Lipid Lowering Medications Flashcards
Lipid lowering agents lower serum levels of:
Cholesterol
Low-density lipoprotein (LDL)
Lipid lowering agents help prevent
Coronary artery disease (CAD)
How do lipid lowering agents help prevent CAD? Hint: 3
1) Protect endothelial tissue
2) Prevents plaque from rupturing
3) Slow down the progression of atherosclerosis
Cholesterol
A lipid that is an essential part of bile acid & cell membranes
It’s insoluble in blood
A precursor of the steroid hormone
Triglyceride
A lipid made from fatty acids & glycerol
Acquired through diet
Stored in adipose tissue
Levels correlate with LDL & are inverse to HDL
Lipoproteins
carrier proteins that aid in the transportation of cholesterol & triglycerides in the blood
Lipoproteins are produced by the _____
liver
How does LDL enter the circulation?
As tightly packed cholesterol, triglycerides, & lipids from the liver to the peripheral tissue
LDL is carried by
proteins; broken down for energy or stored for future use as energy
What is LDL known as?
“bad cholesterol”
LDL is the primary transport molecule for _____
Cholesterol
How does HDL enter the circulation?
as loosely packed lipids
What is HDL used for?
Energy; picks up remnants of fat & cholesterol from the peripheral tissues back to the liver where it is excreted in the bile
Total cholesterol desired level
< 200
HDL is known as what?
“good cholesterol”
LDL desired level
< 130
HDL desired level
50 or higher
Triglycerides desired level
< 200
Total cholesterol borderline high levels
200-239
LDL borderline high levels
130-159
HDL borderline high (low) levels
40-49
Triglycerides borderline high levels
200-399
Total cholesterol high levels
240 and higher
LDL high levels
160 and higher
HDL high (low) levels
< 40
Triglycerides high levels
400 and higher
What is the desired LDL level in diabetics & pts at risk?
< 70
List non-modifiable risk factors for CV: (3)
1) Genetic predisposition
2) Age
3) Gender
What gender is at higher risk?
Males greater than females
females equal after menopause
List modifiable risk factors for CV: (8)
1) metabolic syndrome
2) cigarette smoking
3) sedentary lifestyle
4) high-stress levels
5) hypertension
6) obesity
7) diabetes
8) untreated bacterial infection
All risk factors for CV are related to ______
inflammation
List the different classes of lipid lowering drugs
1) HMG CoA reductase inhibitors (statins)
2) Fibrates
3) cholesterol absorption inhibitor
4) PCSK9 inhibitors
5) bile acid sequestrants
6) niacin
List examples HMG CoA reductase inhibitors (statins) Hint: 5
1) Lovastatin (Mevavor)
2) Pravastatin (Pravachol)
3) Simvastatin (Zocor)
4) Atorvastatin (Lipitor)
5) Rosuvastatin (Crestor)
List examples Fibrates Hint: 3
1) Gemfibrozil (Lopid)
2) Fenofibrate (Tricor)
3) Fenofibric acid (Tripipix)
List examples of cholesterol absorption inhibitor Hint: 1
1) ezetimibe (zetia)
List examples PCSK9 inhibitors Hint: 2
1) Evolocumab (repatha)
2) Alirocumab (Praulent)
List examples Bile acid sequestrants Hint: 3
1) Colesevelam (Welchol)
2) Cholestyramine (Prevalite)
3) Colestipol (Colestid)
What are the most effective & most prescribed lipid lowering drug?
HMG CoA reductase inhibitors (statins)
How do HMG CoA reductase inhibitors work?
Block synthesis of cholesterol in the liver by competitively inhibiting HMG CoA reductase activity
HMG CoA reductase inhibitors decrease levels of LDL by ____ to _____%
25% to 65%
HMG CoA reductase inhibitors cause modest decrease in _____
Triglycerides (10% to 40%)
HMG CoA reductase inhibitors cause modest increases in _____
HDL (5% to 17%)
What pregnancy category are HMG CoA reductase inhibitors considered?
