WEEK 2 ANTILIPEMICS

Question 1

Describe the action of HMG-CoA reductase inhibitors

Answer 1

Inhibits HMG-CoA reductase, a key enzyme in endogenous cholesterol synthesis, restricting lipoprotein production

Question 2

What is the therapeutic effect of HMG-CoA reductase inhibitors?

Answer 2

Lowers total LDL cholesterol and triglycerides, slightly increases HDL cholesterol. Decreases plaque site inflammation and risk of thromboembolism.

Question 3

Name 1 example of an HMG-CoA reductase inhibitor

Answer 3

Atorvastatin

Question 4

Name 3 side effects of HMG-CoA reductase inhibitors

Answer 4

1. Myopathy/rhabdomyolysis
2. Hepatotoxicity/increased liver enzymes
3. Peripheral neuropathy

Question 5

Why should HMG-CoA reductase inhibitors be taken at night?

Answer 5

The liver produces the most cholesterol at night

Question 6

What are 2 food/drug interactions with HMG-CoA reductase inhibitors?

Answer 6

1. Fibrates
2. Grapefruit

Question 7

Describe the action of bile acid sequestrants

Answer 7

Binds bile acids in the GI tract, forming an insoluble complex, which is then cleared from the body

Question 8

What is the therapeutic effect of bile acid sequestrants?

Answer 8

Decreased plasma cholesterol and LDL cholesterol

Question 9

Name 1 example of a bile acid sequestrant

Answer 9

Cholestyramine

Question 10

What time should bile acid sequestrants be taken?

Answer 10

1 hour before or 4 hours after other medications or vitamins (to prevent binding in GI tract)

Question 11

When should bile acid sequestrants be held?

Answer 11

Bowel obstruction

Question 12

What are 2 side effects of bile acid sequestrants?

Answer 12

1. Constipation (take a fibre supplement)
2. GI upset (take with meals)

Question 13

Describe the action of nicotinic acid

Answer 13

Large doses decrease lipoprotein and triglyceride synthesis by inhibiting the release of free fatty acids from adipose tissue and decreasing hepatic lipoprotein synthesis

Question 14

What is the therapeutic effect of nicotinic acid?

Answer 14

Adjunctive treatment (with bile acid sequestrants or fibrates) to decrease blood lipids

Question 15

What are 3 side effects of nicotinic acid?

Answer 15

1. Flushing (prevent with NSAIDs)
2. Pruritis
3. GI upset

Question 16

What are 3 contraindications for nicotinic acid?

Answer 16

1. Liver disease
2. Hypertension
3. Active bleeding

Question 17

Describe the action of cholesterol absorption inhibitors

Answer 17

Inhibits absorption of cholesterol in the small intestine

Question 18

What is the therapeutic effect of cholesterol absorption inhibitors?

Answer 18

Lowers cholesterol to lower the risk for atherosclerosis

Question 19

What is the name of the only cholesterol absorption inhibitor?

Answer 19

Ezetimibe

Question 20

Cholesterol absorption inhibitors should not be taken which which group of drugs?

Answer 20

Fibrates

Question 21

Describe the 3 actions of fibric acid derivatives (fibrates)

Answer 21

1. Inhibits peripheral lipolysis
2. Decreases triglyceride production by liver
3. Decreases production of triglyceride carrier protein

Question 22

What is the therapeutic effect of fibrates?

Answer 22

Lowers triglycerides and increases HDL

Question 23

Name 1 example of a fibrate

Answer 23

Gemfibrozil

Question 24

When are fibrates used?

Answer 24

When patient not responsive to statins

Question 25

What does fibrates not have an effect on?

Answer 25

LDL levels

Question 26

What group of drugs should fibrates not be used with?

Answer 26

Statins

Question 27

What drug should be used with caution in a patient on fibrates?

Answer 27

Warfarin, as fibrates bind to vitamin K which would normally inhibit warfarin

Question 28

Name 2 side effects of fibrates

Answer 28

1. Gallstones
2. GI upset

Question 29

Name 2 examples of platelet aggregation inhibitors

Answer 29

1. Aspirin
2. Clopidogrel

Question 30

Describe the action of aspirin

Answer 30

Prevents platelet aggregation and vasoconstriction by blocking the production of thromboxane

Question 31

Describe the action of clopidogrel

Answer 31

Prevents platelet aggregation by blocking adenosine diphosphate receptors on platelets