Lipid-lowering agents

Question 1

Statins

Answer 1

HMG-CoA reductase inhibitors
DOC for lowering LDL
MOA: Inhibit cholesterol precursor - mevalonate
SE: Hepatotoxicity, rhabdomyolysis

Question 2

Niacin

Answer 2

DOC for increasing HDL
MOA: inhibits lypolysis in adipose tissue; reduces hepatic VLDL secretion into circulation
SE: Red, flushed face (decreased by ASA or long term use), hyperglycemia -> acanthosis nigricans, hyperurecemia -> gout

Question 3

Bile acid resins

Answer 3

Cholestyramine, Colestipol, Colesevelam
- Decrease LDL (not as good as Statins)
MOA: prevents intestinal re-absorptopn of bile acids –> liver must use cholesterol to make more
SE: Patients hate it (bad taste and GI discomfort), decrease absorption of fat-soluble vitamins, cholesterol gallstones

Question 4

Cholesterol absorption blockers

Answer 4

Ezetimibe
Decrease LDL (not as good as statins)
MOA: Prevents cholesterol reabsorption at small intestine brush border.
SE: Rare, increase in LFTs

Question 5

Fibrates

Answer 5

Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
DOC for decreasing Triglycerides
MOA: Upregulates LPL –> increase in TG clearance
SE: Myositis, hepatotoxicity, cholesterol gallstones