Category X
Pathophysiology of statins (Hint: 5)
1) reduces smooth muscle cell changes
2) reduce inflammatory cells inside plaque
3) stabilize the endothelium
4) reduce friction in the BF
5) reduce proteins associated w/ inflammation
Who should be on a statin? (Hint: 5)
1) Adults w/ a Hx of CVD
2) Those w/ LDL-C level of > than 190 mg/dL
3) Adults 40-75 yrs with diabetes
4) Adults 40-75 yrs w/ LDL-C level of 70-189 mg/dL and a 5-19.9% 10 yr risk of developing CV disease
5) Adults 40-75 yrs w/ LDL-C level of 70-189 mg/dL & a 20% or > 10 yr risk of developing CV disease
When initially giving HMG CoA reductase inhibitors (statins) what should dosing look like?
Start with a lower dose & increase as needed
When should statins be given?
Evening/ bedtime
What two statins are the exception and can be given in the morning?
Rosuvastatin & Atorvastatin
When should a lipid panel be checked after starting a statin?
4-6 weeks after starting med
Which statin is the most potent?
Rosuvastatin
List the most common CNS effects of statins Hint: 4
1) Headache
2) Dizziness
3) Insomnia
4) Fatigue
List the most common GI effects of statins Hint: 4
1) Flatus
2) Abdominal pain
3) N/V
4) Constipation
What should be avoided in patients taking statins?
Grapefruit juice!!
What are 3 other adverse effects of statins?
1) Myopathy
2) Increase in liver enzymes
3) Can cause Coenzyme Q10 deficiency
How can you reduce myopathy that is caused from statins?
By using the lowest effective dose
Myopathy from statins can cause ______
Rhabdomyolysis
We need to be cautious when combining ____ & _____ to avoid myopathy
Statins & Fibrates
Active ____ disease is a contraindication of using statins
Active liver disease
Increase in liver enzymes from statins is dependent on _____
dose
True or false:
Serious liver problems from statins are common
FALSE: they are rare
How can increase in liver enzymes from statins be managed?
Reduce the dose or stop the medication until levels return to normal
Endothelial function:
List 6 things that shred the blood vessels
1) Diabetes
2) Smoking
3) Hypertension
4) Dyslipidemia
5) Obesity
6) Aging
Factors that cause shredding of blood vessels can lead to ____ ____
Oxidative stress
Oxidative stress leads to ____ ____
Endothelial dysfunction (reduced NO bioavailability)
Endothelial dysfunction lead to what 5 things
1) Leukocyte adhesion & inflammation
2) Lipid deposition
3) Vascular smooth muscle cell proliferation
4) Vasoconstriction
5) Plt aggregation & thrombosis
When there is endothelial dysfunction what can it lead to the progression of?
Progression of atherosclerosis & CV disease
What is the action of cholesterol absorption inhibitors?
Works in the SI to inhibit the absorption of cholesterol
List 2 indications for giving cholesterol absorption meds (Ezetimibe)
1) lower serum cholesterol levels
2) for those who cannot tolerate statins
True or false:
Cholesterol absorption inhibitors can be given in combination with statins
TRUE
List 4 adverse effects of cholesterol absorption inhibitors
1) Abdominal pain & diarrhea (most common)
2) Upper airway infections
3) Arthralgias
List 2 contraindications of using cholesterol absorption inhibitors
1) allergies
2) pregnancy or lactation
A ____ produced by the liver, plays a role in regulating ____
protein; LDL
PCSK9 inhibitors are often reserved for what people?
People with very high LDL levels or those who cannot tolerate statins
PCSK9 inhibitors are often given in conjunction with what med?
Statins
What 3 things do PCSK9 inhibitors help decrease?
1) LDL
2) Cholesterol
3) Triglycerides
PCSK9 inhibitors are considered _____ antibodies
Monoclonal antibodies
Guidelines for administration of PCSK9 inhibitors
Admin by SubQ injection, either weekly or monthly
List 4 side effects of PCSK9 inhibitors
1) Itching
2) Swelling
3) Pain
4) Bruising at injection site
How do Bile acid sequestrants work?
