Hyperlipidemia Pharm

Question 1

Statin MOA and effect

• Lovastatin, Fluvastatin, Simvastatin, Pravastatin,
• Atrovastatin, Rosuvastatin

Answer 1

Inhibit HMG-CoA Reductase, the rate limiting step in cholesterol synthesis

*leads to increased LDL receptor expression on hepatocytes, leading to a decrease in circulating LDL

Question 2

Lovastatin, Fluvastatin, Simvastatin, Pravastatin decrease LDL-C in the _____-_____ range.

Answer 2

low-medium range

Question 3

Atrovastatin, Rosuvastatin decrease LDL-C in the _____-_____ range.

Answer 3

medium-high range

Question 4

Absolute contraindications for statins (2)

Answer 4

Liver disease, pregnancy

• relative contraindications are use with fibrates or niacin
• metabolized by CYP450 enzymes

Question 5

Most common statin side effects (2)

Answer 5

myalgias (with normal CK), new onset DM

Question 6

Which statin is not metabolized by the CYP450 system?

Answer 6

Pravastatin

Question 7

Ezetimibe MOA and indication

Answer 7

Blocks cholesterol uptake by blocking the NPC1L1 transport protein in enterocytes and liver canaliculi

Indications:

• adjunct to statin therapy in high risk pts
• alternative if statins not tolerated
• homozygous sitosterolemia (rare dz where body stores plant sterols)

Question 8

Evolocumab MOA

*same as alirocumab

Answer 8

anti-PCSK9 ab

*PSCK9 normally binds and tags LDL receptors for lysosomal destruction, blocking PSCK9 increases LDL receptor recycling and therefore increases LDL uptake by the liver

Question 9

Bile acid sequesterant MOA

*Cholestyramine, Colesevelam

Answer 9

Binds bile acids, preventing reabsorption

• increases hepatic bile acid synthesis from cholesterol, leading to increased LDL receptor activity and LDL removal from the blood
• decreased coronary deaths in clinical trials

Question 10

NIacin (vitamin B3) MOA

Answer 10

inibits hepatocyte diacylglycerol aceyltransferase-2, a key enzyme for TG synthesis

• lowers TG, LDL, increases HDL
• no longer recommended, no decrease in CVD mortality

Question 11

Niacin adverse effects

Answer 11

Flushing, GI distress, hepatotoxicity, hyperglycemia, hyperuricemia

Question 12

Fibrate drug effects and indication

Gemfibrozil, fenofibrate

(unknown MOA)

Answer 12

Fibrates primarily decrease serum TG levels

• ASCVD benefits not proven
• Primay indication is prevention of acute pancreatitis in those with very high TGs

Question 13

Gemfizobril possible adverse effect when combined with statin

Answer 13

Risk of myopathy +/- rhabdomyolysis

• Fenofibrate does not have this risk!!!
• fibrates also increase risk of cholesterol gallstones (moreso with older ones)

Question 14

Omega-3-acid Ethyl Esters (fish oil) effects

*Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA)

(unknown MOA)

Answer 14

Decreased hepatic production of VLDL

*decreased cardiovascular events!!!

Question 15

Metabolic syndrome criteria (5)

*need 3/5 for diagnosis

Answer 15

• Elevated waist circumference
• Elevates TG
• Elevated fasting glucose
• HTN
• Reduced HDL