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Cardiovascular Pharmacology > Lipid Lowering Medications > Flashcards

Lipid Lowering Medications Flashcards

1
Q

Mechanism of Statins

A

Inhibit HMG-CoA reductase, preventing synthesis of mevalonate in the liver and decreasing LDL-c. Also increases expression of LDLR on liver surface, lowering LDL-c even more

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2
Q

Clinical effects of Statins

A

Reduce LDL-c by 20-60%, reduce relative risk of CVD by 20%

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3
Q

What are the high potency Statins?

A

Atorvastatin and rosuvastatin

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4
Q

What are the 3 major side effects of Statins?

A

Hepatotoxicity (measured using ALT/AST, 3x normal limit is considered acceptable), myopathy (due to CYP3A4 inhibition), diabetes (increased risk for developing it)

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5
Q

Which Statins can you use to avoid potential myopathy and why?

A

Rosuvastatin, pravastatin, fluvastatin; these statins do not inhibit CYP3A4

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6
Q

Which Statins are metabolized by CYP3A4? CYP2C9? Neither?

A

CYP3A4: atorvastatin, simvastatin, lovastatin, basically all the other statins
CYP2C9: rosuvastatin, fluvastatin
Neither: pravastatin

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7
Q

Which two compounds increase the toxicity of all statins?

A

Cyclosporine (immune suppressant) and grapefruit juice (inhibits CYP activity in the intestines)

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8
Q

Mechanism of PCSK9 inhibitors

A

Inhibit PCSK9, which is normally produced in the liver to inhibit LDLR localization to the surface

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9
Q

Clinical administration and effects of PCSK9 inhibitors

A

IV administration. Reduces LDL-c by an additional 50% when used in conjunction w/a high potency statin. Commonly used in patients w/Familial Hypercholesterolemia

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10
Q

Side effects of PCSK9 inhibitors

A

Myalgias, delirium, dementia

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11
Q

Mechanism of Ezetimibe

A

Blocks NPC1L1 transporter on enterocytes, lowering dietary cholesterol uptake

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12
Q

Clinical effects of Ezetimibe

A

Lowers LDL-c by 20%

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13
Q

Side effects of Ezetimibe

A

Digestive issues (diarrhea, bloating, etc.) but NO drug-drug interactions

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14
Q

Mechanism of Bile Acid Sequestrants

A

Bind bile acids in the gut to prevent reuptake, forcing the liver to synthesize more using cholesterol and resulting in increased LDLR and decreased LDL-c

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15
Q

Clinical effects of Bile Acid Sequestrants

A

Lowers LDL-c by 20%

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16
Q

Naming of Bile Acid Sequestrants

A

Cole/chole prefix (cholestyramine, colestipol, etc.)

17
Q

Side effects of Bile Acid Sequestrants

A

Digestive issues (hemorrhoids, constipation, bloating, etc.), may interfere w/oral drug uptake

18
Q

Mechanism of Fibrates

A

PPARα agonist
Inhibit VLDL secretion (decrease LDL-c)
Inhibit ApoC3, a protein that normally inhibits LPL (decrease TGs)
Promote ApoA1 synthesis (increase HDL-c)

19
Q

Clinical effects of Fibrates

A 
Used clinically to lower TGs by 20-50%
Also:
Lowers LDL-c by 5-20% in patients w/normal TGs
Raises LDL-c in patients w/high TGs
Raises HDL-c by 10-20%
20
Q

Naming of Fibrates

A

“fibr” in the name (fenofibrate, clofibrate, gemfibrozil, etc.)

21
Q

Mechanism of Niacin

A

Inhibit ApoA1 degradation (increase HDL-c)
Inhibit TG synthesis in liver (decrease TGs, VLDL/LDL-c)
Inhibit TG mobilization in adipose (decrease TGs)

22
Q

Clinical effects of Niacin

A

Used clinically to lower TGs by 20-50%
Also:
Lowers LDL-c by 5-25% in patients w/normal TGs
Raises HDL-c by 15-25%

23
Q

Side effects of Fibrates

A

Dyspepsia (indigestion), myopathy, gallstones

24
Q

Contraindications of Fibrates

A

Severe renal disease or sever hepatic disease

25
Q

Side effects of Niacin

A

Flushing, GI distress, hyperuricemia, hepatotoxicity, hyperglycemia

26
Q

Contraindications of Niacin

A

Liver disease, severe gout, peptic ulcer disease

27
Q

Mechanism of Omega-3 FAs

A

Inhibit VLDL and ApoB synthesis (decrease TGs)

28
Q

Clinical effects of Omega-3 FAs

A

Lower TGs

29
Q

What is the “first line” drug for lowering LDL-c?

A

Statins

30
Q

What are the three “second line” drugs for lowering LDL-c?

A

PCSK9 inhibitors, ezetimibe, bile acid sequestrants

31
Q

What drug can be used to raise HDL-c?

A

Niacins (no scientific evidence that raising HDL-c is effective for reducing risk of CVD)

32
Q

Which two drugs are used to lower TGs?

A

Fibrates, Omega-3 FAs

Note: make sure there is no secondary cause for TGs (diabetes, hypothyroidism, etc.) before using drugs

Cardiovascular Pharmacology (5 decks)

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