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NURS 572 Pharm Ch 49
Ch 49 lipid lowering agents
| Question | Answer |
|---|---|
| what are the classes of lipid lowering agents-5 | HMGCoA reductase inhibitors---nicotinic acid---bile acid-binding resins---fibric acid derivatives/fibrates----ezetimibe |
| What class is BEST at lowering LDL | HMG-CoA reductase inhibitors do this best |
| MOA HMG-CoA reductase inhibitors | they block the enzyme, so more LDL receptors can be made which then allow LDL to bind,removing LDL from bloodstream |
| do HMG-CoA reductase inhibitors have additional pleitrophic effects that decrease risk of HA | Yes - primary action is to DECREASE LDL----also moderate increase of HDL, moderate decrease TG |
| how long does it take for HMG-CoA's to become effective | dose dependent, peaks in 4-6 weeks |
| tell me 3 cautions with the HMG-CoA's class | pregnancy category X---hepatotoxic---myopathy/rhabdomylosis |
| Names of HMG-CoAreductase inhibitors - 7 | the 'statin family --- atorvastatin, fluvastatin, lovastatin, pravastatin, pitvastatin, simvastatin |
| which to statins have greatest efficacy | atorvastatin, rosuvastatin |
| which statin must be taken in lower dose to avoid myopathy | simvistatin |
| Nicotinic acid/niacin MOA | decrease triglyceride carrier VLDL, of which LDL is a by-product |
| Primary/secondary actions nicotinic/niacin | primary = decrease TGs--------------secondary = inc. HDL---dec. LDL |
| ADRs nicotinic acid/niacin | compliance limiting flushing/itching ----hepatotxic |
| MOA of bile-acid binding resins | bind bile acids in GI---liver makes more bile acids---bile acids made from cholesterol---liver INCREASES LDL RECEPTORS---lowers LDL |
| Primary action of bile-acid binding resins | primary ---inc HDL------lower LDL same MOA as statins, which is why they are often used in combo |
| downside of bile-acid containing resins | they actually inc TGs, but benefits outweigh |
| major ADR of bile acid binding resins | constipation --- BUT NO LIVER TOXICITY |
| name 3 bile acid binding resins | cholestyramine---colestipol---colesevelam |
| which bile acid binding resin likely to be selected bwo best tolerated | colesevelam wins this prize |
| fibric acid-fibrates - we don't know MOA, what is their major effect | primary = dec TGs as well as niacin/nicotinic------ secondary -----dec LDL---incl HDL |
| ADRs of fibrates | hepatotoxic --- myopathy---GALLSTONES |
| name 3 fibric acid/fibrates | gemfibrozil---fenofibrate---choline fenofibrate |
| what stand alone drug acts as border patrol | ezetimibe---blocks chol from being absorbed at brush border |
| what does ezetimibe do, though not particularly well, which is why it's 2nd/3rd add-on drug | mod inc HDL - - - not enough data to rank its dec LDL, dec TG |
| ezetimibe class | stand alone- border patrol |
| fenofibrate ----choline fenofibrate | fibric acid/fibrate |
| gemfibrozil | fibric acid/fibrate |
| cholestyramine | bile acid binding resin |
| colestipol | bile acid binding resin |
| cholestyramine | bile acid binding resin |
| niacin | nicotinic acid |
| any of the statins in this class | HMG-CoA reductase inhibitor |
Created by:
lorrelaws
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