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Pharm 1 > Lipid Lowering Medication > Flashcards

Lipid Lowering Medication Flashcards

1
Q

LDL

A

Bad cholesterol
-mainly responsible for development of atherosclerosis

Brings cholesterol to the cells for utilization

*Deposits extra cholesterol into vascular tissues ->atherosclerosis

Most LDL removed by the liver
-Liver disease=problem

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2
Q

HDL

A

Good cholesterol

Removes excess cholesterol from the cells and brings them to liver to be excreted

Can also remove cholesterol from directly from artery walls

Stops atherogenic lipoproteins from oxidizing

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3
Q

Medications Lowering LDL Levels

A 
Statins 
Ezetimibe
Bile Acid Sequesterants 
PCSK9 Inhibitors 
Niacin
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4
Q

Medications Lowering Triglyceride Levels

A

Omega 3s
Niacin
Fibrin Acid Derivatives

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5
Q

High Intensity LDL Lowering Statins

A

Greater than or equal to 50%

Atorvastatin 40-80mg

Rosuvastatin 20-40mg

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6
Q

Moderate Intensity LDL Lowering Statin Medications

A

30-50%

Atorvastatin 10-20mg 
Rosuvastatin 5-10mg 
Simvastatin 20-40mg 
Pravastatin 40-80mg 
Lovastatin 40mg
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7
Q

Adverse Effects Statins

A

Pregnancy Category X

Hepatic Dysfunction/Headache

Muscle Complications: Myalgia, Myopathy, Rhabdomyolysis
-women, order age, people with severe kidney dysfunction or liver issues(increased LFTs or abuse alcohol) higher risk of muscle problems

*switch to ROSUVASTATIN

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8
Q

STATINS DDIs

A

Atorvastatin, Lovastatin, Simvastatin : CYP3A4
-avoid grapefruit juice, protease inhibitors, antifungals, warfarin

Binding: Bile Acid Sequestrants and Calcium containing products

Simvastatin and Amlodipine
*max dose of simvastatin is 20mg when given with amlodipine

*rule of thumb: use ROSUVASTATIN if patient is taking multiple meds

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9
Q

Bile Acid Sequestrants TARGET and MOA

A

TARGET: lower LDL

  • Not actually absorbed
  • bind to bile acid in GI tract to increase excretion
  • less bile acid in circulation
  • more cholesterol is utilized to create more bile acids
  • decreased LDL in circulation
  • not absorbed, will have no systemic side effects
  • given usually when a patient cannot have statin
  • LAST LINE FOR LDL LOWERING
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10
Q

Bile Acid Sequestrants Generic Drugs

A

Cholestyramine -powder

Colestipol -powder

Colesevelam -tablets

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11
Q

Bile Acid Sequestrants ADVERSE EFFECTS and INTERACTIONS

A

Adverse effects:

  • poorly tolerated
  • significant GI side effects: bloating, gas, constipation, abdominal pain
  • increased TGs

Interactions:

  • bind to many medications, make them ineffective
  • give medication 1 hour before or 4 hours after warfarin, levothroxine, digoxin, statins
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12
Q

Niacin TARGET and MOA

A

Targets: TG
-possibly can increase HDL and lower LDL

MOA:

  • decreases VLDL synthesis (LDL is a byproduct of VLDL synthesis)
  • reduces breakdown of HDL

Vitamin B3: available over the counter at low doses
-but we want patients to be prescribed because of the poor side effects

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13
Q

Niacin ADVERSE EFFECTS and DDIs

A

Adverse effects:

  • flushing (pretreatment with aspirin or NSAID)
  • pruritis (itchiness)
  • increase using acid and/or glucose (not good for diabetes)
  • nausea
  • abdominal discomfort

Pregnancy Category X

DO NOT COMBINE WITH STATINS
-maybe use in statin intolerant patients

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14
Q

Ezetimibe TARGET and MOA

A

Cholesterol absorption inhibitor

Target: LDL
-no effect on TG

MOA:

  • stops absorption of cholesterol in the intestines
  • less cholesterol=less chylomicrons=less serum LDL

Second Line Treatment after Statins
-often used in combo with statins

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15
Q

Ezetimibe ADVERSE EFFECTS and DDIs

A

Adverse effects:

  • diarrhea
  • arthralgia
  • fatigue
  • in combo with statins- increased LFTs

Do NOT administer with Bile Acid Sequestrants

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16
Q

Fibrin Acid Derivatives TARGETS and MOAS

A

Target: TGs

  • use in patients with TG >500
  • number 1 treatment for lowering TG levels

MOA:

  • agonist at PPAR-alpha receptors
  • decreased VLDL synthesis in liver
  • increase lipolysis
  • higher clearance of TGs
17
Q

Fibric Acid Derivatives Generic Drug Names

A

Gembfibrozil

Fenofibrate

18
Q

Fibric Acid Derivatives ADVERSE EFFECTS and DDIs

A

Adverse effects:

  • myopathy (especially when using with statins)
  • increased LFTs
  • nausea
  • GI upset
  • skin rash

DO NOT GIVE GEMFIBROZIL WITH SIMVASTATIN

  • contraindication
  • BUT can use other fibric acid derivatives with other statins
19
Q

Omega 3s TARGET and MOA

A

Target: TGs

MOA:

  • inhibition of TG secretion from the liver
  • promotes metabolism of TG
20
Q

Omega 3s Drug Names

A

Available OTC and RX
-OTC fish oil

RX:

  • Vascepa
  • Lovaza

OTC formulations can vary

  • must watch for this
  • patients with >500TGs need RX in capsule form rather than OTC
21
Q

Omega 3s ADVERSE EFFECTS

A

Fishy taste (can put in freezer to combat this)

Burping

Antiplatelet effect at very high doses

  • potential risk for bleeding
  • must stop before surgery especially if on statin and aspirin too
22
Q

PCSK9 Inhibitors TARGET and MOA

A

Target: LDL
-HUGE effect:can lower LDL up to 70%

MOA:

  • monoclonal antibodies that stop PCSKP proteins
  • PCSK9 proteins normally increase free LDL in system
  • these drugs allow for more LDL to be cleared from the blood

WORKS BEST for FAMILIAL HYPERCHOLESTEROLEMIA

  • but very expensive, so reserve for patients who fail other agents
  • ex: familial hypercholesterolemia patient not responding to statin
23
Q

PCSK0 Inhibitors Drug Agents

A

Alirocumab
Evolocumab

Injectible Only

24
Q

PCSK9 Inhibitors ADVERSE EFFECTS and DDIs

A

Adverse Effects

  • injection site reactions
  • non specific effects common with monoclonal antibodies (headache, arthralgia, myalgia, limb pain, fatigue

Drug Interactions

  • NONE that we know of
  • encourage use with statins

Pharm 1 (4 decks)

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