Exam3Lec4Antihyperlipidemics Flashcards
What are the 2 reasons why someone might have high cholesterol?
made a joke
Because of low exercise and high saturated fatty acids
What is CHD correlated with in terms of LDL and HDL?
High LDL (“bad”) and low HDL (“good”)
antihyperlipidemins taken chronically
What are the 5 ACC/AHA Guidelines on the Management of Blood Cholesterol?
- Healthy lifestyle
- Clinical ASCVD: ↓ LDL-C by > 50% with high-intensity statin with a nonstatin when LDL > 70
- Severe hypercholesterolemia: High-intensity statin at highest tolerated dose
- DM & LDL-C > 70 mg/dL, 40-75 y/o : Moderate-intensity statin
- 10-year ASCVD risk > 7.5%, 40-75 y/o: Consider moderate-intensity statin
high-intensitty statin: atorvastatin/ rosuvastatin
non statin: ezetimibe or cholestyramine
For patients who took high intensity statins Atorvastatin and Rosuvastatin daily, what happened to their LDL lvls?
LDL-C ↓ by > 50%
For patients who took moderate intensity statins (a&r, S&Prav, L&F) , daily, what happened to their LDL lvls?
LDL-C ↓ by 30 -50%
For patients who took moderate intensity statins (a&r, S&Prav, L&F) , daily, what happened to their LDL lvls?
LDL-C ↓ by 30 -50%
For patients who took low intensity statins (P and L) , daily, what happened to their LDL lvls?
LDL-C ↓ by < 30%
Which drug(s) are HMG CoA reductace inhibitors?
- Atorvastatin
- Lovastatin
- Pravastatin
- Rosuvastatin
- Simvastatin
- Fluvastatin
- Pitavastatin
all -statins
bolded is hy
MOA for statins in general
Inhibit HMG CoA reductase which is the RLS , this inhibit de novo cholesterol synthesis therefore depleting intracellular supply of cholesterol.
Low IC cholesterol stimulates synthesis for more LDL receptors so there is more LDL uptake from blood
they are Analogs of 3-OH-3-CH3-glutaryl (a cholesterol precursor )
Rank order potency of LDL lowering (from Greatest to Lowest)
Pitavastatin, Rosuvastatin, Atorvastatin > Simvastatin, Pravastatin > Lovastatin, Fluvastatin
Atorvastatin
1. MOA
2. Therapeutic uses
- MOA: Blocks HMG-COA reductase. Leads to Depletion of intracellular cholesterol by incr LDL receptors and bind & internalize circulating LDL (decr LDL, incr HDL, lower TAG))
- Therapeutic uses: hyperlipidemia, plaque stabalization, CHD
incr in LDL receptors and block its exportation (bringing everything outside inside)
Is atorvastatin effective for homo familial hypercholesterolemia?
NO, because it lacks functional LDL receptors
Are statins risk reducers for CHD?
Yes, it doesnt necessarily solve the problem, it should be used in combination with diet and exercise
Atorvastatin
1. SE
2. Drug interactions
- SE: constipation, no preg, confusion/memory impairment, muscle aches, DM
- Drug interactions: Cyclosporine, Itraconazole, Erythromycin, Gemfibrozil, Niacin
bolded hy
rhabdo=muscles
A 43-year-old obese man with type 2 diabetes mellitus is prescribed atorvastatin for the treatment of hyperlipidemia. Which of the following is the mechanism of action of atorvastatin?
A. Triacylglycerol secretion inhibitor
B. HMG-CoA reductase inhibitor
C. Cholesterol absorption inhibitor
D. Cholesterol secretion inhibitor
B. HMG-CoA reductase inhibitor
Which drug(s)s are lipolysis inhibitors?
Niacin: nicotinic acid, Vitamin B3
hy
Niacin
MOA
- Inhibits TAG lipolysis in adipose tissue.
- decr tag syntheis, decr LDL, incr HDL
- incr tissue plasminogen activator, decr fibrinogen
- Reverse some endothelial cell dyfxn, contributing to clots w/ hypercholesterolemia & atherosclerosis
TAG lipolysis-> fatty acid (adiose to liver)-> TAG->VLDL-> LDL
Niacin
1. Therapeutic uses
2. Side effects
3. Pharmacokinetics
4. Drug interactions
- Therapeutic uses: hyperlipidemia, lower LDL, INCR HDL THE MOST
- Side effects: flushing, Hyperuricemia (gout), DM, hepatitis
- Pharmacokinetics: Converted into nicotinamide which has no activity
- Drug interactions: Statins: ↑ muscle & liver toxicity risk
you can decr flushing with ASA and IBU
you need a higher dose to decr LDL
HALLMARK IS THAT IT INCR HDL THE MOST
Which drug(s) are fibrates?
Fenofibrate, Gemfibrozil
bolded is hy
Gemfibrozil
MOA
- Peroxisome proliferator-activated receptor-α (PPAR-α) agonists
- decr TAG by incr lipoprotein lipase), incr HDL, decr LDL
PPAR-α regulates lipid metabolism
HALLMARK=DECR TAG THE MOST