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PHARM > Cholesterol meds > Flashcards

Cholesterol meds Flashcards

1
Q

Which enzyme makes more cholesterol?

A

HMG-CoA reductase

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2
Q

Which lipoproteins contribute to atherosclerosis?

A

LDL; deliver cholesterol to non hepatic tissue

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3
Q

Which lipoprotein protects against atherosclerosis?

A

HDL

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4
Q

What does very low density lipoprotein do (VLDL) do?

A

delivers triglycerides to non hepatic tissue

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5
Q

What non therapeutic interventions should pts try first before meds?

A

diet modification, exercise, quit smoking, manage DM and HTN, med compliant

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6
Q

MOA of statins?

A
  • Inhibit HMG-CoA reductase

- increase # of LDL receptors on hepatic cells

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7
Q

Statin uses?

A
  • lower LDL and total cholesterol

- can raise HDL and lower TG in some patients

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8
Q

T/F. Statins have a heavy 1st pass effect?

A

True

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9
Q

Which enzyme metabolizes statins?

A

CYP3A4 (the 3A4 is isoenzyme of cytochrome P450)

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10
Q

Adverse effects of statins?

A
  • myopathy/rhabdo
  • hepatotoxicity
  • new onset diabetes, memory loss, and cataracts
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11
Q

How do CYP3A4 inhibitors and grapefruit juice interact with statins?

A

Will suppress the enzyme that metabolizes the med → increasing levels in the bloodstream

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12
Q

What are some CYP3A4 inhibitors?

A
  • Macrolide abx: erythromycin
  • Azole antifungal drugs
  • HIV protease inhibitors
  • Amiodarone
  • Cyclosporine (immunosuppressant)
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13
Q

Statins are contraindicated in?

A

pregnancy and liver failure

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14
Q

Which labs should be monitored before administering statins?

A

lipid panel, baseline LFTs and CK level

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15
Q

What is a CK level?

A

creatinine kinase: biomarker for msl injury

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16
Q

Be cautious when taking statins with what other lipid lowering agents d/t risk of liver damage?

A

ezetimibe or fibrates

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17
Q

When giving statins we should monitor for development of which complications?

A

gallstones, myopathy, and liver disease

18
Q

What are bile acid sequestrants?

A

reduce LDL levels typically used as adjuncts to statins

19
Q

What is the prototype for bile acid acid sequestrants?

A

Colesevelam (Welchol)

20
Q

MOA of Colesevelam?

A
  • Increase LDL receptors on hepatocytes
  • actively binding to bile acids to prevent its reabsorption in the intestines.
  • Need cholesterol to make bile
  • Low levels of bile acids will results in increase cholesterol in the liver to be and increase receptor site → less LDL in the blood stream
21
Q

Adverse effects of Colesevelam?

A

Slight constipation

22
Q

Which older agents affect vitamin absorption and worsening constipation?

A

Cholestyramine and colestipol

23
Q

Bile acid sequestrants should not be taken at the same time as what other drugs?

A

thiazide diuretics, digoxin, warfarin, and some abx

24
Q

If taking bile acid sequestrants with meds that have a drug interaction when should it be taken?

A

other meds 1 hour before or 4 hours after

25
Q

Bile acid sequestrants are contraindicated in?

A

liver failure, severe renal dysfunction, and gallbladder disease

26
Q

Which labs should be checked before administering bile acid sequestrants?

A

lipid panel

27
Q

How to limit esophageal irritation and impaction when taking bile acid sequestrants?

A

If powder or granules, mix with water, soup, fruit juice, or applesauce

28
Q

MOA of Ezetimibe?

A
  • acts on small intestines to inhibit dietary cholesterol absorption.
  • prevents reabsorption of cholesterol secreted in the bile.
  • can produce a small increase in HDL
29
Q

Can Ezetimibe be taken with a statin?

A

Yes or alone

30
Q

Ezetimibe adverse effects?

A
  • gall stones if combined with fibrates

- can increase the risk of liver damage if combined with statins

31
Q

Fibrate uses?

A

reduce VLDLs and may have slight increase in HDLs

32
Q

Prototype for fibrates?

A

Gemifibrozil

33
Q

Adverse effects of Gemifibrozil?

A

Rash, GI disturbances, gallstones, hepatotoxicity, myopathy

34
Q

Possible side effect of Gemifibrozil if taken with warfarin?

A

Increase bleeding

35
Q

Possible side effect of Gemifibrozil if taken with statins?

A

rhabdomyolysis

36
Q

What labs should be checked prior to administration of Gemifibrozil?

A

lipid panel and LFTs

37
Q

Gemifibrozil is contraindicated in?

A

liver failure, severe renal dysfunction, and gallbladder disease

38
Q

When should Gemifibrozil be taken?

A

30 minutes before morning and evening meals

39
Q

Which bile acid sequestrant does not affect vitamin absorption?

A

Colesevelam (Welchol)

40
Q

Which bile acid sequestrants cause fat-soluble vitamin deficiency?

A

Cholestyramine and colestipol

PHARM (35 decks)

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