Dyslipidemia

Question 1

Atorvastatin

Answer 1

HMG-CoA reductase inhibitor
Uses: hyperlipidemia, prophylactic for CAD, acute coronary syndrome
Admin: oral
Toxicity: myopathy, hepatic dysfunction, teratogen
Slow onset, long duration, effective at night

Question 2

Evolocumab

Answer 2

PCSK9 inhibitor (inhibits protease that degrades hepatocyte LDL receptors)
Uses: hyperlipidemia, prophylactic for CAD, acute coronary syndrome
Admin: IV injection
Toxicity: pain-related (muscle, back), nausea, neurocognitive events
Monoclonal anti-PCSK9 antibody, lowers serum LDL by ~60% over 12 weeks ($$$)

Question 3

Gemfibrozil

Answer 3

Peroxisome proliferator-activated receptor (PPAR-alpha) agonist (increase synthesis of proteins that break down free fatty acids)
Uses: hypertriglyceridemia, dysbetalipoproteinemia
Toxicity: myopathy, hepatic dysfunction
Used with statins for maximal efficacy

Question 4

Colestipol

Answer 4

Bile acid binding resin
Uses: primary hypercholesterolemia, elevated LDL
Toxicity: GI effects, constipation, diarrhea, flatulence, bloating
Use with statins for maximal efficacy, prevents absorption of other drugs

Question 5

Ezetimibe

Answer 5

Cholesterol transporter NPC1L1 inhibitor (block cholesterol transport, increase LDL receptors on hepatocytes to decrease plasma LDL levels)
Uses: primary hypercholesterolemia, elevated LDL
Toxicity: diarrhea, hepatic dysfunction
Use with statins for maximal efficacy

Question 6

Niacin

Answer 6

Diacylglycerol acyl transferase 2 inhibitor (decrease TG synthesis, LDL, and HDL breakdown), GPCR 109A agonist (inhibits lipolysis)
Uses: primary hyperlipidemias, elevated LDL/VLDL
Toxicity: flushing, hyperuricemia, pruritis
Use with statins or bile acid binding resin for maximal efficacy