Lipid lowering drugs

Question 1

Statin

Answer 1

LDL: decreases x3
HDL: increase
TG: decrease

MOA: inhibit HMG-CoA to mevalonate (cholesterol precursor)

Side effect: hepatotoxicity (high LFT), rhabdomyolysis

Question 2

Niacin (B3)

Answer 2

LDL: decrease x2
HDL: increase x2
TG: decrease

MOA: inhibit lipolysis in adipose tissue, reduce heptatic VLDL secretion.

Side effect: flushing, hyperglycemia, hyperurecemia

Question 3

Bile acid resins

Answer 3

Cholestyramine, colestipol, colesevelam

LDL: decrease x2
HDL: slightly increase
TG: slightly increase

MOA: prevent intestinal reabsorption of bile acid, liver must use cholesterol to make more.

Side effects: pts dont like it (bad taste and GI discomfort), low fat soluble vitamin absorption, cholesterol gallstone.

Question 4

Cholesterol absorption blockers

Answer 4

Ezetimide

LDL: decrease x2
no change on HDL and TG

MOA: prevent cholesterol reabsorption at small intestine brush border.
Side effect: rare LFT, diarrhea.

Question 5

Fibrate

Answer 5

Gemfibrozil, clofirate, vezafibrate, fenofibrate

LDL: decrease
HDL: increase
TG: decrease x3

MOA: upregulate LDL, increase TG clearance

Side effects: myositis, hepatotoxicity (LFT), cholesterol gallstone.