Dyslipidemia

Question 1

What is the MOA for statins?

Answer 1

They inhibit HMG-CoA reductase, a vital step in cholesterol synthesis. The liver then increases cholesterol uptake by increasing the number of LDL receptors

Question 2

Statin: indications?

Answer 2

First-line therapy for primary and secondary prevention of ASCVD
Familial hypercholesterolemia

Question 3

Statin: contraindications?

Answer 3

Active liver disease, pregnancy (cat. X), breast feeding

Question 4

Statin: side effects?

Answer 4

Myopathy, increase in liver enzymes, nausea, ha

Question 5

Statin: onset?

Answer 5

Varies, peak effect in a few weeks

Question 6

Statin: interactions?

Answer 6

Red yeast rice (redundant), Niacin, alcohol, grapefruit, st. john’s wort, sweet orange

Question 7

Ezetimibe: MOA?

Answer 7

Prevents absorption of dietary and biliary cholesterol

Question 8

Ezetimibe: indications?

Answer 8

Adjunctive therapy in homozygous familial hypercholesterolemia and primary hyperlipidemia
Typically used when statin intolerant

Question 9

Ezetimibe: contraindications?

Answer 9

Pregnancy (cat. C) or breast feeding

Question 10

Ezetimibe: side effects?

Answer 10

Increase in liver enzymes

Question 11

Ezetimibe: metabolism?

Answer 11

~30% undergoes glucuronide conjugation in the SI and liver

Question 12

Ezetimibe: interactions

Answer 12

It would lower effectiveness of green tea, O3FA, sitostanol and beta-sitosterol

Question 13

Fibrates: MOA?

Answer 13

Lower production and increased clearance of VLDL
Increased HDL production
Lowers TG

Question 14

Fibrates: indications?

Answer 14

Hypercholesterolemia or mixed dyslipidemia as adjunct therapy or monotherapy in pts who can’t tolerate statins
Hypertriglyceridemia first-line pharmacotherapy

Question 15

Fibrates: contraindications?

Answer 15

Active liver disease, severe renal impairment or ESRD and pre-existing GB disease, and breast feeding

Question 16

Fibrates: side effects?

Answer 16

Dyspepsia, gallstones, myopathy (increased risk with statins)

Question 17

Fibrates: interactions?

Answer 17

Red yeast rice, niacin, alcohol

Question 18

Gemfibrozil increases risk for what side effect when used with statin therapy? and how can we assess severity of this effect?

Answer 18

Myopathy

CK

Question 19

Niacin: MOA?

Answer 19

Unclear, but..it increases lipoprotein lipase activity, enhancing removal of triglycerides from plasma.
Reduces TG synthesis
Increases HDL-C levels

Question 20

Niacin: indications?

Answer 20

Hypercholesterolemia or mixed dyslipidemia as adjunct therapy for pts who do not tolerate fibrates or O3FA, or as monotherapy for pts who do not tolerate statins, BAS, or fibrates
Hypertriglyceridemia second-line pharmacotherapy

Question 21

Niacin: contraindications?

Answer 21

Active liver disease, gout, peptic ulcer disease

Question 22

Niacin: side effects?

Answer 22

Hepatotoxicity, hyperglycemia, hyperuricemia, upper GI distress, flushing itching

Question 23

Niacin: interactions?

Answer 23

Red yeast rice, alcohol

Question 24

Niacin causes flushing, the extended release form has less flushing as a side effect. However, it is not used very often because of an increased risk for what major side effect?

Answer 24

Hepatotoxicity > Acute necrosis

Question 25

Omega-3 fatty acids: MOA?

Answer 25

``` Inhibits the release of FA from adipose tissue. Inhibits beta oxidation of hepatic FA. Inhibits FA synthesis Increases VLDL clearance Lowers TG and increases HDL ```

Question 26

Omega-3 fatty acids: indications?

Answer 26

Hypertriglyceridemia second-line pharmacotherapy

Question 27

Omega-3 fatty acids: contraindications?

Answer 27

Hypersensitivity to fish oil

Question 28

Omega-3 fatty acids: side effects?

Answer 28

Eructation, nausea, dyspepsia, taste changes, and may increase bleeding time.

Question 29

Bile Acid Sequestrants (BAS): MOA?

Answer 29

Resins bind bile acid in the intestine. This reduces enterohepatic recycling. Increases hepatic conversion of cholesterol to bile acid. Up regulates LDL receptors on the liver

Question 30

Bile Acid Sequestrants (BAS): indications?

Answer 30

Hypercholesterolemia for high risk patient who are statin-intolerant or are on maximal tolerated doses of statins

Question 31

Bile Acid Sequestrants (BAS): contraindications?

Answer 31

TG > 300 mg/dL | complete biliary obstruction

Question 32

Bile Acid Sequestrants (BAS): side effects?

Answer 32

Constipation, abdominal discomfort, intestinal gas, dyspepsia, heartburn, diarrhea

Question 33

BAS and ezetimibe both work in the intestine to lower absorption of cholesterol. What change occurs in the liver to lower LDL?

Answer 33

Increase in LDL receptors

Question 34

Bile Acid Sequestrants (BAS): interactions?

Answer 34

Niacin absorption may be hindered