Lipid-lowering agents - Overview

Question 1

Which drugs have the most powerful low-density lipoprotein-lowering effects?

Answer 1

Statins have the strongest reducing effect of all of the lipid-lowering drugs

Question 2

Other than statins, which drugs are indicated for lowering low-density lipoprotein levels?

Answer 2

Niacin, which lowers low-density lipoprotein levels, although less than statins

Question 3

Which lipid-lowering agent causes the greatest increase in high-density lipoprotein levels? Which agents cause a more modest increase?

Answer 3

Niacin causes the greatest increase in high-density lipoprotein levels; statins have a moderate effect on high-density lipoprotein levels

Question 4

Which lipid-lowering agents cause the most significant reduction in triglycerides? Which have a more modest benefit?

Answer 4

Fibrates reduce triglycerides most significantly; statins, bile acid resins, and niacin have a moderate effect in this regard

Question 5

What adverse effects do HMG-CoA reductase inhibitors (eg, lovastatin, atorvastatin) have?

Answer 5

Elevated liver enzymes (which is reversible) and rhabdomyolysis

Question 6

What adverse effects does niacin have?

Answer 6

• Facial flushing, which can be reduced with the use of aspirin and decreases over time
• Hyperglycemia
• Hyperuricemia

Question 7

What adverse effects do bile acid resins (cholestyramine) have?

Answer 7

• Bad taste
• Gastrointestinal discomfort
• Decreased effect on the absorption of fat-soluble vitamins
• Production of cholesterol gallstones

Question 8

What adverse effects do fibrates (eg, gemfibrozil, clofibrate) have?

Answer 8

Elevated liver enzymes and myositis

Question 9

Which category of lipid-lowering agents works by inhibiting the formation of the cholesterol precursor mevalonate?

Answer 9

HMG-CoA reductase inhibitors; this is the rate-limiting step in cholesterol synthesis

Question 10

Which lipid-lowering agent works by inhibiting lipolysis in adipose tissue and reducing hepatic very-low-density lipoprotein secretion into circulation?

Answer 10

Niacin

Question 11

Which category of lipid-lowering agents works by preventing the intestinal reabsorption of bile acids, causing increased hepatic usage of cholesterol to replenish the bile acids?

Answer 11

Bile acid resins (cholestyramine, colestipol)

Question 12

Which category of lipid-lowering agents works by preventing cholesterol reabsorption at the small intestine brush border?

Answer 12

Cholesterol absorption blockers (ezetimibe)

Question 13

Which category of lipid-lowering agents works by upregulating lipoprotein lipase, causing increased triglyceride clearance from the blood?

Answer 13

Fibrates (gemfibrozil, clofibrate, fenofibrate, bezafibrate)

Question 14

A 50-year-old man with hypercholesterolemia is deficient in vitamins A, D, E and K. He also complains of gastrointestinal discomfort since starting a lipid-lowering agent. Which lipid-lowering agent is the most likely cause?

Answer 14

Bile acid resins

Question 15

Which class of lipid-lowering agents is contraindicated in patients with gallstones?

Answer 15

Bile acid resins

Question 16

A patient has recently started taking lovastatin. He presents with diffuse muscle pain and weakness. Which lab test should be ordered?

Answer 16

Creatine kinase to test for rhabdomyolysis

Question 17

Enumerate the lipid-lowering agents and their examples

Answer 17

• HMG-CoA reductase inhibitors
  
  • Lovastatin
  • Pravastatin
• Bile acid resins
  
  • Cholestyramine
  • Colestipol
  • Colesevelam
• Cholesterol absorption inhibitor
  
  • Ezetimibe
• Fibrates
  
  • Gemfibrozil
  • Bezafibrate
  • Fenofibrate
• Niacin (vitamin B3)
• PCSK9 inhibitors
  
  • Alirocumab
  • Evolocumab

Question 18

Which class cause inactivation of LDL-receptor degradation, increasing amount of LDL removed from bloodstream

Answer 18

PCSK9 inhibitors (i.e., Alirocumab, evolocumab)