Lipid Lowering Meds Flashcards
List the secondary causes of hyperlipidemia:
- increased fat intake
- obesity
- type 2 DM
- age
- hypothyroidism
- obstructive liver dz
- drugs (glucocorticoids, birth control)
Untreated hyperlipidemia leads to (2 things):
1) acute pancreatitis (hypertriglycerides)
2) atherosclerosis (hypercholesteremia)
What macrovascular complications can occur with atherosclerosis?
- unstable angina
- MI
- ischemia cerebrovascular disease
- CAD
What microvascular complications can occur with atherosclerosis?
- retinopathy
- nephropathy
Define lipoprotein
macromolecular lipid protein complexes that transport lipids to and from the peripheral tissues
How are lipid / protein portions related?
inversely
high protein + low lipid
low protein + high lipid
List the 5 classifications of lipoproteins
- chylomicrons
- very-low density lipoproteins (VLDL)
- intermediate-density lipoproteins (IDL)
- low-density lipoproteins (LDL)
- high-density lipoproteins (HDL)
List the types of lipoproteins from high lipid to low lipid:
(Charles the V Is a Loose Hoe)
chylomicrons
VLDL
IDL
LDL
HDL
What is the optimal value of each of the lipoproteins?
LDL < 100 mg/dL
TG < 150 mg/dL
Cholesterol < 200 mg/dL
HDL > 60 mg/dL
Statins are isolated from a strain of which microorganism?
aspergillus terrus
Which statins fall under natural, semi-synthetic, and synthetic groups?
natural: Lovastatin
semi-synthetic: Simvastatin, Pravastatin
synthetic: Atorvastatin, Fluvastatin, Rosuvastatin
Statins are structurally similar to an enzyme in the body. What is the enzyme and what effect do statins have?
- structurally related to HMG-CoA
- statins competitively inhibit the enzyme causing an increase in hepatic LDL-Receptor
- the result is a 20-60% decrease in LDL and 10% increase in HDL concentration
What drug class is most effective at reducing LDL?
statins
What is one absolute contraindication to statins?
pregnancy
What 2 statins are prodrugs?
Lovastatin
Simvastatin
Most statins undergo metabolism by _____. (except one…)
hepatic P450 enzymes
(not Pravastatin)
What are some side effects of statins?
- skeletal muscle issues (myalgias –> rhabdo)
- liver enzyme change (incr plasma aminotransferase)
- **drug interactions (3A4 inhibitors; coumadin, abx)
- GI upset
- fatigue
- headache
What is the MOA of bile acid resins?
- increase hepatic bile acid synthesis from cholesterol stores
- increase LDL-R and update of LDL from blood
A patient with increased LDL but normal TG would likely be prescribed what drug class?
bile acid resins
(Colesevelam, Cholestyramine, Colestipol)
How are bile acid resins given? What is the primary side effect?
- PO powder with no systemic absorption
- no other meds 1 hr pre- or 4 hrs post-admin
- major SE = constipation
What is another name for Niacin?
Nicotinic Acid
What is the MOA of Niacin?
- inhibits VLDL synthesis
- inhibits release of FFA from adipose
- increases activity of lipoprotein lipase
Which lipid lowering med is most effective at increasing HDL? What else does this drug do?
Niacin
- also lowers LDL and TG
Side effects of Niacin:
- flushing
- pruritis
- GI upset
- hepatic dysfxn
- hyperglycemia
- gout
- drug interactions (statins)
Which lipid lowering medication should be avoided in liver patients? Why?
Niacin
- extensive first pass hepatic metabolism
What is the MOA of Fibrates?
increased activity of lipoprotein lipase
Which lipid lowering med is most effective at decreasing TG? What else does this drug do?
Fibrates (50% lowered)
- also increase HDL
Side effects of Fibrates:
- GI upset
- HA
- gallstones
- statin interactions (worse muscle pain)
- prolonged PTT (displaces Coumadin)
What is the MOA of Ezetimibe?
selective inhibitor of cholesterol absorption leading to secondary up-regulation of LDL-R
Which drug potentiates the effects of statins?
Ezetimibe (17%)
