Cardio: Drugs Used for Hyperlipidemia

Question 1

MOA of Statins (specifically for lipids)

Answer 1

Competitively block HMG-CoA reductase

-means less mevalonate made

Question 2

What else can statins do, besides lowering lipids?

Answer 2

Plaque Stabilization

Reduce Inflammation
-Decrease CRP

Reverse Endothelial Dysfxn
-increase NO and reduce LDL oxidation

Decrease Thrombogenicity
-reduce expression of TF on endothelial cells

Question 3

Indications of Statins?

Answer 3

CV disease-especially if hyperlipidemia

Question 4

Contrainidcations of Statins?

Answer 4

Active Hepatic disease
-statins can increase injury and LFTs

Pregnancy
-teratogenic

Question 5

Adverse effects of Statins?

Answer 5

Myopathy
-see an increase in CK

Diabetes (new onset)

Hepatotoxicity

Possible Neurologic effects (not serious)

Question 6

Do statins interact with other drugs?

Answer 6

Yes, they are metabolized by the CYP450 system (CYP3A4 or CYP2C9)
-drugs that interfere will increase/decrease levels

Question 7

What groups of people may require a dose reduction of statins?

Answer 7

Older people and East Asians

Question 8

Which statins drugs are metabolized by CYP3A4 and which are CYP2C9?

Answer 8

CYP3A4
-Atorvastatin, Simvastatin, Lovastatin

CYP2C9
-Fluvastatin

Question 9

MOA of Ezetimibe

Answer 9

Inhibits PC1L1 protein to impair dietary and biliary cholesterol absorption at brush boarder of the intestine
-decrease LDL

Question 10

If you are choosing a drug to add to Statins, what is first choice: ezetimibe or PCSK9 inhibitors?

Answer 10

Ezetimibe>PCSK9

Question 11

Indications for Ezetimibe?

Answer 11

Hyperlipidemia

-Familial (homozygous) or Acquired

Question 12

Contraindications of Ezetimibe?

Answer 12

Active Hepatic Disease/severe impairment in combo with statins
-Raise in AST/ALT

Pregnancy in combo with Statins

Question 13

Adverse effects of ezetimibe?

Answer 13

Most common: headache, runny nose, sore throat, some body aches

Question 14

What toxicity is associated with ezetimibe?

Answer 14

Skeletal muscle toxicity with concomitant use with statins

-especially if over 65, have hypothyroidism or renal impairment

Question 15

What are the PCSK9 inhibitors?

Answer 15

Alirocumab and Evolocumab

Question 16

MOA of the PCSK9 inhibitors?

Answer 16

Decrease the amount of LDL receptor degredation

-therefore more LDL is taken out of the circulation

Question 17

Does age, sex, amount of statins or presence of diabetes affect the effect of PCSK9 inhibitors?

Answer 17

No.

-page 11

Question 18

Indications for the PCSK9 inhibitors?

Answer 18

Pateitns with heterozygous FH or those with CVD due to hyperlipidemia

Question 19

Adverse effects of the PCSK9 inhibitors (both evolocumab and Alirocumab)?

Answer 19

Evolocumab
-runny nose, sore throat, cold/flu like symptoms

Alirocumab
-injection site reactions, muscle pain, eye-events

Question 20

MOA of Bile Acid Binding resins?

Answer 20

Bind and block the reuptake of bile acids to force liver to make more
-lowers the amount of LDL

Question 21

Indications of the Bile Acid Binding drugs?

Answer 21

Hypercholesterolemia

Question 22

Contraindications to Bile Acid Binding drugs/

Answer 22

Hypertriglyceridema (>400)
-cause increase in TGs

Dysbetalipoproteinemia

Decreased GI motility or SBO

Question 23

Which of the lipid lowering drugs can cause pancreatitis?

Answer 23

Bile Acid Binding drugs

-increase in triglycerides can cause pancreatitis

Question 24

Adverse effects of bile acid binding drugs?

Answer 24

GI upset
Elevated LFTs
Elevated Triglycerides
Fat Soluble vitamin def
-ADEK

Question 25

What metabolic disorder should you be cognizant of when prescribing the bile acid binding drugs?

Answer 25

Phenylketonuria | -each packet of Colesevelam contains Phenylalanine

Question 26

MOA of Fibrates

Answer 26

Bind and activate PPARa | -increases metabolism of TGs and increase production of HDL

Question 27

What are the indications for the fibrates?

Answer 27

Dyslipidemia | Hypertriglyceridemia

Question 28

What drugs are fibrates?

Answer 28

Fenofibrate Fenofibric Acid Ge fibrozil

Question 29

Contraindications of the fibrates?

Answer 29

Severe Kidney disease (increase Creatinine) Active liver disease Gallbladder disease Nursing Mothers

Question 30

Should fibrates be taken with statins?

Answer 30

No! Increases the amount of muscle toxicity

Question 31

Other Adverse effects of fibrates?

Answer 31

Increase AST, ALT, CPK, and rhinitis GALLSTONES**

Question 32

Are fibrates safe for nursing mothers?

Answer 32

Nope, as they appear in breast milk

Question 33

MOA of Niacin

Answer 33

Not completely understood.. -Reduces cholesterol and TG, increases HDL May increase LPL and release of FFA

Question 34

Indications for Niacin drugs?

Answer 34

Reduce total and LDL cholesterol | -can also reduce risk of recurrent nonfatal MI

Question 35

Contraindications of niacin?

Answer 35

Liver diease Active Peptic Ulcers Arterial bleeding

Question 36

Adverse effects of Niacin?

Answer 36

Flushing -give with NSAIDs Increase Blood sugar -diabetics Increase uric acid -gout! Increase AST/ALT Increase Muscle toxicity (CK)

Question 37

What diseases should niacin not be used in?

Answer 37

``` Diabetics Liver disease Gout Kidney Disease PUD ```

Question 38

Does niacin prolong coagulation?

Answer 38

Has been shown to prolong PT

Question 39

What drugs does niacin interact with?

Answer 39

Bile Acid binders Statins Vitamins can potentiate side effects

Question 40

What should you do with Warfarin in a patient taking statins?

Answer 40

May have to decrease the dose

Question 41

What drugs are niacin?

Answer 41

Niacor: oral Niaspan: oral-exended release tablet