HYPERLIPIDEMIC

DRUGS
 STATINS
CLASS: HMG-CoA MOA Acetoacetyl-CoA
reductase inhibitors
(statins)
HMG-CoA
HMG-
DRUG NAMES: COA
simvastatin, REDUCA
L-Melvonate
SIDE EFFECT: TASE
rosuvastatin, ▪ Myalgia,
atorvastatin rhabdomyolysis
FFP
lovastatin, ▪ Skin rash
▪ Rosuvastatin: renal
pravastatin
failure, pancytopenia,
▪Abdominal cramps, Squalene FFP
INDICATION: diarrhea,
constipation,
➢Hypercholesterolemia
➢Increased LDL levels
➢Coronary artery disease
Cholesterol
CONTRAINDICATION
ROUTE OF
ADMINISTRATION:
✓Active liver disease
ORAL/PO ✓Pregnancy
✓Breastfeeding
 STATINS

PATIENT EDUCATION:
✓Purpose: decrease their LDL and
triglyceride levels, decrease risk of
DRUG INTERACTIONS: coronary artery disease
•Cyclosporine, niacin, gemfibrozil,
✓Bedtime administration preferred
amiodarona, macrolides, antifungals: ↑ risk ✓Avoid grapefruit and grapefruit juice
of rhabdomyolysis ✓Limit alcohol

•Digoxin or warfarin: ↑ levels and toxicity ✓Symptoms to report

Rhabdomyolysis: unexplained muscle
•Oral contraceptives: ↑ estrogen levels pain, weakness; brown urine

✓Lifestyle modifications
•Protease inhibitors, erythromycin, Smoking cessation weight control,
gemfibrozil, grapefruit: statin toxicity physical activity, diet high in
complex carbohydrates and fiber
and low in saturated fat and
cholesterol
 BILE ACID
SEQUESTRANTS
Hepatic bile
acid pool
CLASS: Bile acid
sequestrants SIDE EFFECT:
Hepatic bile acid
▪Constipation
▪Bloating synthesis from
DRUG NAMES: ▪Flatulence cholesterol
cholestyramine ▪Decreased absorption
colestipol of vitamins A, D, E,
and K(cholestyramine,
colesevelam colestipol)
Intrahepatic
pool cholesterol

INDICATION: HMG COAreducatse LDL receptors

➢Hypercholesterolemia expression
➢ Beneficial therapy in statin-intolerant
patients
➢ Safe for children with heterozygous familial LDL , VLDL LDL clearance
hypercholesterolemia
Production
Plasma
ROUTE OF ADMINISTRATION: ORAL/PO LDL-c
 BILE ACID
SEQUESTRANTS

CONTRAINDICATION & DRUG INTERACTIONS:

CAUTIONS: ✓Narrow therapeutic index
medications like :
•Colesevelam: history of Digoxin, Lithium, Theophylline
bowel obstruction; ✓Thyroid medication:
pancreatitis Levothyroxine:BAS drugs binds to
•Cholestyramine: pregnancy, levothyroxine and prevent them
renal impairment from being absorbed.
•Severe hepatic disease ✓Sulfonylureas : Raise the blood
•Renal impairment sugar level
✓Vitamins: Low the level of
vitamins
 FIBRIC ACID
DERIVATIVES MOA

Fibrate
CLASS: Fibrates
SIDE EFFECT: PPAR alpha
DRUG NAMES: ▪ GI: dyspepsia, abdominal
gemfibrozil (Lopid); pain,
fenofibrate (Tricor) ▪Skin: rash, urticaria, pruritus
▪CNS: fatigue, dizziness, Activated PPAR
headache alpha/RXR
▪Muscular: rhabdomyolysis
(increased risk when
combined with colchicine and
INDICATION: statins) PPRE/ target
➢Hypertriglyceridemia ▪Gemfibrozil: pancytopenia,
eosinophilia genes
➢Hypercholesterolema
➢Mixed dyslipidemia

ROUTE OF CONTRAINDICATION
ADMINISTRATION: ➢Gemfibrozil: don’t combine Reverse
ORAL/PO with dasabuvir, repaglinide, or Triglyceride
cholesterol
simvastatin inflammation
➢Fenofibrate: Geritarics,
transport
pancreatitis, diabetes mellitus
 FIBRIC ACID
DERIVATIVES

PATIENT EDUCATION:
DRUG INTERACTIONS:
✓Purpose: decrease their LDL and
➢Coumarin Anticoagulants: triglyceride levels, decrease risk of
prolongation of the PT/INR coronary artery disease
➢Immunosuppressants : ✓gemfibrozil twice each day, 30
cyclosporine and tacrolimus can minutes before breakfast and
produce nephrotoxicity with dinner
✓Take fenofibrate once daily with
decreases in creatinine clearance
food
and rises in serum creatinine ✓Increase their fluid intake while
taking their medication
✓Lifestyle modifications to reduce
the risk of cardiovascular events
✓Can take up to three months to
determine efficacy
 PCSK9 INHIBITORS( Proprotein
convertase subtilisin/Kexin type 9
MOA
SIDE EFFECT:
▪ Local injection site
CLASS:PCSK9 inhibitors PCSK9
reactions
DRUG NAMES: binds
▪Hypersensitivity
▪Evolocumab (Repatha) reactions Flu-like PCSK9
(FULLY HUMAN MONOCLONAL symptom Inhibitors
ANTIBODY) ▪Cough LDL
▪Alirocumab (Praluent) ▪Diarrhea receptors
▪Increased blood
transaminases
▪Muscle spasms
Decrease levels
INDICATION: ▪Myalgia of LDL in the
➢Familial hypercholesterolemia blood
➢Additive therapy for patient STORAGE AND HANDLING
with high cholesterol with INSTRUCTION:
Statins and Ezetimibe ✓Store refrigerated at 2°C to 8°C (36°F to 46°F) Do
not freeze. Do not shake.
ROUTE OF ADMINISTRATION:
✓ For convenience, may be kept at room temperature
Subcutaneously
at 68°F to 77°F (20°C to 25°C) for 30 days.
✓If not used within the 30 days, discard REPATHA.
 PATIENT EDUCATION/ADMINISTRATION
INSTRUCTION

