LDL Lowering Medications Flashcards
What 4 statins lower LDL in low-medium decrease range?
Lovastatin
Fluvastatin
Pravastatin
Simvastatin
What 4 statins lower LDL in low-medium decrease range?
Lovastatin
Fluvastatin
Pravastatin
Simvastatin
What 2 statins lower LDL in medium-high decrease range?
Atorvastatin
Rosuvastatin
What 2 statins lower LDL in medium-high decrease range?
Atorvastatin
Rosuvastatin
MOA for statins?
(-) HMG-CoA Reductase
– enzyme needed to form cholesterol
Why are the systemic concentrations of statins very low?
Liver extracts it from blood, metabolizes it and then excretes in bile
Contraindications for taking Statins?
Pregnancy
Liver disease
Other drugs that affect CYP450
Gemfibrozil
What drug should be not be taken with Statins?
Gemfibrozil (fibrate)
What are the possible side effects of statins?
New onset diabetes
Myalgias
Which statin drugs have a higher risk of causing new onset diabetes?
Atorvastatin
Rosuvastatin
If statins are not working as well as they should be, what is the next drug of choice to add?
Ezetimibe (NPC1L1 (-))
MOA for Ezetimibe
(-) NPC1L1 to block absorption of cholesterol in gut and liver
MOA for Ezetimibe
(-) NPC1L1 to block absorption of cholesterol in gut and liver
Ezetimibe blocks absorption of cholesterol, which will then increase what receptors on the cells?
LDL – decreases LDL in blood stream
What genetic disorder is Ezetimibe approved for?
Homozygous Sitosterolemia
Contraindication for Ezetimibe?
Liver disease
Common side effects of Ezetimibe?
Headache, runny nose and sore throat
If Ezetimibe does not work well with statins, what can be added instead?
PCSK9 (-)s
What are the PCSK9 (-)’s?
Evolocumab
Alirocumab
What are the PCSK9 (-)’s?
Evolocumab
Alirocumab
How are Evolocumab and Alirocumab given and which as more site reactions?
SubQ injections
- Alirocumab has more injection site rxns
Overall result of PCSK9 (-)’s?
Increase LDL receptors on hepatocytes
What are the Bile Acid Sequestrants?
Cholestyramine
Colestipol
Colesevelam
What are the Bile Acid Sequestrants?
Cholestyramine
Colestipol
Colesevelam
Of the Bile acid sequestrants, which is newer and is tolerated better with less side effects?
Colesevelam
What does Colesevelam contain that some patients with Phenylketonuria should watch out for?
Phenylalanine
Describe how Bile Acid Sequestrants work?
- 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
Describe how Bile Acid Sequestrants work?
- 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
What else can Bile Acid Sequestrants treat?
Pruritus from cholestatic liver disease
What are the contraindications for Bile Acid Sequestrants?
- Serum TG > 400 –> can cause pancreatitis
- Dysbetalipoproteinemia
What are the possible side effects of Bile Acid Sequestrants?
- Constipation, hemorrhoids, flatulence
- Nausea, dyspepsia, abdominal pain
- Decrease in fat soluble vitamins (ADEK)
- Elevated liver enzymes
What are the possible side effects of Bile Acid Sequestrants?
- Constipation, hemorrhoids, flatulence
- Nausea, dyspepsia, abdominal pain
- Decrease in fat soluble vitamins (ADEK)
- Elevated liver enzymes
What vitamin can decrease TG’s, LDL and increase HDL?
Niacin (B3)
What vitamin can decrease TG’s, LDL and increase HDL?
Niacin (B3)
Why is Vitamin B3 no longer recommended?
No decrease in mortality
What are the possible side effects of Vitamin B3?
Flushing, pruritus, GI distress
New onset diabetes, angina, hyperuricemia
What are the possible side effects of Vitamin B3?
Flushing, pruritus, GI distress
New onset diabetes, angina hyperuricemia
