lipid lowering drugs

Question 1

what effects do statins have on lipids?

Answer 1

large decrease in LDL
increased HDL
decreased triglycerides

Question 2

what are the side effects of statins?

Answer 2

hepatotoxicity (increased LFTs)

myopathy

Question 3

what is the mechanism of ezetimibe?

Answer 3

decreased intestinal cholesterol absorption

Question 4

what effect does ezetimibe have on lipids?

Answer 4

decreased LDL

Question 5

a drug was given that caused a major drop in triglycerides, a minor decrease in LDL and an increase in HDL. Pt. developed myopathy and cholesterol gallstones. What was the drug?

Answer 5

fibrate

gemfibrozil
bezafibrate
fenofibrate

Question 6

what drugs can exacerbate statin induced myopathy?

Answer 6

fibrates or niacin

Question 7

a drug was given that caused a major drop in triglycerides, a minor decrease in LDL and an increase in HDL. Pt. developed myopathy and cholesterol gallstones. What was the mechanism of the drug?

Answer 7

fibrates - 2 mechnisms

1 - upregulate LPL which leads to increased clearance of triglycerides and decreased synthesis of VLDL
2 - activates PPAR-alpha to induce HDL synthesis

Question 8

what are the lipid effects of niacin?

Answer 8

large decreases in LDL and increases in HDL

decreased triglycerides

Question 9

pt takes a lipid lowering medication that results in hyperglycemia and hyperuricemia. What was the drug?

Answer 9

niacin

Question 10

what is the MOA of niacin?

Answer 10

inhibits lipolysis by inhibiting hormone sensitive lipase in adipose tissue (decreases fatty acid release from adipocytes)

reduces hepatic VLDL synthesis (lower plasma VLDL)

decreases hepatic HDL clearance (higher plasma HDL)

Question 11

what drugs activate PPAR-alpha and upregulate lipoprotein lipase? What is the effect on plasma lipids?

Answer 11

gemfibrozil
bezafibrate
fenofibrate

decreased LDL, increased HDL, large decrease in triglycerides due to increased action of LPL

Question 12

what drug increases the chance of hepatotoxicity/elevated LFTs if given with statins?

Answer 12

ezetimibe – most likely to just cause diarrhiea

Question 13

what effect does ezetimibe have on triglycerides?

Answer 13

no effect on triglycerides or HDL

only decreased LDL

Question 14

pt take a lipid lowering medication and lab studies later show slightly increased triglycerides. What was the drug?

Answer 14

bile acid resin

cholestyramine
colestipol
colesevelam

Question 15

pt presents with atherosclerosis of the LAD, high LDL, and high triglycerides. A drug is given that decreases the synthesis of mevalonate. what should be checked before giving this drug?

Answer 15

LFTs

statin

blocks conversion of HMG-CoA to mevalonate
decreases mortality in CAD pts

Question 16

what is a concern about use of cholestyramine?

Answer 16

decreased absorption of other drugs and decreased absorption of fat-soluble vitamins

Question 17

what is the effect of fish oil and omega-3 fatty acids on lipids?

Answer 17

decreased triglycerides and increased HDL

no effect on LDL

Question 18

what is the mechanism for fish oil and omega-3 fatty acids?

Answer 18

decreased VLDL synthesis

decreased Apolipoprotein B synthesis

Question 19

what drug has the largest effect on lowering triglyceride levels?

Answer 19

fibrates>niacin

statins only modestly lower triglyceride levels
cholestyramine and ezetimibe are promarily used for hypercholesterolemia and have only modest effect (or slight increase) on triglycerides

Question 20

how does cholestyramine decrease LDL?

Answer 20

cholestyramine, colestipol and colesevelam decrease intestinal reabsorption of bile acids, which forces the liver to divert cholesterol toward de novo bile acid synthesis

Question 21

what is the mechanism of a PCSK9 inhibitor?

Answer 21

PCSK9 binds LDL receptor causing its degredation and prevents LDL uptake by the liver

PCSK9 inhibitors are antibodies that prevent LDL receptor degradation, thus enhancing LDL uptake by the liver

Effect is to lower plasma LDL

Question 22

how does niacin lead to hyperuricemia?

Answer 22

decreased renal excretion of uric acid ==> can cause acute gouty arthritis