Page 364 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat
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320 SECTION III CARDIOvASCuLAR ``CARdIOvASCulAR—PHARMACOlOGY CARDIOvASCuLAR ``CARdIOvASCulAR—PHARMACOlOGY
Lipid-lowering agents
dRuG ldl Hdl TRIGlYCERIdES MECHANISMS OF ACTION AdvERSE EFFECTS/PROblEMS
HMG-CoA reductase Inhibit conversion of HMG- Hepatotoxicity ( LFTs),
inhibitors CoA to mevalonate, a myopathy (esp when
(eg, atorvastatin, cholesterol precursor; used with fibrates or
simvastatin) LDL recycling; niacin)
mortality in CAD patients
Bile acid resins slightly slightly Prevent intestinal GI upset, absorption of
Cholestyramine, reabsorption of bile acids; other drugs and fat-
colestipol, liver must use cholesterol to soluble vitamins
colesevelam make more
Ezetimibe /— /— Prevents cholesterol Rare LFTs, diarrhea
absorption at small intestine
brush border
Fibrates Upregulate LPL TG Myopathy ( risk with
Gemfibrozil, clearance statins), cholesterol
bezafibrate, Activates PPAR-α to induce gallstones (via
fenofibrate HDL synthesis inhibition of cholesterol
7α-hydroxylase)
Niacin Inhibits lipolysis (hormone- Flushed face ( by NSAIDs
sensitive lipase) in adipose or long-term use)
tissue; reduces hepatic Hyperglycemia
VLDL synthesis Hyperuricemia
PCSK9 inhibitors Inactivation of LDL-receptor Myalgias, delirium,
Alirocumab, degradation removal of dementia, other
evolocumab LDL from bloodstream neurocognitive effects
Fish oil and marine slightly slightly at high Believed to decrease FFA Nausea, fish-like taste
omega-3 fatty acids doses delivery to liver and decrease
activity of TG-synthesizing
enzymes
FAS1_2019_07-Cardio.indd 320 11/7/19 4:24 PM
