Anti- Hyperlipidemics

Question 1

Statins are (A) inhibitors, and are used as the (B) line drugs against (C)

Answer 1

A: HMG-CoA reductase
B: 1st line!
C: primary AND secondary ASCVD

Question 2

The most potent statin is…

Answer 2

atorvastatin

Question 3

inhibiting HMG-CoA reductase accomplishes what?

Answer 3

induces expression of LDL receptors which increases LDL removal by inhibiting the synthesis of reductase which breaks down LDL receptors

Question 4

Statins can be combined with (A) or (B) if they are not effective alone

Answer 4

resins or exetimibe

Question 5

AE of statins

Answer 5

Myopathy & Rhabdomyolysis

What if myopathy results? Switch to another statin!

Question 6

Statins are contraindicated in which women?

Answer 6

pregnant or lactating

Question 7

statins are metabolized by which enzymes?

Answer 7

CYP3A4 and CYP2C9

Question 8

Bile acid sequestrants are also know as (A) and start with/contain (B)

Answer 8

A-Resins

B- cole/chole

Question 9

Resins are indicated for what uses? are they safe in pregnancy

Answer 9

• Primary & secondary ASCVD
• Antitoxic for cardiac glycosides
• Hyperlipidemia in pregnant women
• Bile-malabsorption-caused diarrhea

Question 10

resin/bile sequestrant MOA

Answer 10

increase bile acid excretion

induce LDL receptors

Question 11

Resins are (A) tolerated. should be avoided in patients with (B) or (C)

Answer 11

A- Well tolerated
B-diverticulitis bc can cause constipation
C- high VLDL bc can increase VLDL

Question 12

Ezetimibe inhibits (A) absorption by inhibiting (B) and reducing hepatic (C) receptors

Answer 12

A- sterol
B- NPC1L1
C-LDL

Question 13

Ezetimibe can replace (A) if patients have too many side effects… ie (B)

Answer 13

can replace statins, if patients experience myopathy etc

Question 14

If statins are at max dosing, you can give injectable (A) inhibitors like (B)

Answer 14

A- PCSK9 inhibitors

B- alirocumab*(praluent)

Question 15

PCSK9 inhibitors work by …

Answer 15

inhibiting PCKS9 inhibits the body’s natural inhibitor of LDL receptors.. making more LDL receptors available for LDL removal

Question 16

PCSK9 inhibitors are especially useful in which inherited disorders?

Answer 16

Adjunctive therapy, especially for those with heterozygous or homozygous familial hypercholesterolemia

Question 17

Fibrates are indicated in …

Answer 17

hyperTRIGLYCeridemia

1st LINE

Question 18

Fibrates lower (A) by increasing (B) and decreasing (C). They increase (D) by increasing the synthesis of (E)

Answer 18

A) Lower VLDL
by increasing B) LPL expression and decreasing C) liver secretion

D) increase HDL by increasing E) synthesis of apo-a1

Question 19

Fenofibrate is toxic to …

Answer 19

Kidneys

Question 20

which fibrate, especially, should not be used with statins? why?

Answer 20

Adverse Effects: If used with a stain, myopathy and rhabdomyolysis are more likely (Gemfibrozil especially)

Question 21

contraindications for fibrates?

Answer 21

Contraindications:

• Gallstones become more likely with use, don’t use if Hx of biliary tract disease
• Avoid in pts with hepatic or renal dysfunction

Question 22

Nicotinic acid is used to treat A and B

Answer 22

Hypercholesterolemia (combine with Statin or resin)

Hypertriglyceridemia

Question 23

Niacin will increase A/B and decrease C/D

Answer 23

increase: HDL, tPA
decrease: VLDL/LDL/Lpa

Question 24

Niacin should be combined with A or B for treating hypercholesterolemia

Answer 24

Statins or resin (bile acid sequestrants)

Question 25

niacin should not be used in patients with (A) dysfunction or active (B)

Answer 25

hepatic dysfunction or active PUD

Question 26

AE of niacin

Answer 26

Adverse Effects: Flush – due to vasodilation/prostaglandins Dyspepsia Liver dysfunction at high doses

Question 27

Summary

Answer 27

``` Hypercholesterolemia: statins ezetimibe -coles /resins/bile seques PCSK9 ApoB antisense ``` Hypertriglyc: fibrates BOTH niacin