Flashcards in Dyslipidemia Deck (34)
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1
What is the MOA for statins?
They inhibit HMG-CoA reductase, a vital step in cholesterol synthesis. The liver then increases cholesterol uptake by increasing the number of LDL receptors
2
Statin: indications?
First-line therapy for primary and secondary prevention of ASCVD
Familial hypercholesterolemia
3
Statin: contraindications?
Active liver disease, pregnancy (cat. X), breast feeding
4
Statin: side effects?
Myopathy, increase in liver enzymes, nausea, ha
5
Statin: onset?
Varies, peak effect in a few weeks
6
Statin: interactions?
Red yeast rice (redundant), Niacin, alcohol, grapefruit, st. john's wort, sweet orange
7
Ezetimibe: MOA?
Prevents absorption of dietary and biliary cholesterol
8
Ezetimibe: indications?
Adjunctive therapy in homozygous familial hypercholesterolemia and primary hyperlipidemia
Typically used when statin intolerant
9
Ezetimibe: contraindications?
Pregnancy (cat. C) or breast feeding
10
Ezetimibe: side effects?
Increase in liver enzymes
11
Ezetimibe: metabolism?
~30% undergoes glucuronide conjugation in the SI and liver
12
Ezetimibe: interactions
It would lower effectiveness of green tea, O3FA, sitostanol and beta-sitosterol
13
Fibrates: MOA?
Lower production and increased clearance of VLDL
Increased HDL production
Lowers TG
14
Fibrates: indications?
Hypercholesterolemia or mixed dyslipidemia as adjunct therapy or monotherapy in pts who can't tolerate statins
Hypertriglyceridemia first-line pharmacotherapy
15
Fibrates: contraindications?
Active liver disease, severe renal impairment or ESRD and pre-existing GB disease, and breast feeding
16
Fibrates: side effects?
Dyspepsia, gallstones, myopathy (increased risk with statins)
17
Fibrates: interactions?
Red yeast rice, niacin, alcohol
18
Gemfibrozil increases risk for what side effect when used with statin therapy? and how can we assess severity of this effect?
Myopathy
CK
19
Niacin: MOA?
Unclear, but..it increases lipoprotein lipase activity, enhancing removal of triglycerides from plasma.
Reduces TG synthesis
Increases HDL-C levels
20
Niacin: indications?
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
21
Niacin: contraindications?
Active liver disease, gout, peptic ulcer disease
22
Niacin: side effects?
Hepatotoxicity, hyperglycemia, hyperuricemia, upper GI distress, flushing itching
23
Niacin: interactions?
Red yeast rice, alcohol
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?
Hepatotoxicity > Acute necrosis
25
Omega-3 fatty acids: MOA?
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
26
Omega-3 fatty acids: indications?
Hypertriglyceridemia second-line pharmacotherapy
27
Omega-3 fatty acids: contraindications?
Hypersensitivity to fish oil
28
Omega-3 fatty acids: side effects?
Eructation, nausea, dyspepsia, taste changes, and may increase bleeding time.
29
Bile Acid Sequestrants (BAS): MOA?
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
30
Bile Acid Sequestrants (BAS): indications?
Hypercholesterolemia for high risk patient who are statin-intolerant or are on maximal tolerated doses of statins
31
Bile Acid Sequestrants (BAS): contraindications?
TG > 300 mg/dL
complete biliary obstruction
32
Bile Acid Sequestrants (BAS): side effects?
Constipation, abdominal discomfort, intestinal gas, dyspepsia, heartburn, diarrhea
33
BAS and ezetimibe both work in the intestine to lower absorption of cholesterol. What change occurs in the liver to lower LDL?
Increase in LDL receptors
34
