Lipid Lowering Mediciations

Question 1

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

Answer 1

Atherosclerosis
Pancreatitis

Question 2

What are the causes of lipid disorders?

Answer 2

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

Question 3

What does hyper triglycerides lead to?

Answer 3

Pancreatitis

Question 4

What does hypercholesterolemia lead to?

Answer 4

Atherosclerosis

Question 5

What macro-vascular complications does atherosclerosis lead to?

Answer 5

Unstable angina
MI
Ischemic cerebrovascular disease
CAD

Question 6

What micro-vascular complications does atherosclerosis lead to?

Answer 6

Retinopathy
Nephropathy

Question 7

What kind of relationship does lipid and protein portions have?

Answer 7

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

Question 8

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

Answer 8

Chylomicrons
VLDL
IDL
LDL
HDL

Question 9

What is the optimal value for LDL?

Answer 9

<100 mg/dl

Question 10

What is the optimal value for cholesterol?

Answer 10

<200 mg/dl

Question 11

What is the optimal value for triglycerides?

Answer 11

<150 mg/dl

Question 12

What is the optimal value for HDL?

Answer 12

> 60 mg/dl

Question 13

What are the 4 high risk groups for statin use?

Answer 13

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%

Question 14

What statins are naturally occurring?

Answer 14

Lovastatin

Question 15

Which statins are semi-synthetic?

Answer 15

Simvastatin
Pravastatin

Question 16

Which statins are synthetic?

Answer 16

Atorvastatin
Fluvastatin
Rosuvastatin

Question 17

What is the medication class of statins?

Answer 17

HMG-CoA reductase inhibitors

Question 18

What are the two mechanisms of action of statins?

Answer 18

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

Question 19

What is the most effective drug for lowering LDL?

Answer 19

statins

Question 20

What lipoproteins do statins affect and how?

Answer 20

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

Question 21

What statins are prodrugs?

Answer 21

Lovastatin
Simvastatin

Question 22

How are statins metabolized?

Answer 22

mostly through P450 enzymes

Question 23

What is the typical duration of action for statins?

Answer 23

~24 hours

Question 24

What is an absolute contraindication for statins?

Answer 24

pregnancy

Question 25

What are statin side effects?

Answer 25

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

Question 26

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

Answer 26

30 days high risk for increase in ALT

Question 27

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

Answer 27

binds to PCSK9 leading to increased hepatic LDL receptors

Question 28

What lipoproteins do PCSK9 inhibitors affect and how?

Answer 28

decreased LDL

Question 29

What are the side effects of PCSK9 inhibitors?

Answer 29

upper respiratory tract infections infection

Question 30

What is the mechanism of action of bile acid resins?

Answer 30

increase hepatic bile synthesis from cholesterol stores and increasing LDL receptors

Question 31

What lipoproteins do bile acid resins affect and how?

Answer 31

decreased LDL

Question 32

What are examples of bild acid resins?

Answer 32

colesevelam cholestyramine colestipol

Question 33

What are examples of PCSK9 inhibitors?

Answer 33

evolocumab alirocumab

Question 34

What are the side effects of bile acid resins?

Answer 34

severe constipation (need to stay well hydrated)

Question 35

What is the mechanism of action of niacin?

Answer 35

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

Question 36

What lipoproteins does niacin affect and how?

Answer 36

decreases LDL decreases triglycerides increases HDL

Question 37

What is the most effective drug for increasing HDL?

Answer 37

niacin

Question 38

What are the side effects of niacin?

Answer 38

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

Question 39

What is the effective dose of niacin?

Answer 39

1-2 gm/day

Question 40

What is the mechanism of action of fibrates?

Answer 40

increased activity of lipoprotein lipase

Question 41

What lipoproteins are affected by fibrates and how?

Answer 41

decreased triglycerides increased HDL

Question 42

What medication is the most effective for decreasing triglycerides?

Answer 42

fibrates

Question 43

What are examples of fibrates?

Answer 43

gemfibrozil fenofibrate bezafibrate

Question 44

What are the side effects of fibrates?

Answer 44

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

Question 45

What is the mechanism of action of Ezetimibe?

Answer 45

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

Question 46

What lipoproteins does Ezetimibe affect and how?

Answer 46

decreased LDL up to 22% may affect triglycerides

Question 47

What are the side effects of Ezetimibe?

Answer 47

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

Question 48

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

Answer 48

decreases triglycerides

Question 49

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

Answer 49

may increase bleeding no evidence of heart disease prevention