Lipid-lowering drugs

Question 1

2 Primary forms of lipids in blood

Answer 1

Cholesterol

Triglycerides

Lipoproteins are the combination of lipids with protein

Question 2

Lipoproteins

Answer 2

Lipoproteins are the combination of lipids (cholesterol, triglycerides) with protein (on surface of particle)

Question 3

Lipoproteins: LDL and HDL

Answer 3

Low-density lipoprotein (LDL) “less desired”, “bad cholesterol”

High-density lipoprotein (HDL) “highly desired”
•Recycles cholesterol

Question 4

Lipid Lowering drugs

Answer 4

HMG-CoA reductase inhibitors (HMGs, or statins)

Question 5

HMG-CoA reductase inhibitors (HMGs, or statins)

Answer 5

HMG-CoA: One of the metabolites in cholesterol synthesis pathway

HMG-CoA Reductase: Critical enzyme for liver cholesterol production

HMG-CoA Reductase Inhibitors LOWER plasma LDL levels by inhibiting HMG-CoA reductase thus increasing liver LDL receptors which increases plasma clearance of LDL.

•First-line Tx

Drugs end in ”statin”

DRUG: Atorvastatin

Question 6

HMG-CoA reductase inhibitor ADVERSE EFFECTS and CONSIDERATIONS

Answer 6

Adverse:
•Muscle pain (myalgia)
•Liver injury (^ enzymes)

Considerations:
•NOT used in pregnancy
•Grapefruit juice inhibits CYP (lovostatin)

Question 7

Other Lipid-Lowering Drugs: Bile Acid Sequestrants

Answer 7

Indication: Type II hyperlipoproteinemia

Adverse Effects: Can decrease absorption of fat soluble vitamins A,D,E,K

Question 8

Order Lipid-Lowering Drugs: Fibric Acid Derivatives (Fibrates)

Answer 8

•Mechanism of action is complex
•Decrease plasma triglyceride levels
•Increase HDL by as much as 10-25%

Adverse: Prolonged prothrombin time (fibrinogen production reduced)

Question 9

Order Lipid-Lowering Drugs: Nicotinic Acid (Niacin)

Answer 9

=Vitamin B3

•Inexpensive
•Reduces VLDL (carrier of triglycerides) from liver
•Inhibit lipase in adipose tissue - breaks down lipids