Lipid Lowering Medications

Question 1

Desired outcomes of Lipid Lowering Agents

Answer 1

Lower levels of: Cholesterol, Low density lipoproteins (LDL)
Prevention of Coronary Artery Disease (CAD): Protects endothelial tissue, prevents plaque from rupturing.

Question 2

HMG COA Reductase Inhibitors

Answer 2

STATINS
Most prescribed lipid lowering drug
Blocks synthesis of cholesterol in liver by inhibiting HMG-CoA reductase activity.
Decrease LDL levels by 25-65%
Increase triglycerides 10-40% and HDL 5-17%).
Reduce inflammation and friction in blood vessels.
Pregnancy category X
Indications: History of CV disease, LDL >190, adults 40-75 w/ diabetes, adults 40-75 with LDL 70-189 with 5->20% 10 year risk of CV disease

Question 3

HMG COA Reductase Inhibitors Adverse Effects

Answer 3

Adverse Effects: CNS (headache, dizziness, insomnia, fatigue)
GI effects (Flatus, abdominal pain, N/V, constipation.
Myopathy (muscle weakness) usually from drug combinations, can lead to..
Rhabdomyolysis – breakdown of damaged skeletal muscle, could be life threatening.
Increase liver enzymes
Coenzyme Q10 deficiency

Question 4

PCSK9 Inhibitors

Answer 4

PCSK9 - Protein produced by the liver, plays a role in regulating LDL
Reduces inflammation and stress on the plaque
Decreases risk of CV events
Often combined with statins
Cholesterol is over 300. Severe atherosclerosis disease.
Are monoclonal antibodies (cloned antibodies) - injection
Evolocumab, Alirocumab (-CUMAB)

Question 5

Bile Acid Sequestrants

Answer 5

Colesevelam
Lower total cholesterol, triglycerides, LDL, and elevate HDL.
Bind with cholesterol in intestine and increase excretion of bile acids in stool.
By enhancing bile excretion, enhance conversion of cholesterol to bile acids by liver.
Can be used in patients with active liver disease.

Question 6

Bile Acid Sequestrants Adverse Effects and Contraindications

Answer 6

CAN be used with pregnant women.
Adverse: GI issues (constipation, abd pain, bloat, diarrhea, heartburn, gallstones)
Inhibit absorption of fat soluble vitamins
Must give immediately after mixing.
Monitor lipid levels (LDL & Vitamin) in 4-6 weeks then every 3-4 months.
May need stool softeners
Questran

Question 7

Cholesterol Absorption Inhibitors

Answer 7

Ezetimibe
Works in small intestine to inhibit absorption of cholesterol.
Indications: Lower serum cholesterol, for those who cant tolerate statins.

Question 8

Cholesterol Absorption Inhibitors Adverse Effects and Contraindications

Answer 8

Adverse: Abdominal pain, and diarrhea.
Arthralgias - aches and pains.
Contraindications: Allergy, Pregnancy/lactation
Combination with a statin
Severe liver disease

Question 9

Niacin (Vitamin B3)

Answer 9

Inhibits release of free fatty acid from adipose tissue.
Increases rate of triglyceride removal from plasma.
Lower total cholesterol, triglyceride, and LDL, elevates HDL.
Given at bedtime

Question 10

Niacin (Vitamin B3) Adverse Effects and Interactions

Answer 10

Adverse: Flushing, nausea, abdominal pain, increased uric acid levels.
Can cause liver toxicity
Interactions: Alcohol
Statins, fibrates

Question 11

Fibrates

Answer 11

Inhibition of cholesterol and synthesis.
Decreased triglyceride synthesis.
Inhibition of lipolysis in adipose tissue
Lower total cholesterol, triglyceride, LDL, elevate HDL
Fenofibrate, Gemfibozil

Question 12

Fibrate Adverse Effects and Interactions

Answer 12

Adverse: Increased uric acid levels
Increased risk of rhabdomyolysis
GI tract
Headache
Interaction: Warfarin
Statins