Pharm- Dyslipidemia Drugs

Front 1

What are the four frontline agents for dyslipidemia?

Back 1

HMG CoA Reductase Ibhibitors (Statins) - competitive inhibition of HMG-CoA reductase (rate limiting enzyme in cholesterol synthesis) thus increases synthesis of hepatic LDL receptors. Ex. Atorvastatin, Lovastatin, Simvastatin, Pravastatin. Lowers LDL 18-55%, increases HDL 5-15%, lowers TG 7-30%.
Niacin - MoA poorly understood
Bile Acid Binding Resins - ex. Cholestyramine, Colestipol. Polymeric anion exchange resins exchange Cl for bile acids, preventing normal bile acid cycling, cannot be absorbed and is pooped out. Decreases LDL 15-30%, Increases HDL 3-5%, has no effect or raises TG!
Fibrates - ex. Gemfibrozil, fenofibrate. Increases expression of lipoprotein lipase gene and thus increases turnover of TG-rich VLDL. Decreases LDL 5-20%, increases HDL 10-20%, decreases TG 20-50%.

Front 2

This dyslipidemia drug lowers LDL by 18-55% and slightly raises HDL. Used as treatment for hypercholesterolemia and mixed type hyperlipidemias. Is considered relatively safe except side effects include: rash, GI disturbances, increase in serum transamiases (watch for hepatotoxicity), and potential rhabdomyolysis. Is CI in hepatic dz, preg/nursing.

A. Atorvastatin
B. Cholestyramine
C. Ezetimibe
D. Gemfibrozil
E. Niacin

Back 2

This describes an HMG CoA reductase inhibitor, which
A. Atorvastatin is.

Front 3

What is the SE/tox of HMG CoA reductase inhibitors (statins)? 4 SE, 2 CI.

Back 3

SE:
- rash
- GI
- increased serum transaminases so watch for hepatotixicity
- 10% myalgia so watch for rhabdomyolysis (reversible)

CI: hepatic dz, pregnant/ nursing

Front 4

This is the least expensive drug of the dyslipidemia drugs and is used for hypercholesterolemia, hyperTG, mixed type lipidemias, low HDL, and as an adjunct to further lower LDL. Has SE of flushing, increase in serum transaminases (watch for hepatotox), exacerbates peptic ulcer dz, hyperuricemia, increases fasting and postprandial glucose. Thus is CI in (5)....

A. Atorvastatin
B. Cholestyramine
C. Ezetimibe
D. Gemfibrozil
E. Niacin

Back 4

E. Niacin

CI: hepatic dz, diabetes, gout, peptic ulcer dz, pregnancy

Front 5

This dyslipidemia drug does NOT get absorbed systemically and is extremely safe and effective. SE are mainly GI (constipation, bloating, farting), and decreased absorbtion of fat soluble vitamins (ADEK) and some other drugs. Has unknown safety in preg/nursing. Patients hate the gritty taste. Do not use with which conditions?

A. Atorvastatin
B. Cholestyramine
C. Ezetimibe
D. Gemfibrozil
E. Niacin

Back 5

B. Cholestyramine , a binding resin. The other binding resin is colestipol.

Front 6

What are the SE and do NOT use with biel acid binding resins cholestyramine and colestipol?

Back 6

GI distress like constipation, bloating, farting. Decreased absorption of fat soluble vitamins (ADEK) and many drugs. Unknown safety in preg/ nursing. Patients hate gritty taste.

DO NOT USE WITH hyperTG, mixed type lipidemias as TG can increase in hyperTG!

Front 7

What is the MoA of Ezetimibe?

Back 7

Inhibits intestinal transporters required to absorb dietary cholesterol, thus decreases cholesterol delivery to liver. Works to decreases LDL and TG. No effect on HDL.

Front 8

What is the DOC for hyperTG?

Back 8

Fibrates like Gemfibrozil, fenofibrate! These increase the expression of lipoprotein lipase gene and increases turnover of TG-rich VLDL. SE: nausea, risk of gallstones. Posible rhabdomyolysis too (though fenofibrate is less likely). CI in renal dz, liver dz, fallbladder dz, preg/nursing

Front 9

Of the four groups of frontline dyslipidemia drugs: fibrates, niacin, resin, statins, put in order from most to least effective:
A. LDL-C lowering drugs
B. HDL-C increasing drugs
C. TG loewring drugs

Back 9

A. LDL-C: Statins (18-55%), Resins (15-30%), Niacin (5-25%), Fibrates (5-20%)
B. HDL-C: Niacin (15-35%), fibrates (10-20%), statins (5-15%), resins (3-5%)
C. TG lowering: fibrates (20-50%) = niacin (20-50%), statins (7-30%), resins (no effect or even increases!)

Front 10

Which dyslipidemia drugs have the possible SE of increased serum transaminases (thus watch for hepatotox) and potential rhabdomyolysis?

Back 10

Statins - CI: hepatic dz, preg/nursing

Fibrates - renal dz, liver dz, gallblader dz, preg/nursing

Front 11

Match the dyslipidemia drug to its CI.
1. hepatic dz, diabetes, gout, peptic ulcer dz, pregnancy
2. hepatic dz, preg/nursing
3. hepatic dz, renal dz, gallbladder dz, preg/nursing

Statins, Niacin, Fibrates

Back 11

1. hepatic dz, diabetes, gout, peptic ulcer dz, pregnancy = NIACIN
2. hepatic dz, preg/nursing = STATINS
3. hepatic dz, renal dz, gallbladder dz, preg/nursing = FIBRATES

Front 12

List the CI for
1. Statins (2)
2. Niacin (5)
3. Fibrates (4)

Back 12

1. Statins: hepatic dz, preg/nursing
2. Niacin: hepatic dz, diabetes, gout, peptic ulcer dz, pregnancy
3. Fibrates: hepatic dz, kidney dz, gallbladder dz, preg/nursing

Front 13

What is FIsh oil's MoA?

Back 13

Inhibits VLDL-TG synthesis. Thus, lowers TG.