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Flashcards in Lipid lowering agents Deck (12):

Statins: mechanism, effects on LDL, HDL, and tirglycerides

statins inhibit HMG CoA reductase, which prevents the converstion of HMG-CoA to mevalonate, a precursor in cholesterol synthesis. they also incr. LDL receptor expression.
LOTS of LDL reduction, a little HDL incr, and a little triglyceride decrease.


side effects or problems with statins

may cause hepatotoxicity or rhabdomyolysis, esp. when combined with niacin or fibrates


niacin: mechanism, effects on LDL, HDL, and triglycerides

Decreases hepatic VLDL synthesis and inhibits lipolysis in adipose tissue.
it causes moderate LDL reduction, moderate HDL incr, and a little triglyceride reduction


Niacin side effects and problems

can cause cutaneous flushing, though this decreases with long term use or ASA
hyperglycemia (can cause acanthosis nigricans)
hyperuricemia, which may worsen gout


Bile acid resins examples

cholestyramine (and colestipol, colesevelam)


bile acid resin effects on LDL, HDL and triglycerides; mechanism

moderate decr. LDL, slight incr. in HDL and slight incr. in triglycerides.
bile acid resins reabsorption of bile acid in the gut. the liver must use up cholesterol to produce more bile acids.


Side effects/problems with bile acid resins

patients hate it. tastes bad, causes GI discomfort, decreases abosorption of ADEK vitamins. may cause cholesterol gallstones


Ezetimibe effect on LDL, HDL, triglycerides. mechanism

decreases absorption of cholesterol in the gut.


gemfibrozil effects on LDL, HDL, triglycerides.

mild decr. in LDL, mild incr. in HDL, LOTS of decr. in triglycerides.


gemfibrozil mechanism of action

upregulates lipoprotein lipase to incr. TG clearance. also activates PPAR-alpha to induce HDL synthesis.


gemfibrozil side effects and problems

myositis (incr. risk with statins), hepatotoxicity, cholesterol gall stones (esp. with bile acid resins)


ezetimibe side effects/problems

incr in LFTs (rare), diarrhea.