Hyperlipidemia

Question 0

Bile acid-binding resins
“BARs”
(Cholestyramine, colestipol, colesevelam)

Answer 0

-for hyperlipidemia
-DEC LDL
-INC HDL
MOA
-bind to bile acids to prevent reabsorption
-INC bile acid synthesis which DEC cholesterol content
-stimulate production of hepatic LDL receptors, INC LDL clearance
ADE
-pancreatitis
-dyspepsia, bloating, abdominal discomfort
-hypertriglyceridemia, elevated transaminases
Interactions
-levothyroxine, warfarin, verapamil, phenytoin

Question 1

Statins

Answer 1

-for hyperlipidemia
-DEC LDL
-DEC tirglycerides
-INC HDL
-improves endothelial function
-improves plaque stability
-anti-inflammatory effects
MOA
-inhibits HMG CoA (interrupts the conversion of HMG CoA to mevalnate)
-rate limiting step in cholesterol biosynthesis
ADE
-Rhabdomyolysis
-INC in serum transaminases
-myalgia
Contraindications
-liver disease
-elevations of serum transaminases
-pregnancy category X
-CYP3A4
-Glucuronidation (Gemifibroizil)
-Grapefruit juice
-red yeast rice

Question 2

Fibric acid derivatives

Answer 2

-for hyperlipidemia
-“-fibros”
-DEC triglycerides
-DEC LDL
-INC HDL
MOA
-activates nuclear transcription factor PPAR-alpha
-regulates genes that control lipid and glucose metabolism
-inhibits lypolysis
ADE
-INC serum transaminases
-myalgia, weakness
Contraindication
-hepatic or renal dysfunction
-primary bilary cirrhosis
-gall bladder disease
Drug interaction
-Gemfibrozil

Question 3

Niacin

nicotinic acid

Answer 3

-for hyperlipidemia
-DEC triglycerides
-DEC LDL
-INC HDL
MOA
-inhibit triglyceride synthesis
-INC LPL activity
-INC HDL synthesis
ADE
-flushing
-dspesia, peptic ulcer disease, nausea
-hyperuricemia, glucose intolerance
-elevations in ALT/AST
Contraindication
-liver diease
-pregnant

Question 4

Ezetimibe/Zetia

Answer 4

-for hyperlipidemia
-DEC in LDL
-can add to statin for INC effect
MOA
-inhibit cholesterol absorption at the brush border
ADE
-more ADE when combined w/ statins
-myopathy
-INC in serum transaminases

Question 5

Omega-3

fish oil

Answer 5

-for hyperlipidemia
-DEC triglycerides
-DEC risk of CHD
-neutraceutical
MOA
-reduces hepatic triglyceride synthesis
-INC triglyceride clearance
ADE
-dyspepsia, taste aversion
-prolonged bleeding time