Questions and Answers
What drug class does Cholestyramine belong to?
What drug class does Ezetimibe belong to?
Which of the following is another name for the statin drug class?
What side effect is associated with Nicotinic Acid?
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Which medications need liver enzyme monitoring for hepatotoxicity?
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What is the MOA of Niacin?
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What is the beneficial effect of Atorvastatin compared to other statins?
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What is a common adverse effect of Fibrates?
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The drug __________ is a fibric acid used for lowering triglycerides.
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Which fenofibrates are taken without food?
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Study Notes
Hyperlipidemia Drug Classes and Mechanisms of Action
- Bile Acid Sequestrants/Resins: Cholestyramine, Colestipol, Colesevelam categorized under this class, help reduce LDL cholesterol.
- Nicotinic Acids: Includes Niacor (immediate release), Slo-Niacin (sustained release), and Niaspan (extended release), all focusing on lowering lipids.
- Fibric Acids (Fibrates): Gemfibrozil, Fenofibrate, and Fenofibric acid are effective in lowering triglycerides and increasing HDL.
- Cholesterol Inhibitors: Ezetimibe works by preventing cholesterol absorption in the intestine.
- Omega-3 Fatty Acids: Lovaza and Vascepa serve to lower triglycerides effectively.
Dosage and Administration Insights
- Statins: Atorvastatin, Rosuvastatin, and Pitavastatin do not require nighttime dosing.
- Mevacor (Lovastatin): Statin that should be taken with meals to enhance absorption.
- Fenofibrate Dosing: TriCor and Antara can be taken without food; Lofibra and Lipofen are taken with meals, while Lopid (Gemfibrozil) is taken BID 30 minutes before meals.
Monitoring and Adverse Drug Effects
- Liver Enzyme Monitoring: AST/ALT levels must be closely monitored for patients on statins, niacins, and fenofibrates due to potential hepatotoxicity.
- Adverse Effects of Nicotinic Acid: Include flushing/itching, hyperglycemia, hyperuricemia, and orthostatic hypotension.
- Adverse Effects of Fibrates: Dyspepsia, risk of gallstones, and myopathy are common among this drug class.
- Drug Interactions: Fibrates can cause muscle toxicity when combined with statins or niacin.
Clinical Considerations
- Contraindications for Lovastatin and Simvastatin: These statins are contraindicated with strong CYP3A4 inhibitors.
- LFT Management in Statins: Discontinue statins after liver function tests exceed three times the upper limit of normal (ULN).
- Lipid Level Effects: Certain medications like amiodarone and prednisone can increase lipoprotein levels, affecting overall lipid profiles.
Additional Notes
- Statins and Renal Function: Atorvastatin, Rosuvastatin, and Pitavastatin doses do not need adjustment in patients with renal failure, enhancing their utility in diverse patient populations.
- Global Risk Assessment: Parameters such as age, gender, HDL, and total cholesterol are assessed, excluding LDL or triglycerides.
Key Benefits
- Welchol Advantages: Fewer drug-drug interactions (DDIs), reduced gastrointestinal effects, and a tablet formulation that negates the need for bad-tasting alternatives.
- Atorvastatin Benefits: Taken at any time of day, minimal CYP3A4 metabolism, and no need for renal dose adjustments.
Agents Affecting Triglyceride Levels
- Decreasing Agents: Omega-3 fatty acids (Lovaza/Vascepa), fenofibrates, niacins, and statins can effectively lower triglycerides, while resins may inadvertently increase triglycerides.
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Description
Test your knowledge on various drug classes and mechanisms of action related to hyperlipidemia. This quiz covers key medications, including bile acid sequestrants and nicotinic acids. Perfect for medical students and healthcare professionals looking to brush up on their pharmacology.
