Lipid Lowering (Drugs)

Question 1

Atorvastatin

Answer 1

Statin
- Competitive Inhibitor of HMG-CoA

MOA:
- Inhibits the rate limiting step of cholesterol synthesis
–> Decrease Cholesterol Levels
–> Increase LDL Receptors
–> Reduces Receptor Degradation

Decreases Overall LDL
- Some decrease in TG and HDL

Question 2

Rosuvastatin

Answer 2

Statin
- Competitive Inhibitor of HMG-CoA

MOA:
- Inhibits the rate limiting step of cholesterol synthesis
–> Decrease Cholesterol Levels
–> Increase LDL Receptors
–> Reduces Receptor Degradation

Decreases Overall LDL
- Some decrease in TG
- Increase in HDL-C

Question 3

Cholestyarmine

Answer 3

Bile-Acid Sequestrant
- Prevent Bile Acid resorption in small intestine

MOA:
- Lowers Bile Acid Pool
–> Cholesterol is used to synthesize more bile acid

Question 4

Niacin

Answer 4

AKA Nicotinic Acid

MOA:
- Increases HDL Levels

Also:
- Reduced TG synthesis
- Reduced VLDL production
- Decrease LDL

Question 5

Clofibrate

Answer 5

Fibrate - PPAR Activator (Binds to alpha subunit)

MOA:
- Increases expression of target genes
–> Reduce TG
–> Increase LPL
–> Increase HDL
–> Increase LDL particle size (Harder to penetrate tissue walls)

Question 6

Ezetimibe

Answer 6

NPC1L1 Inhibitor

MOA:
- Dietary cholesterol does not enter small intestine
–> Reduces formation of chylomicron reducing delivery of chylomicron remnants to liver

• Upregulation of LDL Receptor
• Hepatic Cholesterol Biosynthesis

Question 7

Alirocumab

Answer 7

PCSK9 Inhibitors
- Prevent Degradation of LDL Receptors

Question 8

Evolocumab

Answer 8

PCSK9 Inhibitors
- Prevent Degradation of LDL Receptors