Question 33

monoclonal antibody inhibitor indications

Answer 33

primary hyperlipidemia, reduce risk of MI/stroke in pts with CAD **have to fail statin therapy and secondary therapy + have hx of CAD to be cleared by insurance to get this drug

Question 34

monoclonal antibody inhibitor CI

Answer 34

hypersensitivity

Question 35

monoclonal antibody inhibitor SE

Answer 35

injection site pain/irritation