Deja review Cardio/Renal agents - Antihyperlipidemic agents

Question 1

What is the MOA of the “statin” class of antihyperlipidemics?

Answer 1

Inhibition of hydroxymethylgltaryl coenzyme A (HMG-CoA) reductase (rate limiting step of cholesterol biosynthesis), thus inhibiting the intracellular supply of cholesterol, INC number of cells surface low density lipoproteins (LDL) receptors which further reduces plasma cholesterol levels via INC metabolism

Question 2

How do statins affect the lipid profile?

Answer 2

Mainly reduces LDL, moderate reduction of triglycerides (TGs), moderate elevation of high-density lipoproteins (HDL)

Question 3

Give examples of medications in the statin drug class

Answer 3

Atorvastatin, rosuvastatin, simvastatin, pravastatin, lovastatin, fluvastatin

Question 4

What are the adverse effects of statin drugs?

Answer 4

INC liver function tests (LFTs), dose-dependent rhabdomyolysis, myalgia and myopathy, diarrhea, drug induced lupus, drug-drug interactions, contraindicated in pregnancy (category X)

Question 5

What lab tests should be used to monitor for statin toxicity?

Answer 5

LFTs, creatine phosphokinase (CPK)

Question 6

What is the most potent antihyperlipidemic agent to elevate high density lipoprotein (HDL)?

Answer 6

Niacin

Question 7

Niacin is also known as what?

Answer 7

Vitamin B3, nicotinic acid

Question 8

What is the MOC of niacin?

Answer 8

High dose niacin inhibits very low density lipoprotein (VLDL) and apoprotein synthesis in hepatocytes, INC tissue plasminogen activator (tPA), DEC fibrinogen

Question 9

How does niacin affect the lipid profile?

Answer 9

Elevation of HDL, reduction of LDL, reduction of VLDL, reduction of TGs

Question 10

What are the adverse effects of niacin?

Answer 10

Facial flushing, hyperuricemia, hyperglycemia, hepatotoxicity, pruritus, nausea, abdominal pain

Question 11

How is facil flushing counteracted in patients on niacin therapy?

Answer 11

Pretreatment with aspirin to counteract the prostaglandin release

Question 12

What new antihyperlipidemic agent works by inhibiting absorption of cholesterol at the brush border in the small intestine?

Answer 12

Ezetimibe

Question 13

What are the adverse effects of Ezetimibe?

Answer 13

Diarrhea, abdominal pain, headache, arthralgias

Question 14

Which antihyperlipidemic drug class DEC VLDL, LDL, TGs and INC HDL by activating lipoprotein lipase?

Answer 14

Fibrates

Question 15

Give examples of medications in the fibrate drug class

Answer 15

Gemfibrozil, clofibrate, fenofibrate

Question 16

What is the major effect that fibrates have on the lipid profile

Answer 16

Reduction of TGs

Question 17

What are the adverse effects of gemfibrozil?

Answer 17

Cholelithiasis, nausea, diarrhea, abdominal pain, myositis, hypokalemia, INC levels of warfarina dn sulfonylureas via protein-binding displacement

Question 18

What is the MOC of bile acid sequestrants?

Answer 18

Anion exchange resins that bind bile acids/salts in the small intestine, thus preventing their reabsorption, DEC bile acids results in INC plasma cholesterol uptake by hepatocytes to replenish bile acid levels, thus DEC plasma LDL levels

Question 19

Give examples of bile acid sequestratns

Answer 19

Cholestyramine, colestipol, colesevelam

Question 20

What are the adverse effects of bile acid sequestrants?

Answer 20

Constipation, bloating, flatulence, nausea, impaired absorption of fat soluble vitamins, imparied absorption of warfarin, digoxin, acetyl salcylic acid (ASA), tetracycline (TCN), thiazide diuretics

Question 21

What over the counter medication, naturally found in certain fish, can DEC TG levels and be useful in the prevention of coronary heart disease (CHD)?

Answer 21

Omega 3 fatty acids