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Cholesterol Lowering Drugs Work In Many Different Ways

How Do Statins Work?

Statins block the production of cholesterol in the liver itself. They lower LDL, the "bad"
cholesterol, and triglycerides, and have a mild effect in raising HDL, the "good" cholesterol. These
drugs are the first line of treatment for most people with high cholesterol. Side effects can include
intestinal problems, liver damage, and in a few people, muscle tenderness.
Examples of statins include:

• Crestor
• Lipitor
• Lescol
• Mevacor
• Pravachol
• Zocor

Statins-HMG-CoA reductase inhibitors (hydroxymethylglutaryl-coenzyme A reductase


inhibitors)

Atorvastatin (Lipitor)-most widely used

 MOA: Inhibits enzyme needed for hepatic synthesis of cholesterol; increases number of
LDL receptors in liver cells that remove LDL
• ↓ Total cholesterol, ↓ LDL, ↓ triglycerides, HDL may or may not ↑

Indications: Increase total cholesterol, protect from MI, raise HDL levels,

Labs: pre treatment and during treatment

 Lipid profile: HDL, LDL, total chol


 Triglycerides
 Liver function

Cholesterol Absorption Inhibitor ezetimibe (Zetia)

 MOA: Acts on small intestines to


• inhibit absorption of cholesterol
• Decrease delivery of intestinal cholesterol to the liver→
• ↓ hepatic cholesterol stores
• ↑ cholesterol clearance from blood
 Mechanism complementary to statins
How Does Nicotinic Acid Work?

Nicotinic acid is a B-complex vitamin. It's found in food, but is also available at high doses by
prescription. It lowers LDL cholesterol and raises HDL cholesterol. The main side effects are
flushing, itching, tingling and headache. Examples of nicotinic acid medication include:

• Nicolar and Niaspan

How Do Bile Acid Resins Work?

These drugs work inside the intestine, where they bind to bile from the liver and prevent it from
being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these
drugs work by depleting the body's supply of cholesterol. The most common side effects are
constipation, gas and upset stomach. Examples of bile acid resins include:

• Questran and Questran Light


• Colestid
• WelChol

How Do Fibrates Work?

Fibrates reduce the production of triglycerides and can increase HDL cholesterol. Examples of
fibrates include:

• Atromid
• Tricor
• Lopid

Ezetimibe lowers bad LDL cholesterol. Its a new class of cholesterol-lowering drug that works to
stop cholesterol absorption in the intestine.

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