Lipid Lowering Agents Review Flashcards
(34 cards)
name all of the statins
simvastatin (zocor)
pravastatin (pravachol)
lovastatin (mevacor)
fluvastatin (lescol)
rosuvastatin (crestor)
pitavstatin (livalo)
what is the MoA of statins?
reduce hepatic cholesterol biosynthesis which also increases the number of hepatic LDL receptors and enables more LDL to be delivered to the liver. Overall, decreases LDL-c in serum and decreases amount of cholesterol available for the formation of VLDL
how do statins effect LDL/HDL/TG
decrease LDL
slight increase HDL
decrease TG
which two statins are rarely used due to DD interactions?
lovastatin and simvastatin
what is the compound in grapefruit which makes it an inhibitor of Cyp3A4?
flavinoid
which drugs/drug classes induce cyp3A4 and thus decrease plasma concentration of statins metabolized by this pathway?
St john’s wort
rifampin
seizure meds like carbamazepine and phenytoin
statins cause _______ of LDL receptors
upregulation
which statin has the least risk of myopathy and makes it a good choice if pt is not tolerating a more effective statin?
pravastatin
what is the MoA of niacin?
reduces hepatic VLDL secretion and enhances VLDL clearance which reduces the supply of circulating FFA’s and lowers serum LDL
how does niacin effect LDL/HDL/TG
moderately lowers LDL
significantly increases HDL
lowers TG
what labs should be obtained before initiating niacin therapy and 6 weeks after target dose is reached?
LFTs, uric acid, and fasting glucose
what is the most common SE of niacin?
what are other SEs?
flushing
itching, dry skin, abdominal pain, N/V
why do we give baby aspirin to pts on niacin?
when should baby aspirin be administered?
what should patients avoid around taking their niacin?
pts commonly experience flushing which is a prostaglandin-mediated response. aspirin inhibits this pathway and thus should prevent flushing
baby aspirin should be taken 30 minutes before niacin
pts should avoid spicy foods and hot showers
why is niacin considered a non-ideal option for hyperlipidemia?
pts experience too severe of flushing before therapeutic dose can be reached
what are the names of the two fibrates?
gemfibrozil (lopid)
fenofibrate (tricor)
what is the MoA of fibrates?
activate lipoprotein lipase and promote delivery of TG’s to adipose, and interfere w/ VLDL formation in liver
how do fibrates effect LDL/HDL/TG
moderate decrease in LDL
moderate increase in HDL
significant decrease in TG
what labs should be obtained before initiating fibrate therapy and 6 weeks after target dose is reached?
lipid levels, LFTs, uric acid, and fasting glucose
also monitor for hypokalemia
what are SEs of fibrates?
upset stomach, diarrhea, fatigue, N/V, and abdominal pain
what is an adverse rxn of fenofibrate that should be monitored?
impaired renal function
what are the names of the 3 bile acid sequestrants?
cholestyramine
colestipol
colesevelam
what is the MoA of bile acid sequestrants?
the bile acid binding resins exchange chlorine ions for bile acids from gut and the bile acid resin complex is excreted. this causes the liver to synthesize new bile acids from cholesterol. the liver increases LDL receptors to decrease serum LDL
how do bile acid sequestrants effect LDL/HDL/TG
lower LDL
almost no effect on HDL
may slightly increase TG
what should be monitored after starting bile acid sequestrant therapy?
lipid profile checked at 4 weeks and monitor for constipation
