Anti-hyperlipedemic Flashcards
(5 cards)
Statins
- Longer half lives and greater lipid lowering effects?
- MOA
- What benefit?
- Side effects
- Most hydrophobic ones? Means?
- Fewest drug-drug interactions?Bc
- Contrarx, special dosing
- High: Atorvastatin, Rosuvastatin
- Med: Prava, Lova, Simva, Fluva, Pita
- MOA: competitive inhibitor of HMG-CoA reductase –> reduced synth of cholesterol
- Mortality benefit
SE:
- Elevated liver enzymes, myalgias, rarer rhabdo
Most hydrophob: Atorva, Simva; Least: Rosuva, Prava –> means greater muscle intake –> greater side effects
Fewest interx: Rosuva and Prava, bc metabolized by CYP2C9 rather than CYP3A4
Contrarx: Pregnancy; pts with renal or hepatic insufficiency and Asians require special dosing
Fibrates
- MOA
- Main effects
- Adverse effects
Fenofibrate, Gemfibrozil, Clofibrate
- MOA: increases peripheral lipolysis by upregulating lipoprotein lipase and decreases hepatic triglyceride production
- Main effects: Decreases TG alot, Increase HDL, no effect on LDL
- ADE: Gallstones, GI upset, abnormal liver enzymes, myositis
Niacin
- MOA
- Main effects
- ADE
- Contraindx
MOA: inhibits apolipoprotein B synth –> decreased VLDL and triglycerides synthesis and secretion by liver
Main effects: Decrease LDL, Increase HDL
ADE: flushing (arachidonic acid pathway –> increased prostaglandin2 / aspirin/NSAIDs can reduce), liver toxicity, itching, activation of peptic ulcer, hyperglycemia and reduced insulin sensitivity
Contraindx: peptic ulcer, liver disease
Bile acid sequestrants
- MOA
- Main effect
- ADE
Cholestyramine, colesevelam, colestipol
- Bind bile salts and stay in intestinal lumen –> decreased bile absoprtion and increased excretion –> increased bile synthesis from cholesterol
- Main effect: Decrease LDL, esp with a statin
- ADE: GI intolerance (bloating, ab pain, constipation), binds negatively charged drugs and fat soluble vitamins (should take 1-2 hours after or 4-6 before other drugs)
Cholesterol absorption inhibitor
- MOA
- Main effect
- ADE
Ezetimibe
- Block enterocyte chylomicron receptor –> inhibit intestinal cholesterol absorption
- Main effect: Decrease LDL esp with statin
- ADE: foul smelling stool