Bind with cholesterol in the intestine; the complex can not be absorbed; & is excreted in the stool
By promoting an increase in bile acid excretion what do bile acid sequestrants do?
They enhance the conversion of cholesterol to bile acids by the liver
Bile acid sequestrants can be used in what type of patients?
Patients with acute liver disease
What do bile acid sequestrants decrease & increase?
Decrease: LDL
Increase: Triglycerides
Slightly increase: HDL
4 things to note about bile acid sequestrants
1) Strong record of efficacy & safety
2) They are NOT used routinely
3) Can be used with pregnant women
4) Can be used together with fibrates
List 6 side effects of bile acid sequestrants
1) Constipation
2) Abdominal pain
3) Bloating
4) Diarrhea
5) Heartburn
6) Gallstones
What can bile acid sequestrants inhibit absorption of?
Inhibit absorption of fat soluble vitamins (A, D, E, & K)
list 3 actions of Niacin
1) inhibits release of free fatty acid from adipose tissue
2) Increases rate of triglyceride removal from plasma
3) Lower total cholesterol, triglyceride, & LDL levels & elevate HDL
What time of day should Niacin be given?
Bedtime
Is Niacin commonly used today?
No; not used much anymore
List 4 adverse effects of Niacin
1) Flushing
2) Nausea
3) Abdominal pain
4) Increase uric acid levels
What kind of toxicity can Niacin cause?
Hepatotoxicity (liver)
List 3 drug interactions with Niacin
1) Alcohol
2) Statins
3) Fibrates
What is Niacin often taken with to prevent flushing?
Aspirin
List 4 actions of fibrates
1) inhibition of cholesterol & synthesis
2) decreases triglyceride synthesis
3) inhibition of lipolysis in adipose tissue
4) lower total cholesterol, triglyceride, & LDL, & elevate HDL levels
When should lipid levels be monitored for someone taking fibrates?
In 4 to 6 weeks then every 3 to 4 months
List 5 adverse effects of Fibrates:
1) flushing of face & neck
2) increase uric acid levels
3) increase risk of Rhabdomyolysis (rare)
4) GI tract
5) Headache
List 2 drug interactions of Fibrates
1) Warfarin
2) Statins
Omega 3 fatty acid is derived from?
Fish oil
Omega 3 fatty acids decease _____ levels
Triglycerides
List 4 side effects of omega 3 fatty acids
1) Burping
2) Fishy taste
3) Diarrhea
4) Change in taste
Omega 3 fatty acids decrease risk of _____
pancreatitis
List 4 drugs considered Omega 3 fatty acids
1) Lovera
2) Vascepa
3) Epanova
4) Omtryg
What can high doses of omega 3 fatty acids interfere with?
Blood clotting
Question 1:
A patient is prescribed Pravastatin. What class does this medication belong to?
A) Cholesterol absorption inhibitor
B) Fibrate
C) HMG CoA reductase inhibitor
D) Bile acid sequestrant
C) HMG CoA reductase inhibitor
Question 2:
Which statement below accurately describes how statin medications work to lower cholesterol levels?
A) Statins increase the activity of LDL receptors in the liver by increasing the bioavailability of bile acids
B) Statins inhibit bile acid in the GI tract from being absorbed resulting in the liver converting cholesterol into bile acid
C) Statin increase hydroxymethylglutaryl coenzyme A (HMG - CoA) which results in increased renal excretion of cholesterol
D) Statins inhibit HMG CoA reductase which then inhibits cholesterol synthesis in the liver
D) Statins inhibit HMG CoA reductase which then inhibits cholesterol synthesis in the liver
Question 3:
The patient has been prescribed Lovastatin and you are educating him on the importance of diet and exercise. In discussing diet, which food item should you tell the patient to avoid while taking this medication?
A) Aged-cheese
B) Bananas
C) Grapefruit
D) Spinach
C) Grapefruit
Question 4:
Which medication is a cholesterol absorption inhibitor?
A) Pravastatin
B) Ezetimibe
C) Evolocumab
D) Omtryg
E) Cholestyramine
B) Ezetimibe
