Lipid Pharm

Question 1

Statins (MOA/AE/Tests)

Answer 1

*FIRST line therapy

MOA: inhibit HMG CoA reductase = increase LDL R exp. = decrease LDLC (and decrease TGs)

AE:
-Hepatotoxicity
-SKM toxicity (mmmr)

*should get baseline LFTs (ALT/AST) and CK

Increased SKM tox with:
1. Increased statin dose
2. Drug-drug interactions
3. Low thyroid hormone levels
4. Low vitamin D levels

Question 2

Ezetimibe (MOA/AE)

Answer 2

MOA: inhibits NPC1L, increase LDL R exp. = decrease LDLC

AE: minimal

Question 3

Cholestyramine, Colestipol, Colesevelam (MOA/AE)

Answer 3

BA Sequestrants

MOA: increase LDL R exp. = decrease LDLC

AE: very safe bc not absorbed systemically
-GI (bloat/constipation/nausea/flatulence)
-Can affect GI abs. of other drugs/fat sol vits

Question 4

Alirocumab, Evolocumab (MOA/AE)

Answer 4

PCSK-9 Inhibitors (monoclonal antibody, SC inj)

MOA: increase LDL R exp. = decrease LDLC

AE:
-Inject site rxn
-Allergic rxn

Question 5

Niacin (MOA/AE)

Answer 5

MOA: activate gpcr on adipose, decrease TG synthesis = decrease VLDL and LDLC

AE: FIDHHHH
-Flushing, itching, dyspepsia, headache
-Hepatotoxicity
-Hyperglycemia
-Hyperuricemia

*Increased risk of SKM toxicity with statins

Question 6

Fenofibrate, Gemfibrozil (MOA/AE)

Answer 6

FIBrates

MOA: activate PPARα, decrease VLDL, may increase LDLC (increase fatty acid ox. also)

AE:
-GI (dyspepsia, abd. pain, diarrhea, constipation)
-Increase gallstone formation
-Increase risk of SKM tox with statins (esp. gem)

Question 7

Highest LDL-C Lowering

Answer 7

Statins, PCSK9 inhibitors

Question 8

Highest TG Lowering

Answer 8

Fibrates, Niacin, Statins

Question 9

Highest HDL-C Raising

Answer 9

Niacin

Question 10

Used for: Hyperthyroidism

Answer 10

Anti-thyroid drugs (Meth and PTU)

MOA: inhibit thyroid peroxidase, decrease levels of TH

AE:
-Rash
-Hepatotoxicity
-Agranulocytosis

Meth preferred; PTU = black box warning for
hepatotoxicity (reserved for intolerance to methimazole or 1st trimester pregnancy)