CVS - lipid lowering drugs

Question 1

Type I hyperlipidemia

Answer 1

familial hyperchylomicronemia

LPL deficiency

Question 2

Type IIA hyperlipidemia

Answer 2

familial hypercholesterolemia

decrease LDL receptors

Question 3

Type IIB hyperlipidemia

Answer 3

familial mixed hyperlipidemia

overproduction of VLDL by the liver

Question 4

Type III hyperlipidemia

Answer 4

familial dys-betalipoproteinemia

overproduction of IDL

Question 5

Type IV hyperlipidemia

Answer 5

familial hypertriglyceridemia

overproduction of VLDL

Question 6

Type V hyperlipidemia

Answer 6

familial mixed hypertriglyceridemia

increased production of VLDL/ CMs

Question 7

5 groups of drugs used for hyperlipidemia

Answer 7

FERNS

1. Niacin
2. Fibrates (gemfibrozil)
3. Resins (cholestyramine)
4. Statins: HMG-CoA reductase inhibitors (lovastatin)
5. Ezetimibe

Question 8

Niacin MOA

Answer 8

• inhibits lipolysis in adipose tissue -> decrease plasma lipid levels
• increases HDL
• decreases circulating fibrinogen and increases t-PA: reverse thrombosis (hypercholesterolemia & atherosclerosis - type IIb and IV)

Question 9

Niacin ADR

Answer 9

hyperuricemia and gout - (also inhibits uric acid oxidation so it cannot be excreted)
flush and itch

Question 10

Fibrates drugs (3)/ fibric acid derivatives

Answer 10

• gemfibrozil
• fenofibrate
• clofibrate

Question 11

Fibrates MOA

Answer 11

ligands for PPAR-a (peroxisome proliferators activated receptor) ->
increase activity of LPL ->
decrease VLDL, increase HDL

Question 12

Fibrates clinical use

Answer 12

treats type III hyperlipidemia - VLDL elevation

Question 13

Fibrates ADR

Answer 13

nausea
rashes
gallstones
myositis (inflammation of muscles, causing muscle weakness)

Question 14

Resins (bile acid binding) drugs (2)

Answer 14

• colestipol

- cholestyramine

Question 15

Resins MOA

Answer 15

binds bile acids and salts in SI, decreasing bile acid conc ->
increase conversion of cholesterol to bile acids ->
end up decreasing cholesterol-containing LDL

Question 16

Resins clinical use

Answer 16

type IIa hyperlipidemia

+ niacin: type IIb

Question 17

Resins ADR

Answer 17

GIT: constipation, nausea, flatulence

impaired fat-soluble vitamins - ADEK

Question 18

HMG CoA reductase inhibitors drugs (4)

Answer 18

(-statin)

• lovastatin
• simvastatin
• pravastatin
• fluvastatin

Question 19

HMG CoA reductase inhibitors MOA

Answer 19

inhibit HMG CoA = inhibit cholesterol synthesis

increase in LDL receptors -> depletion of intracellular cholesterol

Question 20

HMG CoA reductase inhibitors clinical use

Answer 20

lowers cholesterol for all types of hyperlipidemias

Question 21

HMG CoA reductase inhibitors ADR and CI

Answer 21

• affects liver function
• myopathy and muscle soreness
  CI: pregnancy, nursing moms, children, teenagers

Question 22

Ezetimibe MOA

Answer 22

selective inhibitor of NPC1L1 (cholesterol transport protein)

Question 23

Ezetimibe clinical use

Answer 23

reduce LDL
readily absorbed in intestines
+ simvastatin = vytorin

Question 24

Ezetimibe ADR

Answer 24

reversible impaired hepatic fn