Lipid Lowering Agents Review

Question 1

name all of the statins

Answer 1

simvastatin (zocor)
pravastatin (pravachol)
lovastatin (mevacor)
fluvastatin (lescol)
rosuvastatin (crestor)
pitavstatin (livalo)

Question 2

what is the MoA of statins?

Answer 2

reduce hepatic cholesterol biosynthesis which also increases the number of hepatic LDL receptors and enables more LDL to be delivered to the liver. Overall, decreases LDL-c in serum and decreases amount of cholesterol available for the formation of VLDL

Question 3

how do statins effect LDL/HDL/TG

Answer 3

decrease LDL
slight increase HDL
decrease TG

Question 4

which two statins are rarely used due to DD interactions?

Answer 4

lovastatin and simvastatin

Question 5

what is the compound in grapefruit which makes it an inhibitor of Cyp3A4?

Answer 5

flavinoid

Question 6

which drugs/drug classes induce cyp3A4 and thus decrease plasma concentration of statins metabolized by this pathway?

Answer 6

St john’s wort
rifampin
seizure meds like carbamazepine and phenytoin

Question 7

statins cause _______ of LDL receptors

Answer 7

upregulation

Question 8

which statin has the least risk of myopathy and makes it a good choice if pt is not tolerating a more effective statin?

Answer 8

pravastatin

Question 9

what is the MoA of niacin?

Answer 9

reduces hepatic VLDL secretion and enhances VLDL clearance which reduces the supply of circulating FFA’s and lowers serum LDL

Question 10

how does niacin effect LDL/HDL/TG

Answer 10

moderately lowers LDL
significantly increases HDL
lowers TG

Question 11

what labs should be obtained before initiating niacin therapy and 6 weeks after target dose is reached?

Answer 11

LFTs, uric acid, and fasting glucose

Question 12

what is the most common SE of niacin?
what are other SEs?

Answer 12

flushing

itching, dry skin, abdominal pain, N/V

Question 13

why do we give baby aspirin to pts on niacin?
when should baby aspirin be administered?
what should patients avoid around taking their niacin?

Answer 13

pts commonly experience flushing which is a prostaglandin-mediated response. aspirin inhibits this pathway and thus should prevent flushing
baby aspirin should be taken 30 minutes before niacin
pts should avoid spicy foods and hot showers

Question 14

why is niacin considered a non-ideal option for hyperlipidemia?

Answer 14

pts experience too severe of flushing before therapeutic dose can be reached

Question 15

what are the names of the two fibrates?

Answer 15

gemfibrozil (lopid)
fenofibrate (tricor)

Question 16

what is the MoA of fibrates?

Answer 16

activate lipoprotein lipase and promote delivery of TG’s to adipose, and interfere w/ VLDL formation in liver

Question 17

how do fibrates effect LDL/HDL/TG

Answer 17

moderate decrease in LDL
moderate increase in HDL
significant decrease in TG

Question 18

what labs should be obtained before initiating fibrate therapy and 6 weeks after target dose is reached?

Answer 18

lipid levels, LFTs, uric acid, and fasting glucose
also monitor for hypokalemia

Question 19

what are SEs of fibrates?

Answer 19

upset stomach, diarrhea, fatigue, N/V, and abdominal pain

Question 20

what is an adverse rxn of fenofibrate that should be monitored?

Answer 20

impaired renal function

Question 21

what are the names of the 3 bile acid sequestrants?

Answer 21

cholestyramine
colestipol
colesevelam

Question 22

what is the MoA of bile acid sequestrants?

Answer 22

the bile acid binding resins exchange chlorine ions for bile acids from gut and the bile acid resin complex is excreted. this causes the liver to synthesize new bile acids from cholesterol. the liver increases LDL receptors to decrease serum LDL

Question 23

how do bile acid sequestrants effect LDL/HDL/TG

Answer 23

lower LDL
almost no effect on HDL
may slightly increase TG

Question 24

what should be monitored after starting bile acid sequestrant therapy?

Answer 24

lipid profile checked at 4 weeks and monitor for constipation

Question 25

what makes bile acid sequestrants non-preferred therapy?

Answer 25

they have a lot of DD interactions by decreasing their absorption

Question 26

what is the most common SE of bile acid sequestrants?
what do they effect intestinal absorption of?

Answer 26

constipation
vitamins ADEK, folic acid, magnesium, iron, and zinc

Question 27

which bile acid sequestrant is a good therapy option in pregnancy? what should be monitored?

Answer 27

colestipol
since it increases TGs there is an increases risk of pancreatitis which should be monitored

Question 28

what is the brand name for ezetimibe?
what is the MoA?

Answer 28

zetia
inhibits absorption of cholesterol at the small intestine brush border

Question 29

how does ezetimibe effect LDL/HDL/TG

Answer 29

lowers LDL
almost no effect on HDL
slightly lowers TG

Question 30

what are SEs of ezetimibe?

Answer 30

diarrhea, abdominal pain, arthralgia

Question 31

what are the names of the 2 PCSK9 inhibitors?

Answer 31

praluent and repatha

Question 32

what is the MoA of PCSK9-Is?

Answer 32

PCSK9 is a protease that promotes LDL receptor degradation… they inhibit the degradation of LDL receptors

Question 33

how effective are PCSK9-Is at lowering LDL?

Answer 33

they reduce LDL by 50-60%, making them more effective than statins

Question 34

what are common SEs of PCSK9-Is?

Answer 34

none