Lipid pharm

Question 1

HMG co-A reductase inhibitors- MOA

Answer 1

HMG = precursor to cholesterol. Competitively inhibits cholesterol synthesis & depletes intracellular supply-> increasing uptake from blood.

Question 2

HMG co-A reductase inhibitors - Indications

Answer 2

AKA- statins-First line tx for high LDL. Reduce CHD risks

- plaque stabilization, endothelial function, inhibit thrombus formation, anti-inflammatory

Question 3

HMG co-A reductase inhibitors - AE

Answer 3

• Contraindicated in pregnancy, children, active liver disease
• Liver failure, myopathy

Question 4

Nicotinic acid- Niacin- MOA

Answer 4

• Inhibits lipolysis of adipose tissue
• lowering hepatic VLDL, LDL.
• Reduces catabolism of HDL
• Boosts plasminogen activation

Question 5

Nicotinic acid- Niacin-Indications

Answer 5

• Increases HDL and reduce LDL by 10-20%.

- Reduce MI risk.

Question 6

Nicotinic acid- Niacin-AE

Answer 6

• hepatotoxicity, hyperglycemia, cutaneous flush, pruritus, uricemia & gout
• Contraindicated: liver & gout

Question 7

Fibric Acid- gemfibrozil, clofibrate, fenofibrate- MOA

Answer 7

• Increases rate of gene expression for proteins which increase expression of lipoprotein lipase and decreasing apolipoprotein
• Inhibit TG production, increase HDL

Question 8

Fibric Acid- gemfibrozil, clofibrate, fenofibrate- Indications

Answer 8

• hyper-triacylglycerolemias (hereditary)

- Mixed evidence that reduces risk of CHD

Question 9

Fibric Acid- gemfibrozil, clofibrate, fenofibrate- AE

Answer 9

GI disturbances, lithiasis, myositis,

Question 10

HMG co-A reductase inhibitor- Risk Factors

Answer 10

Advanced age, CKD, preoperative, alcohol, grapefruit juice, hypothyroid

Question 11

Bile Acid Sequestering- MOA

Answer 11

• Bind to bile acids preventing reuptake and increasing excretion in feces
• Forces cholesterol to be turned into additional bile acid

Question 12

Bile Acid Sequestering- Indication

Answer 12

• Used in conjunction with statins to reduce cholesterol

Question 13

Bile Acid Sequestering- AE

Answer 13

• May elevate TG

- GI disturbance, impaired absorption of fat soluble vits. & medications

Question 14

Omega 3- MOA

Answer 14

Reduces hepatic triglyceride synthasis

Question 15

Omega 3- Indications

Answer 15

Hypertriglyceridemia

Question 16

Omega 3- AE

Answer 16

Eructation, taste changes, dyspepsia, constipation

Question 17

Degree of cholesterol elevation- when to add drug

Answer 17

• > 100 mg + 20% 10 yr risk
• > 130 mg +2 risk factors
• > 160 + 0-1 risk factor
• Start with statin

Question 18

Presence of hypertriglyceride

Answer 18

• Lifestyle modification
• > 500 use fibrates or nicotinic acid
• < 500 use LDL therapy

Question 19

Patient compliance

Answer 19

• Simple, fewest side effects, clear instructions

Question 20

Concurrent disorders

Answer 20

• Treat HTN & DM in combination with reducing levels

- Assess for secondary conditions

Question 21

Monitoring

Answer 21

• Follow up 6-8 weeks after drug therapy

- Titrate & recheck until optimal