Hyperlipidemias

Question 1

Name the HMG COA Reductase Inhibitors

Answer 1

End in -statin

Question 2

Name the Fibrates

Answer 2

Gemfibrozil

Fenofibrate

Question 3

Name the Bile Acid Sequestrants

Answer 3

Cholestyramine
Colesevelam
Colestipol

Question 4

Name the Cholesterol Absorption Inhibitors

Answer 4

Ezetimibe

Question 5

Niacin

Answer 5

Used to decrease hyperlipidemia

Question 6

Name the Omega 3 Fatty Acids

Answer 6

Docosahexaenoic Acid

Eicosapentaenioc Acid

Question 7

Hyperlipidemia

Answer 7

Elevation in lipoproteins

Question 8

5 types of lipoproteins

Answer 8

Chylomicrons
VLDL
LDL
IDL
HDL

Question 9

Lipoproteins

Answer 9

Transport cholesterol and triglycerides because they can’t dissolve in blood.

Question 10

Chylomicrons

Answer 10

Transport dietary lipids (cholesterol and triglycerides) from intestine to liver.
Can deposit triglycerides in organs and body as travels to liver.

Question 11

VLDLs

Answer 11

Made in liver and transport triglycerides (TG) to tissues.

Once TG are removed and it’s only Cholesterol, becomes LDL

Question 12

LDLs

Answer 12

Transports cholesterol (C) to tissues 
Deposits C in artery wall forming an atheroma. (Atherosclerosis)
Return to liver after done circulating

Question 13

HDLs

Answer 13

Made by liver and intestine
Picks up cholesterol in body and takes it to the liver
Cleans up atheromas

Question 14

Results of Hyperlipidemia

Answer 14

Acute Pancreatitis
Atherosclerosis
-Leading cause of death for males and females in US
-Correlated with high LDL and low HDL
-High cholesterol can be caused by lifestyle AND genetics

Question 15

Type 1 (Familial Hyperchylomicronemia)

Answer 15

Increased chylomicron level
No effective drug tx
Only diet therapy

Question 16

Treatment goals for hyperlipidemia

Answer 16

Less than 200 Total Cholesterol
Less than 130 LDL
Greater than 60 HDl

Question 17

Treatment options for hypercholesterolemia

Answer 17

If moderate hyperlipidemia: changes in diet, exercise and weight reduction
LDL>160 plus additional risk factor: Drug therapy
If 2 or more risk factors, tx is aggressive. May need to get LDL as low as 70.

Question 18

Treatment options for hypertriacylglycerolemia

Answer 18

Diet and exercise

Niacin and fibrates are most effective drugs to decrease triglyceride levels

Question 19

MOA of HMG CoA Reductase Inhibitors

Answer 19

Analog of HMG
Competes for the HMG CoA reductase, inhibiting cholesterol synthesis.
Lower cholesterol levels in liver causes an increase in LDL receptors to take in more LDL from blood
Prevents release of VLDL

Question 20

MOA of Niacin (Nictotinic acid)

Answer 20

Increases HDL levels
Inhibits lipolysis in adipose tissues (reduces circulating triglycerides)
Increases secretion of tissues plasminogen activator and decreases plasma fibrinogen levels (helps reverse endothelial damage and platelet cascade)

Question 21

Fibrates

Answer 21

Increases genetic expression of lipoproteins.
Results in lowered trigylceride (TG) concentration and increased HDL levels

Used to treat high TG levels

Question 22

MOA of Bile Acid Sequestrates

Bile Acid-Binding Resins

Answer 22

Binds to bile in the intestines and prevents from being reabsorbed. (The liver needs cholesterol to make bile)
Since it can’t recycle the bile, it uses more cholesterol to make more. LDL receptors are increased and cholesterol is taken in from the plasma. Doesn’t work if homozygous for type IIA (familial hypercholesterolemia) since no LDL receptors

Question 23

Cholesterol Absorption Inhibitor

Answer 23

Ezetimibe
Inhibits absorption of cholesterol from diet.
Liver will use stores, produce C and take up from blood.
Very long half life (22 hours) so can’t use if liver problems

Question 24

Therapeutic Uses and Adverse Effects of HMG CoA Reductase Inhibitor

Answer 24

Not as effective for those homozygous for familial hypercholesterolemia since they don’t have LDL receptors
Excreted by bile and feces so kidney issues aren’t a problem. Adverse Effects:
Dissolution of muscle (rare)
Can’t use for pregnant, kids or teens

Question 25

Therapeutic Uses and Adverse Effects of Niacin

Answer 25

Used often in combo with statins, 1 decreases LDL and 1 raises HDL Adverse Effects: "niacin flush" can be decreased with aspirin gout

Question 26

Therapeutic Uses and Adverse Effects of Bile Acid Sequestrates (Bile Acid-Binding Resins)

Answer 26

**cholestyramine can be used to tx biliary obstruction from accumulation of bile acids. Insoluble in water and very large. Excreted completely in feces Adverse Effects: Impair absorption of fat-soluble vitamins Interfere with intestinal absorption of certain meds. Can't take at same time.