Advise latex-sensitive patients that the needle cover of the glass single-dose
prefilled syringe and the single-dose prefilled autoinjector contain dry natural
rubber that may cause allergic reactions in individuals sensitive to latex

Instructions for Use each time the use of REPATHA.

✓ Prior to use, allow REPATHA to warm to room temperature for at least 30
minutes for the prefilled autoinjector or syringe and for at least 45 minutes for
the on-body infusor with prefilled cartridge if REPATHA has been
✓Visually inspect REPATHA prior to administration.
✓REPATHA is a clear to opalescent, colorless to pale yellow solution.
✓Do not use if the solution is cloudy, discolored, or contains particles.
✓ Administer REPATHA subcutaneously into areas of the abdomen, thigh, or
upper arm that are not tender, bruised, red, or indurated.
✓ Avoid injecting into areas with scars or stretch marks.
✓Rotate injection sites for each administration.
✓The 420 mg dose of REPATHA can be administered: over 5 minutes by using
the single-dose on-body infusor with prefilled cartridge, or by giving 3 injections
consecutively within 30 minutes using the single-dose prefilled autoinjector or
single-dose prefilled syringe
 NIACIN DERIVATIVES NIACIN

SIDE EFFECT: MOA

•”Niacin flush”
CLASS: Vitamin B3 •Headaches
DGAT2
•Paresthesia
DRUG NAMES: •Abdominal pain
Niaspan, Niacor •Flatulence
•Hyperglycemia TG SYNTHESIS
•Hyperuricemia
•Hepatitis
INDICATION: •Increased blood
➢Hypertriglyceridemia transaminases ApoB
DEGRADATION
ROUTE OF
ADMINISTRATION:
ORAL/PO

DRUG INTERACTION:
VLDL
✓HMG-CoA reductase inhibitors :
Increase risk of rhabdomyolysis
✓Aspirin: Concomitant aspirin may LDL Lp(a)
decrease the metabolic clearance of
nicotinic acid.
 PATIENT EDUCATION

➢To take at bedtime, after a low-fat snack.

➢ Administration on an empty stomach is not recommended
➢To carefully follow the prescribed dosing regimen, including the
recommended titration schedule.
➢ Flushing is a common side effect of niacin therapy that usually
subsides after several weeks of consistent niacin use. taking blood
pressure medications.
➢To take aspirin (approximately 30 minutes before taking
NIASPAN®) or a nonsteroidal anti-inflammatory drug (e.g.,
ibuprofen) may minimize flushing.
➢To avoid ingestion of alcohol or hot drinks
➢To notify physician if taking vitamins or other nutritional
supplements containing niacin or related compounds such as
nicotinamide.
➢The tablets should not be broken, crushed or chewed, but should
be swallowed whole.
 Selective Cholesterol-
Absorption Inhibitors MOA

Ezetimibe
CLASS: Selective
Cholesterol-Absorption
Inhibitors SIDE EFFECT:
Headache
DRUG NAMES: Arthralgias Inhibition of
Ezetimibe Myalgias action of
Rhabdomyolysis Decrease
NPC1L1

dietary
cholesterol
INDICATION:
➢ Hypercholesterolemia. Potential
➢Combination Therapy DRUG INTERACTION:
benefit in
with HMG-CoA Reductase treating NAFLD
Cyclosporine:
Inhibitors,fenofibrate,
Concomitant use
increases ezetimibe and
ROUTE OF cyclosporine
ADMINISTRATION: concentrations Potential benefit in
ORAL/PO treating & preventing
cholesterol gallstone
 Adenosine Triphosphate-
Citrate Lyase (ACL) Inhibitor
Citrate

SIDE EFFECT: Bempedoic Acyl

CLASS: adenosine Muscle pain acid
triphosphate-citrate Hyperuricemia
Acetyl-CoA
lyase (ACL) Abdominal
inhibitor pain
Anemia
DRUG NAMES:
Bempedoic acid
DRUG INTERACTION: HMG-CoA
➢Simvastatin,
INDICATION: Pravastatin: Increase
➢ adjunct to diet and maximally risk myopathy
tolerated statin therapy Mevalonic acid
➢Familial hypercholesterolemia

ROUTE OF ADMINISTRATION: ORAL/PO

Cholesterol
 PATIENT EDUCATION

➢Risk of Hyperuricemia: Advise patients of the risk of elevated

serum uric acid levels, including development of gout
➢Risk of Tendon Rupture: Inform patients of the risk of tendon
rupture. Advise patients to rest at the first sign of tendinitis or
tendon rupture and to immediately contact their healthcare
provider
➢Pregnancy Advise pregnant women of the potential risk to a
fetus
 THANK YOU
Do your part by caring for the
heart.