Hypercholesterolemia

Question 1

Atorvastatin

Answer 1

Class: Statins

MOA: HMG-CoA reductase → more LDL receptor → decrease LDL

Adverse Effect/Contradictions: pregnancy, liver disease, myopathy/rhabdomyolysis

Clinical Pearls: most effect drug to lower LDL levels

Question 2

Cholestyramine

Answer 2

Class: Bile-Acid binding Resins

MOA: forms insoluble complex with bile salt → bile not absorb

Adverse Effect/Contradiction: decrease uptake of vitamins (A, D, E, K)

Question 3

Ezetimibe

Answer 3

MOA: inhibits NPC1L1 on small intestine (enterocyte) → inhibit cholesterol absorption

Contradiction: liver disease, myopathy

Question 4

Niacin

Answer 4

MOA: inhibits hormone sensitive lipase → decrease cholesterol in blood

Adverse Effect/Contradiction: liver disease, skin (flushing, itching)

Clinical Pearls: best drug for increasing HDL levels

Question 5

Gemfibrozil

Answer 5

Class: Fibrates

MOA: increase PPAR-alpha activation → decrease TG level, VLDL, and LDL-C

Adverse Effect/Contradiction: liver disease, gallstones

Question 6

Alirocumab, Evolocumab

Answer 6

Class: PCSK9 inhibitors

MOA: prevent degradation of LDL receptors