Lipid Lowering

Question 1

PCSK9 Inhibitors

Answer 1

Alirocumab and Evolocumab

Question 2

PCSK9 Inhibitors MOA

Answer 2

Monoclonal Antibodies stop PCSK9 proteins; proteins cant bind to LDL anymore = more free LDL to be cleared from blood

Question 3

PCSK9 Inhibitors ADRs

Answer 3

Injection site reactions
Headache
Arthralgia
Myalgia
Limb pain
Fatigue

Question 4

PCSK9 inhibitors target

Answer 4

targets LDL; familial hypercholesteremia

don’t use with statin

Question 5

Fibric Acid Derivatives drugs

Answer 5

Gemfibrozil and Fenofibrate

Question 6

Fibric Acid Derivatives MOA

Answer 6

Agonist at PPAR Alpha Receptor
Decreases VLDL synthesis in liver
Increased Lipolysis (breaks down TG)

Question 7

Fibric Acid Derivatives ADRs

Answer 7

Myopathy (with statins)
Increased LFTs
Nausea
GI upset
Skin Rash

Question 8

Fibric Acid Derivatives Contraindications

Answer 8

NO gemfibrizil and simvastatin because of additive myopathy effect

Question 9

Fibric Acid Derivative Target

Answer 9

Used in patients with TG>500, very effective

Question 10

Omega 3s

Answer 10

Fish Oil (OTC) Vascepa, Lovaza

Question 11

Omega 3s MOA

Answer 11

Inhibition of TG secretion from the liver Promotes metabolism of TG

Question 12

Omega 3s ADRs

Answer 12

Fishy taste, burping, Antiplatelet effects at high doses

Stop before surgery

Question 13

HMG CoA Reductase Inhibitors

Answer 13

Rosuvastatin
Atorvastatin
Simvastatin
Lovastatin
Pravastatin
Fluvastatin

Question 14

HMG CoA Reductase Inhibitors MOA

Answer 14

Competitive inhibition of HMG CoA reductase to stop synthesis of cholesterol
Liver will up regulate LDL receptor to result
increased LDL uptake by liver (more cholesterol clearance)

Question 15

Intensity of statins

Answer 15

High Intensity: atorvastatin (40-80mg) and rosuvastatin (20-40mg)

Moderate intensity: Atorvastatin (10-20mg), Rosuvastatin (5-10 mg), Simvastatin (20-40mg), Pravastatin (40-80mg), Lovastatin (40mg)

low intensity: fluvastatin (20-40mg)

Question 16

HMG CoA Inhibitor ADRs

Answer 16

Teratogenic
Hepatic dysfunction (AST/ALT monitor)
Headache

Question 17

Statins and Muscle Complications

Answer 17

Myalgia: pain (no variation in CPK)
Myopathy: weakness (slight CPK elevation)
Rhabdomyolysis: breakdown (high CPK)

Question 18

Bile Acid Sequestrants

Answer 18

Cholestyramine
Colestipol
Colesevelam

Question 19

Bile Acid Seq MOA

Answer 19

Bind to Bile acid in GI tract to increase excretion = less bile acid = use up more cholesterol to make bile acid = decrease LDL

Question 20

Bile Acid Seq ADRs

Answer 20

Poorly tolerated (only for statin intolerant)
GI effects: bloating, gas, constipation, abdominal pain, increased TG?

Question 21

Bile Acid Seq Interactions

Answer 21

binds to many medications and makes meds ineffective

Give med 1 hour before or 4 hours after

Question 22

Bile Acids and Pregnancy

Answer 22

Safe to use in pregnancy

Question 23

Niacin

Answer 23

Vitamin B3

Question 24

Niacin target

Answer 24

TGs; used in hypertriglyceridema, can possibly increase HDL and lower LDL

Question 25

Niacin MOA

Answer 25

Decrease VLDL synthesis (targets endogenous cholesterol)

HDL is a byproduct of VLDL synthesis

Question 26

Niacin ADRs

Answer 26

FLUSHING
Pruritis
Increased Uric Acid (gout) and or glucose
Nausea
Abdominal Discomfort
Pregnancy Category X

Question 27

Niacin interactions

Answer 27

For those who are potentially statin intolerant

Don’t combine with statins

Question 28

Cholesterol Absorption Inhibitor

Answer 28

Ezetimibe

Question 29

Ezetimibe target

Answer 29

LDL

Question 30

Ezetimibe MOA

Answer 30

Stops absorption of cholesterol in the intestines

Less cholesterol= less chylomicrons=less serum LDL

Question 31

Ezetimibe ADRs

Answer 31

Diarrhea
Arthralgia
Fatigue
Increased LFTs (with statins)

Question 32

Ezetimibe contraindications

Answer 32

do not combine with bile acid sequestrants

Question 33

Ezetimibe combinations

Answer 33

Use with statins

considered 2nd in line treatment (after statins)