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USMLE Biochemistry > Lipid drugs > Flashcards

Lipid drugs Flashcards

1
Q

At what LDL level is seen as high?

A

> 200mg/dL

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2
Q

Below what level of HDL is considered low?

A

< 45mg/dL

- Little evidence that raising low levels reduces risk

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3
Q

What is a normal TG level?

A

< 150mg/dL

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4
Q

What is the main risk associated with elevated triglycerides?

A

Pancreatitis

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5
Q

What are statins used to treat specifically?

A

Elevated LDL-C

- Rarely used to treat elevated TG or low HDL-C

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6
Q

What is usually used as a guidline for whether to start a patient on statins?

A 
QRISK score (>5%)
- Old guidelines mainly based on LDL and risk factors
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7
Q

When would high TG or low HDL be treated?

A

Triglycerides

  • > 500
  • High non-HDL cholesterol (TC-HDL)

Low HDL
- Patients w. established CAD

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8
Q

What are all the lipid lowering drugs?

A
  • Statins
  • Niacin
  • Fibrates
  • Absorption blockers
  • Bile acid resins
  • Omega-3 fatty acids
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9
Q

What are the effects of statins?

A

HMG-CoA reductase inhibitors

  • Decrease cholesterol synthesis in liver
  • Increase LDL receptors in liver
  • Decrease LDL (to a lesser degree TG and increase HDL)
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10
Q

What is thought to be the mechanism behind muscle aches with statins?

A

Low levels of coenzyme Q in muscles

- People can take supplements

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11
Q

How can you differentiate muscle conditions as a side-effect of statin therapy?

A

Myalgias

  • Normal CK levels
  • Weakness, soreness

Myositis
- Increased CK

Rhabdomyolysis

  • Weakness, pain, dark urine
  • CKs in 1000s
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12
Q

What can statins cause which may result in death?

A

Rhabdomyolysis

- Acute renal failure, leading to death

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13
Q

What drugs may increase the risk of Rhabdomyolysis in combination with statin therapy?

A
  • Cyclosporine

- Gemfibrozil (fibrate)

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14
Q

What are the hydrophilic statins?

A
  • Pravastatin
  • Fluvastatin
  • Rosuvastatin
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15
Q

What are the lipophilic statins?

A
  • Atorvastatin
  • Simvastatin
  • Lovastatin
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16
Q

What is an advantage of hydrophilic statins?

A

Cause less myalgias (e.g rosuvastatin)

17
Q

What are statins metabolised by?

A

Liver P450 system

18
Q

What do P450 inhibitors (e.g grapefruit juice) increase the chances of with statins?

A
  • LFTs

- Myalgias

19
Q

What is the overall effect of niacin on lipid levels?

A

Lower LDL and increase HDL

  • Main effect increasing HDL (decreased HDL breakdown)
  • Decreased VLDL
  • Decreased FA mobilization (decreased TG)
20
Q

What are the side-effects of niacin?

A
  • FLushing
    (aspirin can inhibit PGs)
  • Hyperglycemia
  • Huperuricemia (gout)
21
Q

Give examples of fibrates

A
  • Gemfibrozil
  • Clofibrate
  • Bezafibrate
  • Fenofibrate
22
Q

What do fibrates activate?

A

PPAR-a

  • Modifies gene transcription
  • Increase activity lipoprotein lipase
  • Increase FA oxidation -> decreased VLDL
  • Increase TG breakdown
23
Q

What patients are given fibrates?

A

High triglycerides

24
Q

What are the side-effects of fibrates? (e.g Gemfibrozil, Clofibrate)

A
  • Myositis (rhabdo w. gemfibrozil)
  • Increased LFTs
  • Cholesterol gallstones
25
Q

What is an example of an absoption blocker?

A

Ezetimibe

26
Q

How does Ezetimibe work?

A

Intestinal brush border

  • Highly selective for cholesterol
  • Increased LDL receptors on liver
  • Does not affect vits ADEK, triglycerides
27
Q

What are side-effects of absorption blockers (e.g Ezetimibe)?

A
  • Increased LFTs

- Diarrhea

28
Q

What are examples of bile acid resins (less used now)?

A
  • Cholestyramine
  • Colestipol
  • Colesevelam
29
Q

Describe how bile acid resins work?

A
  • More bile excretion in stool
  • Liver converts cholesterol -> bile to makeup losses
  • Modest lowering LDL
30
Q

What are some of the ~side-effects of bile acid resins?

A
  • Bloating
  • Bad taste
  • ADEK vits not absorbed
  • Cholesterol gallstones
31
Q

What are the effects of omega-3 fatty acids on lipid levels?

A

Incorporated into cell membranes

  • Reduce VLDL production
  • Lowers triglycerides
  • Modest increase in HDL
32
Q

What is the mechanism behind PCSK9?

A

Degrade LDL receptors

  • Bind to LDL receptors
  • LDL receptor transported to lysosome
33
Q

Give examples of PCSK9 inhibitors

A
  • Alirocumab
  • Evolocumab
    Monoclonal antiBs
34
Q

What is the mechanism of action behind PCSK9 inhibitors?

A
  • Decrease LDL-receptor degrasation
  • Increased LDL receptors on hepatocytes
  • Decrease LDL cholesterol in plasma (>60%)
35
Q

How are PCSK9 inhibitors administered?

A

SC injection

36
Q

What are side-effects of PCSK9 inhibitors?

A
  • Administration - injection site reaction

- Memory problems

USMLE Biochemistry (44 decks)

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