Drugs for Hyperlipidemia

Question 0

Niacin

Answer 0

Vit B3, Nicotinic Acid
Dec VLDL prod in liver by dec FFA delivery to liver
Effective against hyperTGmia
Tox: intense flushing and itching (reverse with aspirin), peptic ulcer, hyperglycemia, hyperlipidemia, hyperuricemia(GOUT), myositis, RHABDOMYOLYSIS

Question 1

Cholestyramine and Colestipol

Answer 1

Bile Acid Resins
Lose cholesterol by binding bile acids in gut and prevent their reabsorption
NEVER absorbed = zero bioavailability
Mix with 8oz of water, space out from meals
Tox: CHOLELITHIASIS (gallstones), bloating, constipation, diarrhea, interfere with drug absorption (thiazides, digoxin, warfarin, fat-soluble vits)

Question 2

Lovastatin, simvastatin and other statins

Answer 2

HMG CoA Reductase inhibitors
Rate-lim step in cholesterol syn in liver -> dec LDL (25-45%)
Inc LDL receptors
Tox: HEPATIC TOXICITY (check liver fx tests), RHABDOMYOLYSIS , drug interactions (erythromycin, ketoconazole, grapefruit juice -> inc levels of statin drugs)
Contra: pregnancy

Question 3

Gemfibrozil and Fenofibrate

Answer 3

Fibrates
PPARalpha agonist= inc lipase activity -> degrade VLDL TGs
Tox: myositis, gallstones, liver toxicity (ESP with statin)
Contra: pts with hepatic and renal dysfx, gallstone cholesterol

Question 4

Ezetimibe

Answer 4

Inhibits intestinal absorption of sterol by inhibiting brush border Es
Red LDL
Tox: small inc in hepatic dysfx when given with statin, GI distress

Question 5

Omega 3 FA (Lovaza)

Answer 5

Stim Lipase -> dec VLDL, inc HDL
Dec inflammation and cancer?
Tox: may inc LDL, dec blood clotting