Drugs that Lower Cholesterol
What is Ezetimbe/Zetia?
A drug that inhibits the absorption of cholesterol in the small intestine. Its efficacy has not yet been proven
Why can fibrates not be taken with statins?
Because both statins and fibrates cause muscle damage
What are the names of the bile acid sequestrants (binding resins)?
Cholestyramine/Questran and Colesevelam/Welchol
What are the symptoms of Rhabdomyolysis?
Dark urine, Creatinine Kinase 10 times normal
Is Rhabdomyolysis rare?
Extremely, as of 2012 it is not even considered a side effect of statins
Why can fibrates not be taken with warfarin?
Fibrates cannot be taken with Warfarin because fib rates displace warfarin from albumin, raising the level of warfarin in the blood. This can cause internal bleeding.
What drugs cannot be taken with statins?
Fibrates/gemfibrozil aka Lopid and Niacin because they both can cause hepatotoxicity
What are fibrates?
Fibric acid drugs used to reduce high trigylceride levels
What are the side effects of niacin?
Flushing (prevent with aspirin), GI disturbances, hepatotoxicity, hyperglycemia/use caution with diabetics
What are the negative side effects of Gemfibrozil?
Gallstones, myopathy, liver disease
What is the prototype fibrate?
Gemfibrozil/Lopid
What is another name for statins?
Hmg coA reductase inhibitors
What are the five classes of drugs that lower cholesterol?
Hmg coA reductase inhibitors or statins Bile acid - binding resins Nicotinic Acid Fibric Acid Derivatives (fibrates) Ezetimbe - Zetia
What is the method of action of bile acid binding resins?
Increasing the number of LDL receptors on hepatocytes which decreases absorption of LDL in the small intestine
What are the negative side effects of Zetia?
It can cause muscle damage like the statins and the fibrates
What are the side effects of statins?
Myopathy, Kidney Damage, Hepatotoxicity, fetal harm/pregnancy class X
What is myopathy?
Statins can cause muscle injury. Muscles are broken down and the damaged portions travel to the kidneys, this can cause kidney damage called Rhabdomyolysis
Is Gemfibrozil effective at lowering LDL cholesterol?
NO
Who has the highest risk for Myopathy?
Older people, people with small frames, hypothyroidism
What are the therapeutic goals of niacin?
Reduces LDL cholesterol, VLDL's, Triglycerides and also can raise HDL
What is the method of action for statins?
Statins MOA: Increase the number of LDL receptors in hepatocytes Inhibit the rate limiting enzyme in cholesterol biosynthesis in order to decrease LDL and increase HDL
What drugs can fibrates not be taken with?
Statins and warfarin
What patients is niacin contraindicated for?
Those with liver damage or gout
How should bile acid resins be given with other drugs?
Wait at least two hours before giving the other drugs
What are the adverse effects of bile acid binding resins?
constipation, decreased absorption of fat soluble vitamins and MEDICATIONS!
What is the therapeutic goal of bile acid sequestrants?
reduce LDL cholesterol in conjunction with diet modification and exercise
What is the therapeutic goal of statins?
to lower levels of LDL cholesterol in combination with diet modification and exercise.
