Exam 2- Drugs for Dyslipidemia

Question 1

HMG-CoA Reductase Inhibitors

Answer 1

Examples:
Remember "statin"
*Atorvastatin*
*Fluvastatin*
*Lovastatin*
Pravastatin
Rosuvastatin
Simvastatin

Block early step in cholesterol synthesis
ATP preference
Improve endothelial function (possibly by non-lipid effect)
Maintain plaque stability and prevent thrombus formation
Stop statin if side effects of myositis or rhabdomyolysis occur
Incidence is about 6 out of 10,000
Many effects may be unrelated to HDL/LDL ratio
Consider coenzyme Q supplementation (probably not really helpful)
Avoid taking with grapefruit juice which contains furanocourmarins (inhibit CYP450)

Question 2

Bile Acid-Binding Resins

Answer 2

Examples:
Remember "coles"
Cholestyramine
Colestipol
Colesevelam

Reduce gastric reabsorption of cholesterol
Inhibit enterohepatic recirculation of bile acids leading to increased expression of LDL receptors
May cause severe GI side effects
Increased triglyceride levels
K deficiency may occur

Question 3

Cholesterol Absorption Inhibitor

Answer 3

Examples:
Exetimibe

Blocks intestinal cholesterol absorption
Reduces LDL-C (limited evidence)
No evidence it improves long-term outcomes
Has been combined with statins

Question 4

Fibric Acid Derivatives

Answer 4

Examples:
Remember “fibr”
Fenofibrate
Gemfibrozil

Increase expression of lipoprotein lipase
Increase LDL receptor expression
Increase HDL and markedly reduce triglycerides
Drive uptake, utilization, and catabolism of fatty acids
Rhabdomyolysis is a side effect

Question 5

Niacin

Answer 5

AKA: Nicotinic Acid
Use: Hyperlipidemia
Inhibits lipolysis
Reduces triglycerides and increases HDL
High dose/fast release promotes flushing
Sustained release have higher incidence of hepatic toxicities
Promotes hyperuricemia and triggers gout attacks
Now questionable if niacin really does much

Question 6

Fish Oil (Omega 3)

Answer 6

AKA: EPA and DHA
Used when triglycerides exceed 500 mg/dL
Unknown mechanism
Side effect of fish burp