Lipid Drugs

Question 1

What is the MOA of statins?

Answer 1

They block HMG-CoA reductase, an enzyme needed for cholesterol synthesis in the liver. This lowers cholesterol in liver cells, leading to an increase in LDL receptors, which pull more LDL (bad cholesterol) out of the blood.

Question 2

What is the main use of statins?

Answer 2

Lowering LDL cholesterol

Question 3

What is the MOA of Niacin?

Answer 3

Inhibits fat breakdown in fat tissue, reducing free fatty acids the liver uses to make triglycerides. This lowers VLDL (a precursor to LDL) and LDL while raising HDL cholesterol.

Question 4

What is the main use of Niacin?

Answer 4

Increasing HDL cholesterol in conditions like familial hyperlipidemia

Question 5

What is the MOA of Fibrates?

Answer 5

Activates PPAR-alpha, which enhances the breakdown of triglycerides by increasing lipoprotein lipase activity and decreases VLDL production. They also increase HDL by enhancing apolipoprotein AI and AII.

Question 6

What is the main use of Fibrates?

Answer 6

Reducing triglycerides particularly in conditions like hypertriglyceridemia or Type III hyperlipidemia.

Question 7

What is the MOA of Bile Acid Sequestrants?

Answer 7

Binds bile acids in the intestine, preventing their reabsorption. This forces the liver to use more cholesterol to make bile acids, reducing blood LDL levels.

Question 8

What is the main use of Bile Acid Sequestrants?

Answer 8

Lowering LDL cholesterol. Often used as add on with other hyperlipidemia drugs.

Question 9

What is the MOA of Ezetimibe?

Answer 9

Blocks cholesterol absorption in the small intestine, decreasing cholesterol delivered to the liver.

Question 10

What is the main use of Ezetimibe?

Answer 10

Lowers LDL. Used as add on to statins.

Question 11

What is the MOA of fish oils?

Answer 11

Reduces liver production of triglycerides and VLDL.

Question 12

What is the main use of fish oils?

Answer 12

Lowers very high triglycerides.

Question 13

Which lipid drugs are approved in children?

Answer 13

Statins are first line treatment
Bile Acid Sequestrants

Question 14

What are contraindications for taking Statins?

Answer 14

Absolute Contraindications:
Active liver disease.
Pregnancy and lactation (Category X).
Hypersensitivity to statins.

Relative Contraindications:
History of statin-associated myopathy or rhabdomyolysis.
Severe renal impairment (risk of muscle toxicity)

Question 15

What are the most potent stains?

Answer 15

Rosuvastatin
Atorvastatin

Question 16

What are the advantages of taking Rosuvastatin and Pravastatin?

Answer 16

1. Hydrophilic statins (less penetration into non-hepatic tissues, so less side effects like myopathy)
2. Not metabolized by CYP450 making these good drugs for patients with polypharmacy

Question 17

What is the low potency statin?

Answer 17

Fluvastatin

Question 18

What is the main concern of co-administering a statin with gemfibrozil, cyclosporine, or erythromycin?

Answer 18

Increased risk of myopathy and rhabdomyolysis, a potentially severe muscle breakdown condition that can lead to kidney damage.

Question 19

Which statins are approved for use in children?

Answer 19

Atorvastatin (10+)
Pravastatin (8+)
Rosuvastatin (8+)

Question 20

What are contraindications for taking Niacin?

Answer 20

Active liver disease
Active peptic ulcers
Diabetes
Gout
Pregnancy

Question 21

What are side effects of Niacin?

Answer 21

Flushing and Pruritus
GI Symptoms
Hepatotoxicity
Impaired Glucose Tolerance
Hyperuricemia and Gout
Rhabdomyolysis

Question 22

What are contraindications for taking fibrates?

Answer 22

Severe liver disease.
Severe kidney disease
Pre-existing gallbladder disease (fibrates increase cholesterol in bile, raising the risk of gallstones).
Concurrent use with statins, particularly gemfibrozil, due to an increased risk of myopathy and rhabdomyolysis.

Question 23

What are side effects of taking fibrates?

Answer 23

GI symptoms
Myopathy and Rhabdomyolysis
Gallstones
Liver toxicity

Question 24

What are drug interactions to monitor when taking fibrates?

Answer 24

Statins: Increased risk of muscle toxicity, especially when
Warfarin: Increases risk of bleeding.
Bile Acid Sequestrants:
Can reduce fibrate absorption. Administer fibrates 1 hour before or 4-6 hours after bile acid sequestrants.
Immunosuppressants (cyclosporine):
Fibrates may worsen kidney function in patients taking cyclosporine.

Question 25

What are major sources of fish oil?

Answer 25

Marine sources (fatty fish, fish oil supplements, Krill oil)
Plant based sources from flaxseed, chia seeds, and walnuts.

Question 26

What are side effects of Fish Oils?

Answer 26

Gastrointestinal (GI): Nausea, diarrhea, bloating, and abdominal discomfort.
Fishy aftertaste or burps (“fish burp”).
Unpleasant taste or halitosis in some cases.

Question 27

What are lab monitoring tests needed when a patient is taking statins?

Answer 27

LDL, HDL, triglycerides, ALT/AST, CK

Question 28

What labs should be monitored for a patient taking Niacin?

Answer 28

LDL, HDL, triglycerides, ALT/AST, glucose, and uric acid

Question 29

What labs should be monitored when a patient is taking fibrates?

Answer 29

HDL, triglycerides, AST/ALT, CK, renal function

Question 30

What lipid drugs are safe for use in pregnancy?

Answer 30

Omega 3 fatty acids
Bile Acid Sequestrants