Cholesterol lowering medications

Question 1

What type of drug is Atorvastatin

Answer 1

HMG-CoA reductase inhibitor

Question 2

How does Atorvastatin work?

Answer 2

competitively inhibit conversion of HMG-CoA to
mevalonate–>increase in LDL receptors, which bind and remove circulating LDL-cholesterol,

Question 3

When do you not use Atorvastatin?

Answer 3

breastfeeding, active liver disease

Question 4

What are the side effects of Atorvastatin?

Answer 4

Myopathy(muscle weakness)
Diarrhea
Rhabdomyolysis(muscle pain)
Hepatotoxicity

Question 5

Pneumonic to remember statins:

Answer 5

statins are HMG-CoA:

H: Hepatotoxicity
M: Myopathy
G: GI Side Effects (Diarrhea)
C: CPK Increase

A: Avoid in Breastfeeding

Question 6

What type of drug is ezetimibe?

Answer 6

cholesterol absorption inhibitor

Question 7

What is the brand name of ezetimibe?

Answer 7

Zetia

Question 8

How does ezetimibe work?

Answer 8

Inhibits absorption of cholesterol at the brush border of the small intestine

decreases total Cholesterol, LDL-cholesterol (LDL-C), ApoB, and triglycerides (TG) while increasing HDL-cholesterol (HDL-C).

Question 9

When should ezetimibe not be used?

Answer 9

Breastfeeding
Active liver disease

Question 10

What side effects can ezetimibe cause?

Answer 10

Rhabdomyolysis
Hepatotoxicity

Question 11

What type of drug is colesevelam?

Answer 11

Bile acid sequestrant

Question 12

What is the brand name of colesevelam?

Answer 12

Welchol

Wel= think “Well” (take with liquid); Chol = think “cholesterol”

Question 13

How does colesevelam work?

Answer 13

binds with bile acids in the intestine to form an insoluble complex that is eliminated in feces.

Question 14

When do you not want to use colesevelam?

Answer 14

History of bowel obstruction
Triglycerides > 500 mg/dL
Hypertriglyceridemia induced pancreatitis

Question 15

What are the side effects of using colesevelam?

Answer 15

• Constipation
• Pancreatitis
• Bowel obstruction

Question 16

What are the counseling points of using colesevelam?

Answer 16

This medication is used to lower cholesterol levels
* Take with food
* Packet/granules: Mix with 120-240 mL of water
* Tablets: Swallow with liquid

Question 17

What type of drug is fenofibrate?

Answer 17

Fibric acid derivative

Question 18

What is the brand name of fenofibrate?

Answer 18

Antara, Fenoglide

Question 19

How does fenofibrate work?

Answer 19

activate peroxisome proliferator-activated receptor α
(PPARα), which increases lipolysis and elimination of triglyceride-rich particles from plasma

Result: decrease in triglycerides–> alteration in the size and composition of LDL from small, dense particles to large buoyant particles.

    - These larger particles have a greater affinity for 
        cholesterol receptors and are catabolized rapidly.

Question 20

When do you not use fenofibrate?

Answer 20

Gallbladder disease

Question 21

What side effects does fenofibrate cause?

Answer 21

Increased transaminases
Hepatotoxicity
Rhabdomyolysis (especially in combination with a statin)

Question 22

What are the counseling points for fenofibrate?

Answer 22

This is used to lower bad cholesterol (LDL, TG) and raise good cholesterol (HDL)

This medication comes in many formulations. Some require administration with food (Fenoglide)

Question 23

What type of drug is Niacin?

Answer 23

Antilipemic

Question 24

When do you not use Niacin?

Answer 24

Severe hepatic dysfunction
Peptic ulcer disease

Question 25

What side effects can Niacin cause?

Answer 25

Flushing Headache Hepatotoxicity Rhabdomyolysis *Note: Must slowly titrate to target dose. May be attenuated by giving with food, avoiding alcohol and spicy foods, or taking aspirin 30 minutes before administration

Question 26

What are the counseling points for Niacin?

Answer 26

* This medication is used to lower cholesterol levels * You will start at a low dose and slowly increase over time to decrease side effects * To decrease flushing, avoid alcohol and spicy foods while taking this medication

Question 27

What type of drugs are Omega 3 Ethyl esters?

Answer 27

Omega 3

Question 28

What is the brand name of Omega 3 Ethyl esters?

Answer 28

Lovaza

Question 29

How do Omega 3 Ethyl Esters work?

Answer 29

Reduction in the hepatic production of triglyceride-rich very low-density lipoproteins.

Question 30

When would you not use Omega 3 Ethyl Esters?

Answer 30

Hypersensitivity to drug, fish, or shellfish

Question 31

What side effects can Omega 3 Ethyl Esters cause?

Answer 31

Diarrhea “Fishy” breath, burping, change in taste Elevated LFTs

Question 32

What are the counseling points for Omega 3 Ethyl Esters?

Answer 32

This is used to lower bad cholesterol (LDL, TG) Take with food