Dyslipidemia 4

Question 1

Which drug?

MOA

• Inhibits synthesis and secretion of VLDL, and therefore LDL
• Proposed MOA: inhibition of FFA release from adipose tissue / increased LPL activity / Decreased TG synthesis

Answer 1

Nicotinic Acid

Question 2

Which drug?

• LDL lowering (10-25%)
• Increases HDL (15-35%)
• TGs decreased (25-30%)

Answer 2

Nicotinic Acid

Question 3

The AHA/ACC 13 states the use of Nicotinic Acid therapy to additionally lower non-HDL once LDL target is achieved DID or DID NOT further reduce ASCVD outcomes?

Answer 3

DID NOT

Question 4

• Which form of Nicotinic Acid is available OTC?
• Which form is Rx only?

Answer 4

• OTC: Niacin
• Rx: Niaspan

Question 5

• Which Nicotinic Acid is immediate or sustained release?
• Which is extended release and has a better SE profile?

Answer 5

• Immediate or Sustained: Niacin
• Exended: Niaspan

Question 6

Which drug?

Side Effects:

• Flushing, warmth, tingling which is offset by taking what before dosing?
• Hyperglycemia (insulin resistance)
• Hyperuricemia (gout)
• Hepatotoxicity (related to sustained release form)

Answer 6

• Nicotinic Acid
• sxs offset by taking NSAID (ASA 325)

Question 7

2 contraindications of Nicotinic Acid

Answer 7

• Active peptic ulcer
• Arterial hemorrhage

Question 8

What is the drug interaction of Nicotinic Acid?

Answer 8

Interacts w/ Anticoagulants (may increase bleeding time)

Question 9

Which drug?

MOA:

• Cholesterol is a precursor
• Binds in the intestine which are then eliminated in feces
• Increased excretion increases cholesterol catabolism to form more

Answer 9

BAS (bile acid sequestrants)

Question 10

Which drugs?

• Decreases LDL 15-30%
• Can increase VLDL in combined HLD

Answer 10

BAS

Question 11

• What is the name of 2 BASs?
• How is it administered?

Answer 11

• Cholestyramine (Questran, Prevalite)
• Powder (tastes bad), 1-2 times/day, then gradually increase to greater than 1 month intervals
• Colesevelam (Welchol)
• Tablets (most tolerable , tastes better)

Question 13

What are the side effects of BASs?

(ABCNF) + one more

Answer 13

• Abdominal pain
• Bloating
• Constipation
• Flatulance
• Nausea
• Severe: bleeding w/ chronic use (affects Vit K absorption)

Question 14

What is recommended to patients who take BAS and have other medications?

Answer 14

BAS will bind to other medications (decreases absorption), so administer 1 hour BEFORE, or 4 hours AFTER taking BAS.

Question 15

Which drug?

MOA:

• Uncertain, is thought to inhibit VLDL and TG synthesis in the liver
• Target effect is 20-50% reduction of TGs

Answer 15

O3FAs (Omega 3 Fatty Acids)

Question 16

Which drug?

• Minimal affect on HDL
• Can increase LDL at high doses

Answer 16

O3FAs

Question 17

Which drug?

• Withdraw after 2 months of inadequate tx results
• Only one w/ evidence that lowers cholesterol levels

Answer 17

Omega 3 Acid Ethyl Esters (Lovaza)

Question 18

2 side effects of O3FA

Answer 18

• Eructation - “fish burp”
• Dyspepsia

Question 19

Contraindication of O3FA

Answer 19

• Fish hypersensitivity

Question 20

What 2 drugs does O3FA interact with?

Answer 20

• Anticoagulants
• Antiplatelets

(may enhance bleeding time)

Question 21

What are the 3 agents under development (LANGE)?

Answer 21

• CETP inhibition
• AMP Kinase activation
• Cyclodextrins

Question 22

• Leads to accumulation of mature HDL particles and diminution of the transport of cholesteryl esters to liver

Answer 22

CETP inhibition

(Torcetrapib, anacetrapib)

Question 24

• Increases fatty acid oxidation and insulin sensitivity
• Inhibits cholesterol and triglyceride biosynthesis
• May have merit for management of metabolic syndrome and diabetes

Answer 24

AMP Kinase Activation

Question 25

• Circular sugar polymers
• Can solubilize cholesterol from tissue sites such as arteriosclerotic plaque

Answer 25

Cyclodextrins