Lecture 15 - Lipid Lowering Drugs

Question 1

Type 1 Familial dislipidemia (aka Hyperchylomicronemia) is the only Familial dislipidemia that doesn’t do what? This Dislipidemia causes elevated _______.

Answer 1

Increase risk of CAD

Question 2

Type II Familial Dislipidemia (aka _______) patients typically have MIs before ___ years of age, and present with tendon ______ and Corneal Arcus.

Answer 2

Hypercholesterolemia

20

Tendon Xanthoma

Question 3

Type III Familial dyslipidemia (aka Dysbetaproteinemia) causes elevated _____ AND _____. Look for Palmar ______ in these patients.

Answer 3

Triglycerides and Cholesterol

Palmar Xanthomas

Question 4

Type IV is Hypertriglyceridemia that causes acute ______.

Answer 4

Pancreatitis

Question 5

Statins work to decrease the production of Cholesterol by inhibiting _____-_____ reductase, and they upregulate _____ receptors (thus removing more from the blood.)

Answer 5

HMG-CoA reductase

LDL recetors

Question 6

_______ is the only statin that does not compete for the CYP liver enzymes.

Answer 6

Pravastatin

Question 7

_______ is the statin with the longest lasting effect on HMG-CoA reductase (about 20hrs from a single dose.)

Answer 7

Atorvistatin

Question 8

If liver enzymes are > ___ times their normal value, statins should be discontinued.

Answer 8

> 3 times

Question 9

The risk of ______ from statins is higher in patients who are also taking Fibrates and Nicotinic acid.

Answer 9

Myopathy

Question 10

Statin metabolism is inhibited by anti-______ medications and is accelerated by Barbituates, carbamazepine, rifampin, and phenytoin.

Answer 10

anti-Fungal

Question 11

Bile sequestrants help to lower cardiac events, but they have the consistency of sand, and they may increase serum ______. Also, they have a TON of drug interactions.

Answer 11

Triglycerides

Question 12

Niacin lowers lipids via inhibition of _______ secretion. It is a nicotinic acid, and is among the few meds that will INCREASE _____ levels (and it does so to the greatest degree.)

Answer 12

VLDL

HDL

Question 13

Majority of patients that take niacin experience intense _______ and pruritis of the face and upper body. It is orally bioavailable and has a short half-life. It is not a great medication for diabetics bc it may increase ______ levels, and it may increase ____ acid levels (so not good for patients with gout either).

Answer 13

Flushing

Glucose

Uric acid

Question 14

Fibrates upregulate ______ lipase, so there’s increased clearance of VLDL. It also decreases expression of ___ C-IIII, which is an LPL inhibitor. They also increase _____ acid oxidation.

Answer 14

Lpoprotein lipase

APO C-III

Fatty acid oxidation

Question 15

Fibrate side effects include increased myopathy in patients who are also taking statins, and _______ - gall stones - (so don’t give it to obese and Native American patients).

Answer 15

Cholelithiasis

Question 16

Ezetimibe is an inhibitor of luminal _______ uptake by enterocytes. It has the benefit of being well tolerated.

Answer 16

Cholesterol uptake

Question 17

Lomitapide and Mipomersen are used ONLY for the treatment of _______ (homo or heterozygous?) Familial Hypercholesterolemia.

Answer 17

Homozygous

Question 18

______ inhibitors are used to treat Heterozygous Familial Hypercholesterolemia. Evolocumab and Alirocumab are the generic names of these meds, and they act by increasing the number of ____ receptors on hepatocyte cell membranes.

Answer 18

PCSK9 inhibitors

LDL receptors