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DT3- EXAM 1 > Dislipidemia Drugs- Melissa (3)* > Flashcards

Dislipidemia Drugs- Melissa (3)* Flashcards

1
Q

4 disease states that raise cholesterol levels:

A
  1. Biliary Disease
  2. Renal Disease
  3. Hypothyroidism
  4. Diabetes Mellitus respond well to STATINS
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2
Q

Three disease states that raise TG levels:

A
  1. Alcoholism
  2. Renal Disaese
  3. Diabetes Mellitus
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3
Q

Ideal levels:

  1. cholesterol
  2. LDL-C
  3. TG
A

Cholesterol: UNDER 200
LDL-C: UNDER 100 (acceptable = 100-129)
TG: UNDER 150

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4
Q

Primary causes of hyperlipidemia (2)

A

diet

genetics

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5
Q

3 secondary causes of hyperlipidemia:

A

Drugs (Propranolol, HTZ), Disease (DM), ETOH abuse

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6
Q

What is the first line therapy in hyperlipidemia?

A

DIET MODIFICAITON:

  • Decrease fat (TGs, etc.), carbs, ETOH
  • Increase exercise–> ^HDL prodxn
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7
Q

Cholestyramine, Colesnvelam, Colestipol

Drug Class, ROA, MOA?

A

Resins: Aways start with chol/col

ROA:
PO w/ lots of fluid; NOT ABSORBED GI–> NO bioavailability!

MOA:
Bind bile acids in sm. intestine–>
^ Fecal bile acid excretion–>
DECREASE neg. feedback on 7a-HYDROXYLASE–>
^ Liver conversion cholesterol–> bile acid –>
DECREASE circulating cholesterol

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8
Q

How is Colesevelam administered? Why is this important?

A

Administered as a capsule w/ liquid; becomes gel in GI tract
Less GI sx; better patient compliance

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9
Q

Therapeutic use for Resin drugs?
How long do they take for max effect?
What is max effect?

A
  • Tx ^ cholesterol (~combo treatment for ^ TG/^C pts)

- 4 weeks to max effect= 20% reduction plasma LDL-C

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10
Q

Which patient populations can take resins safely (2)?

Why is this relevant?

A

preggos/ nursing; kiddos +6yrs

*Good alternative to statins which cannot be used in pregnancy or in children under 8yoa

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11
Q

Resins ADRs; when are they worse?

A

GI sx: bloating, constipation, abdominal pain

*Worse if patients don’t take enough fluid!

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12
Q

DD interactions with resins–what is the cause?

How do we avoid this?

A

Resins compromise absorption of fat sol vitamins and drugs

*Take drug 1 hr before or 4 hrs after resin

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13
Q

MOA for all statin drugs?

Recall the two ultimate effects:

A

Competitive inhib. HMG-CoA Reductase (RLS cholesterol synth.)–> DECREASE INDOGENOUS CHOLESTEROL SYNTH. –> ^ LDL-Rs in LIVER + ^ HDL levels

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14
Q

Therapeutic use for ALL statin drugs (2)?

Time to max effect?

A

Hypercholesterolemia; combo tx. in patients with ^ TGs

**2 weeks to max effect

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15
Q

Which two drugs are the most effective statins and can be used to treat ^ TGs?
Why are they so effective (2)?

A

Atorvastatin, Rosuvastatin

  • Longer t 1/2
  • ^ LDR # the most–> LDLR binds APOE–> ^ IDL clearance (w/TGs)
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16
Q

Which statin drug can treat kids 8+ yoa?
Why?
What is the age cut off for all other statin drugs?

A

Pravastatin 8+ yoa (less side effects)
Other Statins 10+ yoa

Pr= Prim, little sister (maybe 8 years old in the first hunger games movie?)

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17
Q

At what time of day does cholesterol synth. peak?

Which statin drugs are taken at night (3)?

A

Cholesterol synth. peaks b/w 12-2AM
Lova-, Fluva-, Simvastatin

Leah is Fast aSLeep at night. (LFS = night time drugs)
This was a good one, thank you! :)

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18
Q

Which statin drug should be taken at dinner (w. food)?

A

Lovastatin

Leah Loves Food!
Take the “L” drug with food!
Also excellent, thank you!!

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19
Q

Which two statin drugs can not be taken with food (dec. absorption)?

