Usmle - Lipid Lowering Agents

Front 1

HMG-CoA reductase inhibitors
Drugs in class?
Mechanism?
Effects on LDL, HDL, Triglycerides?
Side effects?

Back 1

HMG-CoA Reductase Inhibitors
- Lovastatin, pravastatin, simvastatin, atrovastatin, rosuvastatin

Mechanism
1. Inhibit the cholesterol precursor - mevalonate

Effects:
1. LDL - Significant decrease
2. HDL - increase
3. Triglycerides - decrease

Side Effects:
1. Hepatotoxicity (Elevated LFTs)
2. Rhabdomyolysis

Front 2

Niacin
Mechanism?
Effects on LDL, HDL, Triglycerides?
Side Effects?

Back 2

Niacin

Mechanism
1. Inhibits lipolysis is adipose tissue
2. Reduces hepatic VLDL secretion into circulation

Effects
1. LDL - Decreases
2. HDL - Increase (rather significantly)
3. Triglycerides - Decreases

Side Effects:
1. Red, flushed face - Mediated by prostaglandin and inhibited by aspirin
2. Hyperglycemia (acanthosis nigricans)
3. Hyperuricemia (exacerbates gout)

Front 3

Bile Acid Resins
Drugs in class?
Mechanism?
Effect on LDL, HDL, Triglycerides?
Side Effects?

Back 3

Bile Acid Resins
- Cholestyramine, Colestipol, Colsevelam

Mechanism:
1. Prevents intestinal reabsorption of bile acids
2. Liver must use cholesterol to make more

Effects:
1. LDL - Decrease
2. HDL - Slight increase
3. Triglycerides - slight increase

Side Effects
1. Patients HATE IT - tastes bad and causes GI discomfort.
2. Decreased absorption of fat soluble vitamins
3. Cholesterol gall stones

Front 4

Ezetimibe
Class?
Mechanism?
Effect on LDL, HDL, Triglycerides?
Side Effects?

Back 4

Ezetimibe
- Cholesterol absorption blocker

Mechanism:
1. Prevent cholesterol reabsorption at small intestine brush border.

Effects:
1. LDL - Decrease
2. HDL - No change
3. Triglycerides - No change

Side Effects
1. Rare - raised LFTs

Front 5

Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
Class?
Mechanism?
Effects on LDL, HDL, Triglycerides?
Side Effects?

Back 5

Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
Class: Fibrates

Mechanism:
1. Upregulate LPL and increase Triglyceride clearance

Effects:
1. LDL - Decrease
2. HDL - Increase
3. Triglycerides - Huge Decrease

Side Effects:
1. Myositis
2. Hepatotoxicity (Increased LFTs)
3. Cholesterol Gall stones

Front 6

Hydralazine
Class?
Mechanism?
Clinical Use?
Toxicity?

Back 6

Hydralazine
Vasodilator

Mechanism:
1. Increases cGMP causing smooth muscle relaxation. Vasodilates arterioles > vein helping to cause a reduction in after load.

Clinical Use:
1. Severe hypertension, CHF.
2. First line therapy for HTN in pregnancy, with methyldopa.
3. Frequently co-administered with a beta blocker to prevent tachycardia

Toxicity
1. Tachycardia (Reflex) - contraindicated in Angina/CAD
2. Fluid retention, nausea, headache, angina
3. LUPUS LIKE SYNDROME

Front 7

Nitroprusside

Back 7

Nitroprusside
- Short acting
- Increases cGMP via direct release of NO.

Clinical Use:
1. Malignant Hypertension

Problems
- May cause cyanide toxicity

Front 8

Fenoldopam

Back 8

Fenoldopam

- Dopamine D1 receptor agonist - relaxes renal vascular smooth muscle.

Clinical Use:
1. Malignant Hypertension

Front 9

Diazoxide

Back 9

Diazoxide

K+ channel opener - hyperpolarizes and relaxes smooth muscle.

Clinical Use:
1. Malignant Hypertension

May cause HYPERGLYCEMIA due to increased insulin release.

Front 10

Nesiritide
Mechanism?
Clinical Use?
Toxicity

Back 10

Nesiritide

Mechanism
1. Recombinant B-type Natriuretic peptide. Causes increased cGMP and vasodilation.

Clinical Use:
1. Acute DECOMPENSATED heart failure

Toxicity:
1. Hypotension