Lipid Lowering Drugs

Question 1

Mechanism of Statins

Answer 1

Inhibits conversion of HMG CoA to mevalonate by inhibiting HMG CoA reductase –> decreased cholesterol production –> causes up regulation of LDL receptors on hepatocytes

Question 2

Statin effect on LDL, HDL, Triglycerides

Answer 2

LOWERS LDL, increases HDL, decreases TGs

Question 3

S/E of Statins

Answer 3

Myopathy (Esp used with Niacin and Fibrates)

Hepatotoxicity

Question 4

Bile acid resins

Answer 4

Cholestyramine
Colestipol
Colesevelam

Question 5

Bile acid resin mechanism

Answer 5

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

Question 6

Bile acid resin’s effect on LDL, HDL, TGs

Answer 6

Decrease LDL, slightly increase HDL, slightly increase TGs

Question 7

S/E of Bile acid resins (cholestyramine)

Answer 7

GI upset
Decreased absorption of other drugs and fat soluble vitamins
Increased risk of gallstones

Question 8

Ezetimibe mechanism

Answer 8

Prevent cholesterol absorption at small intestine brush border

Question 9

Ezetimibe S/E

Answer 9

Increase LFTs (rare)
Diarrhea

Question 10

Ezetimibe effect on LDL, HDL, TGs

Answer 10

Decrease LDL

No effect on HDL or TGs

Question 11

Fibrates

Answer 11

Gemfibrozil
Clofibrate
Bezafibrate
Fenofibrate

Question 12

Fibrates mechanism

Answer 12

Upregulate LPL –> increased TG clearance
Activates PPAR-alpha to induce HDL synthesis
Suppression of cholesterol 7 alpha hydroxylase

Question 13

Fibrates effect on LDL, HDL, TGs

Answer 13

Decrease LDL, increase HDL, DECREASE TGs

Question 14

Fibrates S/E

Answer 14

Myopathy (increased risk with statins)

Cholesterol gallstones

Question 15

Niacin mechanism

Answer 15

Inhibits lipolysis in adipose tissue

Reduces hepatic VLDL synthesis

Question 16

Niacin effect on LDL, HDL, TGs

Answer 16

Decrease LDL, INCREASE HDL, decrease TGs

Question 17

S/E of Niacin

Answer 17

Hyperglycermia
Hyperuricemia
Red, flushed face (decreased by NSAIDs)