cholesterol meds Flashcards
3 classes that mainly lower TG and increase HDL-C
- fibrates
- fish oils
- niacin
HMG-CoA reductase inhibition→ reduce intrahepatic cholesterol pool→ upregulation of hepatic LDL receptors & removal of LDL from blood
HMG-CoA inhibitor
which class has pleiotropic effects
HMG-CoA inhibitors
contraindications of liver dz, pregnancy & combo w/ fibrates
statins
2 main SE of myopathy/myalgia and abnormal LFTs
statins
best for TG > 400-500 mg/dl to prevent pancreatitits
fibrates
activate LPL and reduce apo CIII (LPL inhibitor)
fibrates MOA
2 major effects of fibrates
lower TG & LDL
increase HDL
contras of liver & severe kidney dz, gallstones, pregnancy
fibrates
SE of gallstones, increased creatinine secr., myalgia/myopathy, GI sx, DVT/PE
SE of fibrates
what class do you use for 2-3 mo before assessing for efficacy
fibrates
which class does Compensatory ↑HMG CoA limit effectiveness making it best used w/ statins?
cholesterol absorption inhibitors (bile acid resins & ezetimibe)
major effect of cholesterol absorption inhibitors
lower LDL
med that blocks bile salt absorption in terminal ileum→ reduce intrahepatic cholesterol pool → upregulation of hepatic LDL receptors + LDL removal
bile acid resin
why arent bile acid resins used much?
tastes gross & makes you super constipated
has contraindications of Elevated TG (esp >200), complex med. regimen and bowel or biliary obstruction
bile acid resins
has dose-dependent SEs of Discomfort & constipation
Less drug absorp., Less fat soluble vitamin absorp.
bile acid resins
MOA of blocking absorption of cholesterol in s. Intestine by inhibiting the NPC1L1 protein→ reduce intrahepatic cholesterol pool→ increase hepatic LDL receptors + LDL removal
Ezetimibe
name the sole med that has severe liver dz as the only CI
Ezetimibe
major effect of niacin (2)
lower TG, increase HDL
also lowers LDL
MOA of niacin vs fish oil (3)
Both
* ↓ VLDL production & TG
* ↓ lipolysis in adipocytes
Niacin only:
* ↓ Apo A-1 catabolism, but ↑chol removal from HDL
Most potent med to increase HDL levels
niacin
which med has CI of Liver dz, gout, uncontrolled T2DM, pregnancy
niacin
which 3 meds/classes has pregnancy as CI?
- statins
- fibrates
- niacin
which med has ADR of Increased prostaglandins causing flushing & itching (less when aspirin taken 30 mins before), belly pain, ulcers, GI sx (less w/ meals), Insulin resistance/hyperglycemia, Hepatotoxicity, Hyperuricemia– Gout, myalgia/myopathy (esp w. statin)
niacin
which med has these effects:
* Lower TG; increase HDL
* non lipid effects of plts, membrane stabilization
fish oil
which med has C/I of Eructation, flatulence, belly pain, bruising/bleeding, A. fib. ?
fish oil
which class has MOA of preventing LDL receptor degradation + preserves recycling to hepatocyte surface → ↑receptor density→ ↑LDL clearance
PCSK9 inhibitors
which class has injection site rxn as sole ADR?
PCSK9 inhibitors
which 4 HTN meds are used in pregnancy
- labtelol
- hydralazine
* nifedipine - methyldopa
1 complaint of cholesterol lowering drugs amongst patient
GI sx
3 meds that cause myopathy
- fibrates
- niacin
- statins