A

Prava-, Pitavastatin

Both start with “P”. Don’t take the “p” drugs when you eat your “peas”.
PRAy for PITA but don’t eat it!

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20
Q

Two prominent ADRs of statin drugs:

A
  • Hepatic dysfunciton (^ALT, AST)

- Myalgia (^CPK) STOP DRUG

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21
Q

Factors that increase hepatic ADRs of statin drugs (3)

A
  • ^dose statin
  • gemfibrosil or nicotinic acid
  • CYP3A4 inhibitors (ketoconazole, erythromycin)
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22
Q

Which two statins cause the LEAST ADRs?

A

Fluvastatin, Pravastain (KIDDOS 8+ yoa!)

–> Consequently, these are also the least potent/ cause the smallest cholesterol reduction.

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23
Q

3 contraindications for statins:

A
  • PREGGOS X!!!/ nursing
  • Liver disease
  • Kiddos under 8/10
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24
Q

Which two statins are prodrugs?

Two potential factors compromising their safety of use?

A

Lova-, Simvastatin
CYP3A4 inhibitors, Grapefruit juice
*Atorvastatin not prodrug, but met. by CYP3A4

“LOve SIMone; she’s a pro.”
or “Leah’s SIMply a PRO at school :)”

25
Which 2 statins are metabolized by CYP2C9?
Rosuva-, Fluvastatin It would be *Freaking *Ridiculous 2 C 9 monkeys at the BCC!
26
Which statin is metabolized by CYP2D6? | 2 clinical implications?
Simvastatin 1. CYP2D6*4 allele--> slow metabolizers--> longer t 1/2 2. SCLO1B1 SNP--> poor hepatic uptake--> ^ plasma levels - -> more ADRs (MSK pain!)
27
SCLO1B1 SNP: clinical significance?
Simvistatin; low hepatic absorption and more MSK pain! | Give these patients lower Simvastatin doses.
28
Ezetimibe: MOA? Describe administration regimen?
Targets *DIETARY cholesterol* Once daily dosing MOA: INHIBIT NPC1L1 transporter--> DECREASE cholesterol absorption at brush boarder enterocytes (sm. intestine)
29
Therapeutic uses for Ezetimibe (2) :
Hypercholesterolemia (decrease LDL-C 20%) independently or combo tx *DOUBLE Statin effectiveness*
30
2 ADRs of Ezetimibe:
Diarrhea with fatty meals; Hepatic dysfxn. *Your poops come out too EZ :)*💩
31
Contraindications to Ezetimibe use (2):
- Hepatic disease (enterohepatic recirculation) | - Resins decrease absorption
32
Alirocumab, Evolocumab: Drug class + MOA? ROA + Dosing regimine?
Remember. --mab = monoclonal antibody PCSK9 Inhibitors Inhibit PCSK9 binding LDL-Rs--> STOP targeting endocytosed receptors for destruction--> ^ LDL-R recycling--> ^ # LDL-Rs *IV infusion every 2-4 weeks
33
ADRs of PCSK9 Inhibitors:
Hypersensitivity | -others really unknown because these are so new
34
Gemfibrozil, Clofibrate, Fenofibrate, Benzafibrate Drug Class? MOA ( + 3 effects)?
Fibrates (have fibr in name) ``` MOA: Bind + stimulate PPAR-a --> 1. ^ FA oxidation/LPL--> DECREASE FFA 2. ^ APO AI/AII--> ^ HDL (15%) 3. DECREASE APO CIII--> ^LPL--> DECREASE VLDL ```
35
2 ADRs of Fibrate drugs--which drugs/ circumstances are worst?
-Gallstones (worst = Clofibrate) -Myopathy (statin combo>>>) (worst = Gemfibrosil, Clofibrate)
36
Which fibrate drug causes the LEAST myopathy?
Fenofibrate *FEeel NO pain with FENOfibrate*
37
Describe why fibrate drugs cause worsened myopathy when combined with statins: Which statins are affected the worst (3)?
Block OATP2 transporter--> can't clear statins from liver--> ^ conc. in circ--> ^ MSK sx. *statins affected = prava-, atorva-, rosuvastatin When the fibrates ruin the OATs, the PARty is ruined! We can't have no bake cookies without OATmeal. No cookies = sucky PARty. PAR = prava, atorva, rosuvastatin
38
3 contraindications for fibrate drugs
