Treatment of Dyslipidemia Flashcards by Jamaira Belmes

Pathogenesis of Hyperlipoproteinemia

PREMATURE ATHEROSCLEROSIS - associated w/ elevated concentrations lipoproteins

📌elevated LDL
📌depressed HDL
📌 hypertriglyceridemia

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Drugs most effective at LOWERING LDL CHOLESTEROL

STATINS
RESINS
EZETIMIBE
NIACIN

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Drugs most effective in LOWERING TRIGLYCERIDE and VLDL and RAISING HDL

NIACIN

FIBRATES

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Statins use in CAD

for STABILIZATION of atherosclerotic plaques

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Drugs that causes FLUSHING

VANC

Vancomycin
Adenosine
Niacin
CCB

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FIBRATES

Fibrates Upregulate Lipoprotein Lipase (FULL)

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Familial hypercholesterolemia

NIACIN + STATIN

STATIN + EZETIMIBE

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Familial Combined Hypercholesterolemia

NIACIN + RESIN

STATIN + FIBRATE

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Disadvantageous Antihyperlipidemic Combinations

FIBRATE + RESIN - CHOLELITHIASIS (increased risk)
STATIN + RESIN - impaired statin absorption
STATIN + FIBRATE - increased risk of myopathy and rhabdomyolysis

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Caused by mutations leading to dysfunctional LDL receptors incapable of taking up LDL from the bloodstream

Homozygous Familial Hypercholesterolemia

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Most effective in increasing HDL levels

NIACIN

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STATINS/HMG-CoA Reductase Inhibitors

Simvastatin
Atorvastatin
Rosuvastatin
Fluvastatin
Pravastatin
Lovastatin
Pitavastatin

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Side effects of STATINS/HMG-CoA Reductase Inhibitors

HEPATOXICITY
myopathy
rhabdomyolysis
GI distress
teratogen

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Most potent among the Statins

Atorvastatin

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(-) hormone sensitive lipase

NIACIN/Nicotinic Acid/Vitamin B3

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MOST EFFECTIVE for INCREASING HDL

NIACIN

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Side effects of Niacin

FLUSHING
myositis
itchy skin
hyperglycemia
hyperuricemia

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Fibric Acid Derivatives

Gemfibrozil
Fenofibrate
Bezafibrate

MOA of Fibric Acid Derivatives

PPAR-a agonists (Peroxisome Proliferation Receptor Alpha) – (+) lipoprotein lipase

(-) apo CIII
(+) apo C1 and CII

Side effects of Fibric Acid Derivatives

rhabdomyolysis
stone formation
myositis
erectile dysfunction

Bile Acid Binding Resins

Cholestyramine
Colesevelam
Colestipol

Side effects of Bile Acid Binding Resins

stone formation

constipation

Cholesterol Absorption Inhibitor

(-) binding sites - NPC1L1 and clathrin AP2

Ezetimibe

decrease LDL, TG
increase HDL

Cholesterol Absorption Inhibitor

PCSK9 (-)

Evalocumab

Aliracumab

Omega 3-FA

DHA | EPA

HIGH LDL

diet and exercise STATIN EZETIMIBE

HIGH VLDL

diet and exercise STATIN FIBRATE

HIGH TRIGLYCERIDES

diet and exercise FIBRATE NIACIN

LOW HDL

diet and exercise NIACIN

HIGH LDL | HIGH VLDL

diet and exercise STATIN EZETIMIBE or NIACIN

HIGH LDL HIGH TRIGLYCERIDES LOW LDL

diet and exercise STATIN + NIACIN + FIBRATES

PJ is a 5-year-old boy. At his checkup, the pediatrician notices cutaneous xanthomas and orders a lipid panel. Repeated measures confirm that the patient’s serum cholesterol levels are high (936 mg/dL). Further testing confirms a diagnosis of homozygous familial hypercholesterolemia. Which of the following interventions will be least effective in this patient? ``` (A) Atorvastatin (B) Ezetimibe (C) Lomitapide (D) Mipomersen (E) Niacin ```

(A) Atorvastatin Homozygous familial hypercholesterolemia is caused by mutations leading to dysfunctional LDL receptors incapable of taking up LDL from the bloodstream. Options B–E would have a cholesterol-lowering effect. Lomitapide and mipomersen are specifically indicated for patients with familial hypercholesterolemia. Reductase inhibitors such as atorvastatin rely on functional LDL receptors to achieve a LDL-lowering effect and thus will not work in patients with homozygous familial hypercholesterolemia

A 46-year-old woman with a history of hyperlipidemia was treated with a drug. The chart below shows the results of the patient’s fasting lipid panel before treatment and 6 mo after initiating drug therapy. Normal values are also shown. Which of the following drugs is most likely to be the one that this patient received? ``` (A) Colestipol (B) Ezetimibe (C) Gemfibrozil (D) Lovastatin (E) Niacin ```

(E) Niacin

A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced Which of the following drugs is most likely to increase this patient’s triglyceride and VLDL cholesterol concentrations when used as monotherapy? ``` (A) Atorvastatin (B) Cholestyramine (C) Ezetimibe (D) Gemfibrozil (E) Niacin ```

(B) Cholestyramine

If this patient is pregnant, which of the following drugs should be avoided because of a risk of harming the fetus? ``` (A) Cholestyramine (B) Ezetimibe (C) Fenofibrate (D) Niacin (E) Pravastatin ```

(E) Pravastatin

The patient is started on gemfibrozil. Which of the following is a major mechanism of gemfibrozil’s action? (A) Increased excretion of bile acid salts (B) Increased expression of high-affinity LDL receptors (C) Increased secretion of VLDL by the liver (D) Increased triglyceride hydrolysis by lipoprotein lipase (E) Reduced uptake of dietary cholesterol

(D) Increased triglyceride hydrolysis by lipoprotein lipase

Which of the following is a major toxicity associated with gemfibrozil therapy? ``` (A) Bloating and constipation (B) Cholelithiasis (C) Hyperuricemia (D) Liver damage (E) Severe cardiac arrhythmia ```

(B) Cholelithiasis

Consumption of alcohol is associated with which of the following changes in serum lipid concentrations? ``` (A) Decreased chylomicrons (B) Decreased HDL cholesterol (C) Decreased VLDL cholesterol (D) Increased LDL cholesterol (E) Increased triglyceride ```

(E) Increased triglyceride

If the patient has a history of gout, which of the following drugs is most likely to exacerbate this condition? ``` (A) Colestipol (B) Ezetimibe (C) Gemfibrozil (D) Niacin (E) Simvastatin ```

(D) Niacin

After being counseled about lifestyle and dietary changes, the patient was started on atorvastatin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of which of the following? ``` (A) Blood urea nitrogen (B) Alanine and aspartate aminotransferase (C) Platelets (D) Red blood cells (E) Uric acid ```

(B) Alanine and aspartate aminotransferase

Six months after beginning atorvastatin, the patient’s total and LDL cholesterol concentrations remained above normal, and he continued to have anginal attacks despite good adherence to his antianginal medications. His physician decided to add ezetimibe. Which of the following is the most accurate description of ezetimibe’s mechanism of an action? (A) Decreased lipid synthesis in adipose tissue (B) Decreased secretion of VLDL by the liver (C) Decreased gastrointestinal absorption of cholesterol (D) Increased endocytosis of HDL by the liver (E) Increased lipid hydrolysis by lipoprotein lipase

Fibrate + Resin

Increased risk of cholelithiasis

Statin + Resin

Impaired statin absorption

Statin + Fibrate

Increased risk of myopathy, rhabdomyolysis