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NURS 572 Pharm Ch 49

Ch 49 lipid lowering agents

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