Second Line Lipid Lowering Agents Flashcards
What’re the indications of Statins?
First line lipid lowering agent
What is the MOA of statins?
Competitive inhibition of HMG-CoA reductase
(Treats hypercholesterolemia)
Effects of Statins on LDL, HDL, and triglycerides?
•LDL: HUGE decrease
•HDL: Increase
•Triglycerides: decrease
What’re some side effects of Statins?
Myalgia, Statin-associated myopathy, and increased liver enzymes
What are fibrates? (Give definition)
Fibric acid derivatives
What’re three drugs of Fibrates? (BFG)
Bezafibrate
Fenofibrate
Gemfibrozil
MOA of fibrates?
Increased lipoprotein lipase activity causing rapid degradation of LDL and triglycerides and induction of HDL synthesis
Indication of Fibrates?
Second line choice in hyperlipidemia, most effective for lowering triglycerides
Adverse effects of Fibrates?
Dyspepsia, myopathy, cholelithiasis and increased liver enzymes (reversible)
What are three drug agents of bile acid resins?
(CCC)
Cholestyramine, colestipol, colesevelam
MOA of bile acid resins?
Lowers cholesterol pool and promotes synthesis of LDL receptors, slightly increases HDL and triglycerides
Indications of bile acid resins?
Combination treatment with statins in hypercholesterolemia, digoxin overdose
Adverse affects of bile acid resins?
Abdominal bloating and cramping
Niacin MOA
Inhibits lipolysis and fatty acid release in adipose tissue
Indications for Niacin administration?
High LDL cholesterol and lipoprotein(a) levels (>50 mg/dL)
-Despite statin and ezetimibe therapy.
Adverse effects of niacin?
Flushing and pruritus (feeling of itching) (pre treatment with aspirin or ibuprofen can minimize the side effect), hyperglycemia, and hyperuricemia and gout
Niacin contraindications?
Liver failure, gout, hemorrhage, gastric ulcer, cardiovascular instability
Ezetimibe MOA?
Selective inhibition of cholesterol reabsorption
Indication(s) of Ezetimibe:
-mono therapy
-combined
-mono: contraindications or statin intolerance
-combo: insufficient LDL cholesterol reduction by statins
Adverse effects of Ezetimibe?
Increased liver enzymes, angioedema, diarrhea, and myalgia
What’re some common PCSK9 inhibitors?
Alirocumab, evolocumab
MOA of PCSK9 inhibitors?
Monoclonal antibodies that inhibit proprotein convertase subtilisin Kexin 9 increases removal of LDL.
-Overall, huge decrease of LDL, increase HDL, and decrease triglycerides
Adverse effects of PCSK9 inhibitors?
Myalgia
