Cholesterol meds

Question 1

Which enzyme makes more cholesterol?

Answer 1

HMG-CoA reductase

Question 2

Which lipoproteins contribute to atherosclerosis?

Answer 2

LDL; deliver cholesterol to non hepatic tissue

Question 3

Which lipoprotein protects against atherosclerosis?

Answer 3

HDL

Question 4

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

Answer 4

delivers triglycerides to non hepatic tissue

Question 5

What non therapeutic interventions should pts try first before meds?

Answer 5

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

Question 6

MOA of statins?

Answer 6

• Inhibit HMG-CoA reductase

- increase # of LDL receptors on hepatic cells

Question 7

Statin uses?

Answer 7

• lower LDL and total cholesterol

- can raise HDL and lower TG in some patients

Question 8

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

Answer 8

True

Question 9

Which enzyme metabolizes statins?

Answer 9

CYP3A4 (the 3A4 is isoenzyme of cytochrome P450)

Question 10

Adverse effects of statins?

Answer 10

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

Question 11

How do CYP3A4 inhibitors and grapefruit juice interact with statins?

Answer 11

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

Question 12

What are some CYP3A4 inhibitors?

Answer 12

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

Question 13

Statins are contraindicated in?

Answer 13

pregnancy and liver failure

Question 14

Which labs should be monitored before administering statins?

Answer 14

lipid panel, baseline LFTs and CK level

Question 15

What is a CK level?

Answer 15

creatinine kinase: biomarker for msl injury

Question 16

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

Answer 16

ezetimibe or fibrates

Question 17

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

Answer 17

gallstones, myopathy, and liver disease

Question 18

What are bile acid sequestrants?

Answer 18

reduce LDL levels typically used as adjuncts to statins

Question 19

What is the prototype for bile acid acid sequestrants?

Answer 19

Colesevelam (Welchol)

Question 20

MOA of Colesevelam?

Answer 20

• 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

Question 21

Adverse effects of Colesevelam?

Answer 21

Slight constipation

Question 22

Which older agents affect vitamin absorption and worsening constipation?

Answer 22

Cholestyramine and colestipol

Question 23

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

Answer 23

thiazide diuretics, digoxin, warfarin, and some abx

Question 24

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

Answer 24

other meds 1 hour before or 4 hours after

Question 25

Bile acid sequestrants are contraindicated in?

Answer 25

liver failure, severe renal dysfunction, and gallbladder disease

Question 26

Which labs should be checked before administering bile acid sequestrants?

Answer 26

lipid panel

Question 27

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

Answer 27

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

Question 28

MOA of Ezetimibe?

Answer 28

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

Question 29

Can Ezetimibe be taken with a statin?

Answer 29

Yes or alone

Question 30

Ezetimibe adverse effects?

Answer 30

- gall stones if combined with fibrates | - can increase the risk of liver damage if combined with statins

Question 31

Fibrate uses?

Answer 31

reduce VLDLs and may have slight increase in HDLs

Question 32

Prototype for fibrates?

Answer 32

Gemifibrozil

Question 33

Adverse effects of Gemifibrozil?

Answer 33

Rash, GI disturbances, gallstones, hepatotoxicity, myopathy

Question 34

Possible side effect of Gemifibrozil if taken with warfarin?

Answer 34

Increase bleeding

Question 35

Possible side effect of Gemifibrozil if taken with statins?

Answer 35

rhabdomyolysis

Question 36

What labs should be checked prior to administration of Gemifibrozil?

Answer 36

lipid panel and LFTs

Question 37

Gemifibrozil is contraindicated in?

Answer 37

liver failure, severe renal dysfunction, and gallbladder disease

Question 38

When should Gemifibrozil be taken?

Answer 38

30 minutes before morning and evening meals

Question 39

Which bile acid sequestrant does not affect vitamin absorption?

Answer 39

Colesevelam (Welchol)

Question 40

Which bile acid sequestrants cause fat-soluble vitamin deficiency?

Answer 40

Cholestyramine and colestipol