Lipid Lowering Agents

Question 1

HMG CoA reductase inhibitors:

Answer 1

Lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin

Question 2

HMG-CoA reductase inhibitors: effects on LDL, HDL, triglycerides

Answer 2

LDL: DECREASED
HDL: increased
Triglycerides: decreased

Question 3

HMG-CoA reductase inhibitors: mech

Answer 3

Inhibit conversion of HMG-CoA to mevalonate, a cholesterol precursor

Question 4

HMG-CoA reductase inhibitors: tox

Answer 4

Hepatotoxicity (Increased LFTs), rhabdomyolysis (especially when used with fibrates and niacin)

Question 5

Niacin (vitamin B3): effects on LDL, HDL, triglycerides

Answer 5

LDL: DECREASED
HDL: INCREASED
Triglycerides: decreased

Question 6

Niacin: mech

Answer 6

Inhibits lipolysis in adipose tissue; reduces hepatic VLDL synthesis

Question 7

Niacin: tox

Answer 7

Red, flushed face, which is decreased by aspirin or long-term use
Hyperglycemia (acanthosis nigricans)
Hyperuricemia (exacerbates gout)

Question 8

Bile acid resins:

Answer 8

cholestyramine, colestipol, colesevelam

Question 9

Bile acid resins: effects on LDL, HDL, triglycerides

Answer 9

LDL: DECREASED
HDL: slightly increased
Triglycerides: slightly increased

Question 10

Bile acid resins: mech

Answer 10

Prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more

Question 11

Bile acid resins: tox

Answer 11

Patients hate it - tastes bad and causes GI discomfort, decrease absorption of fat soluble vitamins (ADEK)
Cholesterol gallstones

Question 12

Cholesterol absorption blockers (ezetimibe): effects on LDL, HDL and triglycerides

Answer 12

LDL: DECREASED
HDL: no effect
Triglycerides: no effect

Question 13

Ezetimibe: mech

Answer 13

Prevent cholesterol absorption at small intestine brush border

Question 14

Ezetimibe: tox

Answer 14

Rare increase in LFTs, diarrhea

Question 15

Fibrates:

Answer 15

Genfibrozil, Clofibrate, Bezafbirate, Fenofibrate

Question 16

Fibrates: LDL, HDL, Tricylcerides

Answer 16

LDL: decreased
HDL: increased
Triglycerides: GREATLY DECREASED

Question 17

Fibrates: mech

Answer 17

Upregulate LPL –> Increased TG clearance

Activates PPAR-alpha to induce HDL synthesis

Question 18

Fibrates: tox

Answer 18

Myopathy (increased risk with concurrent statin use), cholesterol gallstones (with concurrent bile acid resins)