Today, we're talking about chapter six cardiology,
specifically antihyperlipidemics or cholesterol controlling medications.
The four classes that we'll be talking about in this video are going to be HMG-CoA reductase inhibitors,
specifically atorvastatin
which is the generic, and
Lipitor is going to be the brand name.
We also have our fibric acid derivatives - the specific one in this category is going to be fenofibrate,
brand name Tricor.
We have nicotinic acid, which is an over-the-counter product, and the brand name for that is going to be Niacin.
Last we have bile acid sequestrants,
which are going to act in our gut.
Specifically in this video, we'll talk about colesevelam which is the generic and Welchol is the brand name.
We'll be using all four of these
categories to go through all of the different questions here today. The first question is: 'An antihyperlipidemic that reduces
LDL by decreasing our endogenous cholesterol production is?'
A) HMG-CoA reductase inhibitor - atorvastatin (Lipitor)
B) fibric acid - fenofibrate (Tricor)
C) nicotinic acid (Niacin)
or D) bile acid sequestrants - colesevelam (Welchol).
It's going to be atorvastatin or HMG-CoA reductase inhibitor.
Statin medications are specifically going to work to decrease our endogenous
cholesterol production to reduce our LDL. Endogenous just means that it's what our body naturally produces.
Statins usually are going to be given at night time and that's because our body naturally makes its cholesterol in
a state of fasting which usually occurs when we're sleeping, so they're going to have their most benefit at nighttime.
It's not going to be fenofibrate because that's going to be
focusing on decreasing VLDL or triglycerides.
It is not C) nicotinic acid because that is going to work on
increasing HDL or good cholesterol, and it's not D) colesevelam, a bile acid sequestrant.
While this category also reduces LDL, it's going to do so by decreasing our
exogenous cholesterol absorption from the gut versus endogenous or our body's natural cholesterol production.
Next we're going to work on making B) correct, so fibric acid. We have:
'The most effective drug for lowering triglyceride levels and has an increase on HDL levels which is our good cholesterol?'
That's going to be fenofibrate. It's going to be the most effective in lowering VLDL or triglycerides.
While atorvastatin and nicotinic acid both do reduce VLDL,
it's going to do so moderately; we're going to have the most benefit with fabric acid derivatives.
Colesevelam, a bile acid sequestrant
is focusing on lowering LDL levels.
This question is going to make C) correct for nicotinic acid.
'Which medication causes intense skin flushing and is most effective in elevating HDL levels?'
That's going to be nicotinic acid.
This class is specific on increasing our HDL or good cholesterol,
but one of the side effects is that it can cause some skin flushing, so patients that are taking
nicotinic acid or Niacin oftentimes will
take aspirin with it to reduce the side effects.
Atorvastatin and fenofibrate
have moderate HDL increase. When we're really focusing on increasing our HDL levels if they're really low, nicotinic acid is going to be the
mainstay therapy. It's not again colesevelam, a bile acid sequestrants
because that's going to be focusing on decreasing exogenous
LDL from the gut.
This last question here is going to be focusing on making D) correct, colesevelam a bile acid sequestrant.
Which medication should be avoided with fat soluble vitamins as it acts on inhibiting cholesterol absorption from the gut?'
It's going to be bile acid sequestrants, specifically colesevelam.
This is gonna work in our gut to decrease
LDL by decreasing fat absorption, so while we're
inhibiting our fat absorption, this can be detrimental for patients that are also taking fat soluble
vitamins because it can inhibit the absorption of those as well. Atorvastatin, while it's going to decrease LDL production
it's going to do so by decreasing endogenous
LDL, and then fenofibrate is going to be mainly focused on decreasing triglycerides, and nicotinic acid
is mainly going to be focusing on increasing HDL or good cholesterol.