Second Line Lipid Lowering Agents

Question 1

What’re the indications of Statins?

Answer 1

First line lipid lowering agent

Question 2

What is the MOA of statins?

Answer 2

Competitive inhibition of HMG-CoA reductase
(Treats hypercholesterolemia)

Question 3

Effects of Statins on LDL, HDL, and triglycerides?

Answer 3

•LDL: HUGE decrease
•HDL: Increase
•Triglycerides: decrease

Question 4

What’re some side effects of Statins?

Answer 4

Myalgia, Statin-associated myopathy, and increased liver enzymes

Question 5

What are fibrates? (Give definition)

Answer 5

Fibric acid derivatives

Question 6

What’re three drugs of Fibrates? (BFG)

Answer 6

Bezafibrate

Fenofibrate

Gemfibrozil

Question 7

MOA of fibrates?

Answer 7

Increased lipoprotein lipase activity causing rapid degradation of LDL and triglycerides and induction of HDL synthesis

Question 8

Indication of Fibrates?

Answer 8

Second line choice in hyperlipidemia, most effective for lowering triglycerides

Question 9

Adverse effects of Fibrates?

Answer 9

Dyspepsia, myopathy, cholelithiasis and increased liver enzymes (reversible)

Question 10

What are three drug agents of bile acid resins?
(CCC)

Answer 10

Cholestyramine, colestipol, colesevelam

Question 11

MOA of bile acid resins?

Answer 11

Lowers cholesterol pool and promotes synthesis of LDL receptors, slightly increases HDL and triglycerides

Question 12

Indications of bile acid resins?

Answer 12

Combination treatment with statins in hypercholesterolemia, digoxin overdose

Question 13

Adverse affects of bile acid resins?

Answer 13

Abdominal bloating and cramping

Question 14

Niacin MOA

Answer 14

Inhibits lipolysis and fatty acid release in adipose tissue

Question 15

Indications for Niacin administration?

Answer 15

High LDL cholesterol and lipoprotein(a) levels (>50 mg/dL)
-Despite statin and ezetimibe therapy.

Question 16

Adverse effects of niacin?

Answer 16

Flushing and pruritus (feeling of itching) (pre treatment with aspirin or ibuprofen can minimize the side effect), hyperglycemia, and hyperuricemia and gout

Question 17

Niacin contraindications?

Answer 17

Liver failure, gout, hemorrhage, gastric ulcer, cardiovascular instability

Question 18

Ezetimibe MOA?

Answer 18

Selective inhibition of cholesterol reabsorption

Question 19

Indication(s) of Ezetimibe:
-mono therapy
-combined

Answer 19

-mono: contraindications or statin intolerance
-combo: insufficient LDL cholesterol reduction by statins

Question 20

Adverse effects of Ezetimibe?

Answer 20

Increased liver enzymes, angioedema, diarrhea, and myalgia

Question 21

What’re some common PCSK9 inhibitors?

Answer 21

Alirocumab, evolocumab

Question 22

MOA of PCSK9 inhibitors?

Answer 22

Monoclonal antibodies that inhibit proprotein convertase subtilisin Kexin 9 increases removal of LDL.

-Overall, huge decrease of LDL, increase HDL, and decrease triglycerides

Question 23

Adverse effects of PCSK9 inhibitors?

Answer 23

Myalgia