LDL Lowering Medications

Question 1

What 4 statins lower LDL in low-medium decrease range?

Answer 1

Lovastatin
Fluvastatin
Pravastatin
Simvastatin

Question 2

What 4 statins lower LDL in low-medium decrease range?

Answer 2

Lovastatin
Fluvastatin
Pravastatin
Simvastatin

Question 3

What 2 statins lower LDL in medium-high decrease range?

Answer 3

Atorvastatin

Rosuvastatin

Question 4

What 2 statins lower LDL in medium-high decrease range?

Answer 4

Atorvastatin

Rosuvastatin

Question 5

MOA for statins?

Answer 5

(-) HMG-CoA Reductase

– enzyme needed to form cholesterol

Question 6

Why are the systemic concentrations of statins very low?

Answer 6

Liver extracts it from blood, metabolizes it and then excretes in bile

Question 7

Contraindications for taking Statins?

Answer 7

Pregnancy
Liver disease
Other drugs that affect CYP450
Gemfibrozil

Question 8

What drug should be not be taken with Statins?

Answer 8

Gemfibrozil (fibrate)

Question 9

What are the possible side effects of statins?

Answer 9

New onset diabetes

Myalgias

Question 10

Which statin drugs have a higher risk of causing new onset diabetes?

Answer 10

Atorvastatin

Rosuvastatin

Question 11

If statins are not working as well as they should be, what is the next drug of choice to add?

Answer 11

Ezetimibe (NPC1L1 (-))

Question 12

MOA for Ezetimibe

Answer 12

(-) NPC1L1 to block absorption of cholesterol in gut and liver

Question 13

MOA for Ezetimibe

Answer 13

(-) NPC1L1 to block absorption of cholesterol in gut and liver

Question 14

Ezetimibe blocks absorption of cholesterol, which will then increase what receptors on the cells?

Answer 14

LDL – decreases LDL in blood stream

Question 15

What genetic disorder is Ezetimibe approved for?

Answer 15

Homozygous Sitosterolemia

Question 16

Contraindication for Ezetimibe?

Answer 16

Liver disease

Question 17

Common side effects of Ezetimibe?

Answer 17

Headache, runny nose and sore throat

Question 18

If Ezetimibe does not work well with statins, what can be added instead?

Answer 18

PCSK9 (-)s

Question 19

What are the PCSK9 (-)’s?

Answer 19

Evolocumab

Alirocumab

Question 20

What are the PCSK9 (-)’s?

Answer 20

Evolocumab

Alirocumab

Question 21

How are Evolocumab and Alirocumab given and which as more site reactions?

Answer 21

SubQ injections

- Alirocumab has more injection site rxns

Question 22

Overall result of PCSK9 (-)’s?

Answer 22

Increase LDL receptors on hepatocytes

Question 23

What are the Bile Acid Sequestrants?

Answer 23

Cholestyramine
Colestipol
Colesevelam

Question 24

What are the Bile Acid Sequestrants?

Answer 24

Cholestyramine
Colestipol
Colesevelam

Question 25

Of the Bile acid sequestrants, which is newer and is tolerated better with less side effects?

Answer 25

Colesevelam

Question 26

What does Colesevelam contain that some patients with Phenylketonuria should watch out for?

Answer 26

Phenylalanine

Question 27

Describe how Bile Acid Sequestrants work?

Answer 27

- Binds to bile acids to make them insoluble - Excreted in feces - This causes an increase in synthesis of bile acids from cholesterol = Decreases LDL cholesterol

Question 28

Describe how Bile Acid Sequestrants work?

Answer 28

- Binds to bile acids to make them insoluble - Excreted in feces - This causes an increase in synthesis of bile acids from cholesterol = Decrease in LDL cholesterol

Question 29

What else can Bile Acid Sequestrants treat?

Answer 29

Pruritus from cholestatic liver disease

Question 30

What are the contraindications for Bile Acid Sequestrants?

Answer 30

- Serum TG > 400 --> can cause pancreatitis | - Dysbetalipoproteinemia

Question 31

What are the possible side effects of Bile Acid Sequestrants?

Answer 31

- Constipation, hemorrhoids, flatulence - Nausea, dyspepsia, abdominal pain - Decrease in fat soluble vitamins (ADEK) - Elevated liver enzymes

Question 32

What are the possible side effects of Bile Acid Sequestrants?

Answer 32

- Constipation, hemorrhoids, flatulence - Nausea, dyspepsia, abdominal pain - Decrease in fat soluble vitamins (ADEK) - Elevated liver enzymes

Question 33

What vitamin can decrease TG's, LDL and increase HDL?

Answer 33

Niacin (B3)

Question 34

What vitamin can decrease TG's, LDL and increase HDL?

Answer 34

Niacin (B3)

Question 35

Why is Vitamin B3 no longer recommended?

Answer 35

No decrease in mortality

Question 36

What are the possible side effects of Vitamin B3?

Answer 36

Flushing, pruritus, GI distress | New onset diabetes, angina, hyperuricemia

Question 37

What are the possible side effects of Vitamin B3?

Answer 37

Flushing, pruritus, GI distress | New onset diabetes, angina hyperuricemia