Lipid lowering agents Flashcards
Statins: mechanism, effects on LDL, HDL, and tirglycerides
statins inhibit HMG CoA reductase, which prevents the converstion of HMG-CoA to mevalonate, a precursor in cholesterol synthesis. they also incr. LDL receptor expression.
LOTS of LDL reduction, a little HDL incr, and a little triglyceride decrease.
side effects or problems with statins
may cause hepatotoxicity or rhabdomyolysis, esp. when combined with niacin or fibrates
niacin: mechanism, effects on LDL, HDL, and triglycerides
Decreases hepatic VLDL synthesis and inhibits lipolysis in adipose tissue.
it causes moderate LDL reduction, moderate HDL incr, and a little triglyceride reduction
Niacin side effects and problems
can cause cutaneous flushing, though this decreases with long term use or ASA
hyperglycemia (can cause acanthosis nigricans)
hyperuricemia, which may worsen gout
Bile acid resins examples
cholestyramine (and colestipol, colesevelam)
bile acid resin effects on LDL, HDL and triglycerides; mechanism
moderate decr. LDL, slight incr. in HDL and slight incr. in triglycerides.
bile acid resins reabsorption of bile acid in the gut. the liver must use up cholesterol to produce more bile acids.
Side effects/problems with bile acid resins
patients hate it. tastes bad, causes GI discomfort, decreases abosorption of ADEK vitamins. may cause cholesterol gallstones
Ezetimibe effect on LDL, HDL, triglycerides. mechanism
decreases absorption of cholesterol in the gut.
gemfibrozil effects on LDL, HDL, triglycerides.
mild decr. in LDL, mild incr. in HDL, LOTS of decr. in triglycerides.
gemfibrozil mechanism of action
upregulates lipoprotein lipase to incr. TG clearance. also activates PPAR-alpha to induce HDL synthesis.
gemfibrozil side effects and problems
myositis (incr. risk with statins), hepatotoxicity, cholesterol gall stones (esp. with bile acid resins)
ezetimibe side effects/problems
incr in LFTs (rare), diarrhea.
