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Pharmacology Exam 3 > Lipid Lowering Mediciations > Flashcards

Lipid Lowering Mediciations Flashcards

1
Q

What are the two major conditions that can occur with a patient that has untreated hyperlipidemia?

A

Atherosclerosis
Pancreatitis

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2
Q

What are the causes of lipid disorders?

A

Genetic defects in metabolism
Increased fat intake
Obesity
Type II DM
Advanced age
Hypothyroidism
Obstructive liver disease
Drug induced (chronic steroids)

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3
Q

What does hyper triglycerides lead to?

A

Pancreatitis

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4
Q

What does hypercholesterolemia lead to?

A

Atherosclerosis

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5
Q

What macro-vascular complications does atherosclerosis lead to?

A

Unstable angina
MI
Ischemic cerebrovascular disease
CAD

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6
Q

What micro-vascular complications does atherosclerosis lead to?

A

Retinopathy
Nephropathy

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7
Q

What kind of relationship does lipid and protein portions have?

A

Inverse
*Increased protein=decreased lipid
*Decreased protein=increased lipid

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8
Q

What is the order of lipoproteins from most lipid to most protein?

A

Chylomicrons
VLDL
IDL
LDL
HDL

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9
Q

What is the optimal value for LDL?

A

<100 mg/dl

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10
Q

What is the optimal value for cholesterol?

A

<200 mg/dl

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11
Q

What is the optimal value for triglycerides?

A

<150 mg/dl

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12
Q

What is the optimal value for HDL?

A

> 60 mg/dl

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13
Q

What are the 4 high risk groups for statin use?

A
  1. Clinical evidence of atherosclerotic CV disease
  2. Age 40-70 w/DM & LDL >190
  3. Age 40-75 w/o DM, LDL 70-189, and estimated 10 year risk 5-20% and risk enhancers present
  4. Age 40-75 w/o DM, LDL 70-189, and estimated 10 year risk above 20%
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14
Q

What statins are naturally occurring?

A

Lovastatin

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15
Q

Which statins are semi-synthetic?

A

Simvastatin
Pravastatin

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16
Q

Which statins are synthetic?

A

Atorvastatin
Fluvastatin
Rosuvastatin

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17
Q

What is the medication class of statins?

A

HMG-CoA reductase inhibitors

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18
Q

What are the two mechanisms of action of statins?

A

inhibit cholesterol synthesis
competitively inhibit HMB-CoA reductase (increasing hepatic LDL receptors)

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19
Q

What is the most effective drug for lowering LDL?

A

statins

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20
Q

What lipoproteins do statins affect and how?

A

decrease LDL by 20-60%
increase HDL by 10%

21
Q

What statins are prodrugs?

A

Lovastatin
Simvastatin

22
Q

How are statins metabolized?

A

mostly through P450 enzymes

23
Q

What is the typical duration of action for statins?

A

~24 hours

24
Q

What is an absolute contraindication for statins?

A

pregnancy

25
Q

What are statin side effects?

A

skeletal muscle issues
liver enzyme changes
drug interactions (P450 3A4-coumadin, antifungals, antibiotics)
GI upset
fatigue
headache

26
Q

When should liver enzymes be checked after initiating statin therapy and why?

A

30 days
high risk for increase in ALT

27
Q

What is the mechanism of action of proprotein covertase subtillisin/kexin type 9 inhibitors?

A

binds to PCSK9 leading to increased hepatic LDL receptors

28
Q

What lipoproteins do PCSK9 inhibitors affect and how?

A

decreased LDL

29
Q

What are the side effects of PCSK9 inhibitors?

A

upper respiratory tract infections
infection

30
Q

What is the mechanism of action of bile acid resins?

A

increase hepatic bile synthesis from cholesterol stores and increasing LDL receptors

31
Q

What lipoproteins do bile acid resins affect and how?

A

decreased LDL

32
Q

What are examples of bild acid resins?

A

colesevelam
cholestyramine
colestipol

33
Q

What are examples of PCSK9 inhibitors?

A

evolocumab
alirocumab

34
Q

What are the side effects of bile acid resins?

A

severe constipation (need to stay well hydrated)

35
Q

What is the mechanism of action of niacin?

A

inhibits synthesis of VLDL in the liver
inhibits release of free fatty acid from adipose
increases the activity of lipoprotein lipase

36
Q

What lipoproteins does niacin affect and how?

A

decreases LDL
decreases triglycerides
increases HDL

37
Q

What is the most effective drug for increasing HDL?

A

niacin

38
Q

What are the side effects of niacin?

A

flushing (histamine)
pruritis (histamine)
GI upset
hepatic dysfunction
hyperglycemia
gout
drug interactions
augmented muscle pain with statins

39
Q

What is the effective dose of niacin?

A

1-2 gm/day

40
Q

What is the mechanism of action of fibrates?

A

increased activity of lipoprotein lipase

41
Q

What lipoproteins are affected by fibrates and how?

A

decreased triglycerides
increased HDL

42
Q

What medication is the most effective for decreasing triglycerides?

A

fibrates

43
Q

What are examples of fibrates?

A

gemfibrozil
fenofibrate
bezafibrate

44
Q

What are the side effects of fibrates?

A

gallstones
prolonged PTT (coumadin protein binding)
GI upset
headache
statin interaction-augmented muscle pain

45
Q

What is the mechanism of action of Ezetimibe?

A

selective inhibitor of cholesterol absorption leading to up-regulation of LDL receptors

46
Q

What lipoproteins does Ezetimibe affect and how?

A

decreased LDL up to 22%
may affect triglycerides

47
Q

What are the side effects of Ezetimibe?

A

potentiate effects of statins by 17%
very few side effects (none listed)

48
Q

What lipoproteins does omega-3 fatty acids affect and how?

A

decreases triglycerides

49
Q

What are the side effects of omega-3 fatty acids?

A

may increase bleeding
no evidence of heart disease prevention

Pharmacology Exam 3 (2 decks)

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