gallbladder/ liver/ renal disease
39
Nicotinic Acid: | MOA (2)
1. INHIBIT hormone sensitive lipase (adipose cells) --> Decrease lipolysis of fats --> DECREASE FFA return to liver 2. ^LPL --> ^ VLDL clearance (Thank you! :) )
40
Which two classes of drugs are used to treat elevated blood triglycerides? How do they work?
Fibrates and Nicotinic Acid 1. Fibrates: through PPARa 2. Nicotinic acid through hormone sensitive lipase
41
Two caveats to administration of nicotinic acid:
1. CAN'T INTERCHANGE immediate and XR versions (will ^ ADRs) 2. MUST TITRATE DOSE over 4 weeks to the therapeutic dose of 2-6 g/d (will ^ ADRs otherwise.... Like flushing and itching)
42
6 Most common ADRs asstd. with nicotinic acid:
- Itching/ Flushing*** (admin ASA ***to prevent flushing) - PEPTIC ULCERS*** - HYPERURICEMIA (Gout)*** - GLUCOSE INTOLERANCE (DM)*** - Liver disease - Myopathy w/ Statins
43
3 Contraindications for nicotinic acid use:
Bleeding disorders, peptic ulcers, Liver disease | probably gout and DM too if conditions are severe...
44
``` Familial Hyperchylomicronemia (type 1): Describe disease + Treatment ```
Defective LPL or APOCII--> ^ TG/chylomicrons w. 12 hr fast TX: - Diet (limit carbs + fats) - Fibrates + Nicotinic acid- because this is a TG problem! Not cholesterol.
45
``` Familial Hypercholesterolemia (IIa): Describe disease + Drug Treatment ```
Impaired LDL-C clearance *HIGHEST RISK CVD* | TX: #1 Statins -possible combo w/ Ezetimibe or Resin B/c this is a CHOLESTEROL problem!
46
Familial Combined Hyperlipoproteinemia (IIb): | Describe disease + Drug Treatment
^ TG, ^ Cholesterol TX: #1 Statins (Atorvastatin or Rosuvastatin are best- because this is a TG AND CHOLESTEROL problem) Possible combo w/ nicotinic acid
47
``` Familial Dysbetalipoproteinemia (III): Describe disease + Drug Treatment ```
*Abnormal APOE2*--> Can't clear VLDL properly--> ^ TG/cholest., ^IDL + chylomicrons ...Basically, all of the levels are messed up. TX: #1 Fibrates (DECREASE TG 50%) *I don't know a logical reason for not treating the cholesterol issue. *Me either, this perplexed me.
48
``` Familial hypertriglyceridemia (IV) Describe disease + Drug Treatment ``` Which drug makes it worse?
^ TG/ VLDL w/ asstd. hyperuricemia + glucose intolerance TX: #1 Fibrates *NICOTINIC ACID will WORSEN uricemia/ glucose intol.!*
49
Thiazide diuretics effect on lipid profile:
^ cholesterol + ^ TG 10-15%
50
Non-specific B-Blockers (propranolol) effect on lipid profile:
^ TG | DECREASE HDL
51
OCPs effect on lipid profile:
^TG
52
Of all drugs to treat Dislipidemia, which are not labeled to cause hepatic dysfunction/ aren't specifically contraindicated in hepatic failure?
Resins (Because they have no bioavailability) | PCSK9i's (maybe because not enough research yet)
53
NPC1L1 transporter is inhibited by which drug?
Ezetimibe
54
Worst three statins to combine with fibrate drugs:
prava-, atorva-, rosuvastatin
55
What do you give patients to prevent itching/ flushing induced by nicotinic acid?
ASA prophylaxis
56
Which familial lipid disorder has the highest associated risk for CVD?
Familial Hypercholesterolemia (IIa)
57
Three well known CYP3A4 inhibitors
- -Azoles (antifungals) - -grapefruit juice - -erythromycin
58
What are types: | I, IIA, IIB, III, and IV dislipidemia?
``` I. Hyperchylomicronemia IIA. Hypercholesterolemia IIB. Combined Hyperlipidemia III. Dysbetalipoproteinemia IV. Hypertriglyceridemia (the one with glucose/utricle acid issues) ```
59
Which drugs have the following effects? ^TG/cholesterol ^ TG ^TG/ decreased HDL
^TG/cholesterol- Thiazides ^ TG- OCPs ^TG/ decreased HDL- BBers

DT3- EXAM 1 (26 decks)

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