Lipid Lowering Agents

Question 1

List the six classes for treatment of hyperlipidemia

Answer 1

Bile Acid Sequestrants
HMG-CoA Inhibitors
Fibrates
Niacin
Cholesterol Absorption Inhibitors

Question 2

Actions for Bile Acid Sequestrants

Answer 2

Binds bile acids in the intestine, allows excretion in feces instead of reabsorption, causes cholesterol to be iodized in the liver, and serum cholesterol levels to fall

Question 3

Indications for Bile Acid sequestrants

Answer 3

Reduces elevated serum cholesterol in patients with primary hypercholesterolemia, pruritus associated with partial biliary obstruction

Question 4

Parmo for bile acid sequestrants

Answer 4

Not absorbed systemically

Excreted in the feces

Question 5

Contra for bile acid sequestrants

Answer 5

Allergy
Complete biliary obstruction
Abnormal intestinal function
Pregnancy and lactation

Question 6

Adverse effects of bile acid sequestrants

Answer 6

Headache, fatigue, and drowsiness
Direct GI irritation – Nausea, constipation
Increased bleeding times
Vitamin A and E deficiencies

Question 7

D2D fro bile acid sequestrants

Answer 7

Malabsorption of fat-soluble vitamins

Thiazide diuretics, digoxin, warfarin, thyroid hormones, and corticosteroids

Question 8

HMG-CoA Inhibitor

Answer 8

Atrovastatin

Question 9

Actions for HMG-CoA inhibitors

Answer 9

Inhibits HMG-CoA, decreases serum cholesterol levels, LDLs, and triglycerides, increases HDL levels

Question 10

Indication for HMG-CoA Inhibitors

Answer 10

Adjunct to diet in the treatment of elevated cholesterol, triglycerides, and LDL; increase HDL-C in patients with primary hypercholesterolemia; treat familial hypercholesterolemia and two+ risk factors for CAD

Question 11

Pharmo for HMG-CoA Inhibitors

Answer 11

Absorbed from the GI tract, undergo first-pass metabolism by the liver
Excreted in urine and feces

Question 12

C &C for HMG- CoA Inhibitors

Answer 12

Contra- Allergy
Active liver disease or history of alcoholic liver disease
Pregnancy or lactation

Caution- Impaired endocrine function.

Question 13

Adverse Effects for HMG-CoA Inhibitors

Answer 13

GI symptoms: Flatulence, abdominal pain, cramps, nausea, vomiting, and constipation
CNS: Headache, dizziness, blurred vision, cataracts. insomnia, fatigue
Liver failure
Rhabdomylosis

Need to monitor liver enzymes to ensure proper processing and grapefruit juice effects this.
Statins may cause muscle weakness and joint pain that may result in them no longer taking it.

Question 14

D2D for HMG-CoA Inhibitors

Answer 14

Erythromycin, cyclosporine, gemfibrozil, niacina
Digoxin or warfarin
Estrogen
Grapefruit juice

Question 15

Cholesterol absorption

Answer 15

Ezetimibe

Question 16

Action for cholesterol absorption inhibitors

Answer 16

Works in the brush border of the small intestine to inhibit the absorption of cholesterol

Inhibit absorption of cholesterol at the brush boarder.

Question 17

Indication for Ezetimbe

Answer 17

Lower serum cholesterol levels; treat homozygous familial hypercholesterolemia; treat homozygous sitosterolemia to lower sitosterol and campesterol levels

Question 18

Pharmo for Ezetimbe

Answer 18

Absorbed in the GI tract

Metabolized in the liver, excreted in urine and feces

Question 19

C & C for Ezetimbe

Answer 19

Contra- allergy, pregnancy or lactation if combined with a statin.

Caution- Pregnancy or lactation (monotherapy)
Elderly patients
Liver disease

Question 20

Adverse effects for ezetimbe

Answer 20

Abdominal pain and diarrhea
Headache, dizziness, fatigue, URI, back pain
Muscle aches and pain

Question 21

D2D interactions for cholesterol absorption inhibitors

Answer 21

Cholestyramine, fenobibrate, gemfibrozil, or antacids
Cyclosporine
Fibrates
Warfarin

Question 22

Action of Niacin

Answer 22

Vitamin B3, inhibits release of free fatty acids from adipose tissue
Increases rate of triglyceride removal from plasma

Question 23

Action of Fenofibrates

Answer 23

Inhibits triglyceride synthesis in the liver – decreased LDL

Increased uric acid secretion – may stimulate triglyceride breakdown

Question 24

Action of Gemifibrozil

Answer 24

Inhibits peripheral breakdown of lipids
Reduced production of triglycerides and VLDL
Increases HDL