OTHER NON STATINS Flashcards
Niacin
Place in therapy
MOA
Effectiveness
ADRs and Precautions
No clear indication for routine use
inhibits release of free fatty acids from adipose tissue, reducing transport of FFA to the liver and decreasing hepatic TG synthesis; other mechanisms may also occur
- Lowers LDL by 15%-25%
- Lowers TG by 35%-50%
- Raises HDL by 30%-40%
Hyperuricemia – avoid use in gout
Fibrates: Fenofibrate and
Gemfibrozil
Place in therapy
MOA
Effectiveness
ADRs and Precautions
hypertriglyceridemia (≥500 mg/dL)
Agonist of PPAR-alpha (nuclear transcription factor) stimulates fatty acid oxidation, increases LPL synthesis, and reduces apo C-III expression increases TG clearance and synthesis
- Reduces TG: 20%-50%
- Reduces LDL: 5%-20%
- Increases HDL: 10%-20%
Myopathic effects (including rhabdomyolysis)
• Gemfibrozil is contraindicated with statins
• Fenofibrate – use with caution w/ statins
Cholelithiasis
Hematologic effects decreases hemoglobin, hematocrit, and WBC
Omega 3: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA
Place in therapy
MOA
Effectiveness
ADRs and Precautions
hypertriglyceridemia
-Not shown to reduce ASCVD risk when added to statins
Activates PPAR-alpha
- TG ↓19%–↓44%
- LDL ↓6%–↑25%
- HDL ↓5%–↑7%
GI: diarrhea, nausea, dyspepsia
Prolongation of bleeding time
-caution if on anticoagulants or antiplatelets
Inhibitor of Apo B-100 Synthesis?
Mipomersen, indicated for homozygous familial hypercholesterolemia (HoFH)
Mipomersen
indication
MOA
ADRs and Precautions
Orphan drug indicated only for homozygous familial
hypercholesterolemia (HoFH)
Targets mRNA coding for apo B-100 (the principle apolipoprotein of LDL)
hepatotoxicity
Microsomal Triglyceride Transfer Protein Inhibitor (MTTP-I)
Lomitapide
Lomitapide
indication
MOA
ADRs and Precautions
indicated only for homozygous familial hypercholesterolemia (HoFH)
Binds to MTP, preventing assembly of apo-B containing
lipoproteins (VLDL and chylomicrons)
Teratogenic and hepatotoxicity
PCSK9 Inhibitors, (hint-remember the ending)
Alirocumab
Evolocumab
-mab
Alirocumab, Evolocumab
Place in therapy
MOA
Effectiveness
ADRs and Precautions
Adjunct to diet and maximally tolerated statin for the
treatment of adults with heterozygous familial
hypercholesterolemia (HeFH) or clinical atherosclerotic
cardiovascular disease
binds to PCSK9, resulting in decreased degradation of LDL receptors on hepatocytes.
60—70% decrease in LDL
injection site pain, hypersensitivity
