Pharm - Cholesterol Meds

Question 1

When treater high cholesterol, what is the first line of treatment unless what is already present?

Answer 1

First thing to do is manage/change the diet unless the patient already has CAD or PVD or genetic high cholesterol, then do diet and drug.

Question 2

What are 3 dietary recommendations for lowering cholesterol?

Answer 2

Fat calories less than 20-25% of daily intake, saturated fats less than 8% of daily intake, and cholesterol less than 200mg/day.

Question 3

What are the 6 families of drugs to treat high cholesterol?

Answer 3

HMG CoA reductase inhibitors, niacin, fibrates, bile acid resins, cholesterol absorption inhibitors, new treatments.

Question 4

Statins are most effective against treating what specifically?

Answer 4

Most effective in lowering LDL levels.

Question 5

MOA for statins and what are the two effects?

Answer 5

Inhibit HMG CoA reductase, rate limiting step in cholesterol synthesis. Lowers cholesterol synthesis, but also up regulates LDL receptors and pulls more cholesterol into the cells out of the blood.

Question 6

Top 4 statins as far as potency?

Answer 6

Atorva, rosu, simva, and pitava

Question 7

What is important to note about the pharmacokinetics of statins?

Answer 7

They have extensive first pass effect in the liver, so their dominant effect is in the liver.

Question 8

Adverse effect of statins?

Answer 8

Elevated liver enzymes.

Question 9

Niacin is used to treat what 3 things?

Answer 9

Lower TG, lower LDL and best at raising HDL.

Question 10

MOA for niacin?

Answer 10

Inhibits lipolysis which reduces circulating free fatty acids. Decreases break down of HDL.

Question 11

What 2 effects do fibrates have on lower cholesterol?

Answer 11

Lower TG and increase HDL

Question 12

What do statins do to muscle?

Answer 12

Break down, so creatine kinase activity may rise.

Question 13

What patient population is contraindicated for statins?

Answer 13

Pregnancy

Question 14

Most common adverse effect of niacin?

Answer 14

Beta alanine rush.

Question 15

Niacin is contraindicated in what patients?

Answer 15

Liver disease

Question 16

MOA for fibrates?

Answer 16

Agonists for PPARs, which increase lipoprotein lipase and break down fatty acids and lead to lower TG.

Question 17

2 top adverse effects of fibrates?

Answer 17

GI disturbances are most common. Gallstones because increase biliary cholesterol excretion.

Question 18

1 effect of using bile acid resins?

Answer 18

Lower LDL

Question 19

MOA for bile acid/salt resins?

Answer 19

They bind the bile acids/salts and form a complex to be excreted. Because of the drop in bile acids/salts, hepatocytes increase conversion of cholesterol to bile acids. This also drops cholesterol levels, so LDL receptors are unregulated and clear more cholesterol from the blood.

Question 20

Most common adverse effects of bile acid resins?

Answer 20

GI disturbances

Question 21

MOA of cholesterol absorption inhibitors?

Answer 21

Selectively inhibits intestinal absorption of cholesterol

Question 22

1 effect of using cholesterol absorption inhibitors?

Answer 22

Lower LDL

Question 23

What do the new treatment drugs treat, what type of high cholesterol?

Answer 23

Homozygous familial high cholesterol

Question 24

MAO for lomitapide?

Answer 24

Inhibits MTP which lowers production of chylomicrons and VLDL which leads to lowering of LDL.

Question 25

MOA for Mipomersen?

Answer 25

Inhibitor of APOB

Question 26

Black box warning for mipomersen?

Answer 26

Liver toxicity

Question 27

What 3 drug families lower LDL and rank them in order of effectiveness?

Answer 27

Statins, bile acid resins, and niacin

Question 28

Top 3 drug families to increase HDL and rank them in order of effectiveness starting with strongest?

Answer 28

Niacin, fibrates and statins

Question 29

Top 3 drug families to lower TG and rank them in order of effectiveness starting with strongest?

Answer 29

Fibrates, niacin and statins

Question 30

What are the two types of clots?

Answer 30

White and Red