lipid lowering drugs Flashcards
what effects do statins have on lipids?
large decrease in LDL
increased HDL
decreased triglycerides
what are the side effects of statins?
hepatotoxicity (increased LFTs)
myopathy
what is the mechanism of ezetimibe?
decreased intestinal cholesterol absorption
what effect does ezetimibe have on lipids?
decreased LDL
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?
fibrate
gemfibrozil
bezafibrate
fenofibrate
what drugs can exacerbate statin induced myopathy?
fibrates or niacin
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?
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
what are the lipid effects of niacin?
large decreases in LDL and increases in HDL
decreased triglycerides
pt takes a lipid lowering medication that results in hyperglycemia and hyperuricemia. What was the drug?
niacin
what is the MOA of niacin?
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)
what drugs activate PPAR-alpha and upregulate lipoprotein lipase? What is the effect on plasma lipids?
gemfibrozil
bezafibrate
fenofibrate
decreased LDL, increased HDL, large decrease in triglycerides due to increased action of LPL
what drug increases the chance of hepatotoxicity/elevated LFTs if given with statins?
ezetimibe – most likely to just cause diarrhiea
what effect does ezetimibe have on triglycerides?
no effect on triglycerides or HDL
only decreased LDL
pt take a lipid lowering medication and lab studies later show slightly increased triglycerides. What was the drug?
bile acid resin
cholestyramine
colestipol
colesevelam
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?
LFTs
statin
blocks conversion of HMG-CoA to mevalonate
decreases mortality in CAD pts
what is a concern about use of cholestyramine?
decreased absorption of other drugs and decreased absorption of fat-soluble vitamins
what is the effect of fish oil and omega-3 fatty acids on lipids?
decreased triglycerides and increased HDL
no effect on LDL
what is the mechanism for fish oil and omega-3 fatty acids?
decreased VLDL synthesis
decreased Apolipoprotein B synthesis
what drug has the largest effect on lowering triglyceride levels?
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
how does cholestyramine decrease LDL?
cholestyramine, colestipol and colesevelam decrease intestinal reabsorption of bile acids, which forces the liver to divert cholesterol toward de novo bile acid synthesis
what is the mechanism of a PCSK9 inhibitor?
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
how does niacin lead to hyperuricemia?
decreased renal excretion of uric acid ==> can cause acute gouty arthritis
