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Pharm > Lipid Lowering Meds > Flashcards

Lipid Lowering Meds Flashcards

1
Q

List the secondary causes of hyperlipidemia:

A
  • increased fat intake
  • obesity
  • type 2 DM
  • age
  • hypothyroidism
  • obstructive liver dz
  • drugs (glucocorticoids, birth control)
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2
Q

Untreated hyperlipidemia leads to (2 things):

A

1) acute pancreatitis (hypertriglycerides)
2) atherosclerosis (hypercholesteremia)

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3
Q

What macrovascular complications can occur with atherosclerosis?

A
  • unstable angina
  • MI
  • ischemia cerebrovascular disease
  • CAD
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4
Q

What microvascular complications can occur with atherosclerosis?

A
  • retinopathy
  • nephropathy
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5
Q

Define lipoprotein

A

macromolecular lipid protein complexes that transport lipids to and from the peripheral tissues

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6
Q

How are lipid / protein portions related?

A

inversely

high protein + low lipid
low protein + high lipid

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7
Q

List the 5 classifications of lipoproteins

A
  • chylomicrons
  • very-low density lipoproteins (VLDL)
  • intermediate-density lipoproteins (IDL)
  • low-density lipoproteins (LDL)
  • high-density lipoproteins (HDL)
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8
Q

List the types of lipoproteins from high lipid to low lipid:

A

(Charles the V Is a Loose Hoe)
chylomicrons
VLDL
IDL
LDL
HDL

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9
Q

What is the optimal value of each of the lipoproteins?

A

LDL < 100 mg/dL
TG < 150 mg/dL
Cholesterol < 200 mg/dL
HDL > 60 mg/dL

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10
Q

Statins are isolated from a strain of which microorganism?

A

aspergillus terrus

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11
Q

Which statins fall under natural, semi-synthetic, and synthetic groups?

A

natural: Lovastatin
semi-synthetic: Simvastatin, Pravastatin
synthetic: Atorvastatin, Fluvastatin, Rosuvastatin

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12
Q

Statins are structurally similar to an enzyme in the body. What is the enzyme and what effect do statins have?

A
  • structurally related to HMG-CoA
  • statins competitively inhibit the enzyme causing an increase in hepatic LDL-Receptor
  • the result is a 20-60% decrease in LDL and 10% increase in HDL concentration
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13
Q

What drug class is most effective at reducing LDL?

A

statins

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14
Q

What is one absolute contraindication to statins?

A

pregnancy

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15
Q

What 2 statins are prodrugs?

A

Lovastatin
Simvastatin

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16
Q

Most statins undergo metabolism by _____. (except one…)

A

hepatic P450 enzymes
(not Pravastatin)

17
Q

What are some side effects of statins?

A
  • skeletal muscle issues (myalgias –> rhabdo)
  • liver enzyme change (incr plasma aminotransferase)
  • **drug interactions (3A4 inhibitors; coumadin, abx)
  • GI upset
  • fatigue
  • headache
18
Q

What is the MOA of bile acid resins?

A
  • increase hepatic bile acid synthesis from cholesterol stores
  • increase LDL-R and update of LDL from blood
19
Q

A patient with increased LDL but normal TG would likely be prescribed what drug class?

A

bile acid resins
(Colesevelam, Cholestyramine, Colestipol)

20
Q

How are bile acid resins given? What is the primary side effect?

A
  • PO powder with no systemic absorption
  • no other meds 1 hr pre- or 4 hrs post-admin
  • major SE = constipation
21
Q

What is another name for Niacin?

A

Nicotinic Acid

22
Q

What is the MOA of Niacin?

A
  • inhibits VLDL synthesis
  • inhibits release of FFA from adipose
  • increases activity of lipoprotein lipase
23
Q

Which lipid lowering med is most effective at increasing HDL? What else does this drug do?

A

Niacin
- also lowers LDL and TG

24
Q

Side effects of Niacin:

A
  • flushing
  • pruritis
  • GI upset
  • hepatic dysfxn
  • hyperglycemia
  • gout
  • drug interactions (statins)
25
Q

Which lipid lowering medication should be avoided in liver patients? Why?

A

Niacin
- extensive first pass hepatic metabolism

26
Q

What is the MOA of Fibrates?

A

increased activity of lipoprotein lipase

27
Q

Which lipid lowering med is most effective at decreasing TG? What else does this drug do?

A

Fibrates (50% lowered)
- also increase HDL

28
Q

Side effects of Fibrates:

A
  • GI upset
  • HA
  • gallstones
  • statin interactions (worse muscle pain)
  • prolonged PTT (displaces Coumadin)
29
Q

What is the MOA of Ezetimibe?

A

selective inhibitor of cholesterol absorption leading to secondary up-regulation of LDL-R

30
Q

Which drug potentiates the effects of statins?

A

Ezetimibe (17%)

Pharm (19 decks)

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