This animated video covers statins, fibrates, niacin, bile resins, and ezetimibe. We will discuss mechanisms of action, which part of the lipid profile is affected by each drug, and common side effects.
In this scene we will cover lipid-lowering agents we will cover statins fib rates niacin bile resins and easy type the setting for our scene is michelangelo studio where several of his assistants are going about their days let’s start by drawing a statue in the lower left corner this statue will represent statins our first group of drugs in this category statue
Statins examples of statins include atorvastatin simvastatin lovastatin and many others all ending in the suffix statin note that we drew this in the lower corner because statins most prominently effect low-density lipoprotein levels in blood before we go further we want to note that all of these medications share the common property of favorably affecting various
Parts of a patient’s lipid profile for example lowering the low-density lipoprotein or triglyceride levels or increasing high density lipoprotein levels however each drug group here is known for most affecting a particular component for example statins are most known to reduce the level of low-density lipoproteins ldl s so we have to put it in the lower corner
A test question might present a patient whose ldl levels are normal but then asks what can be given to raise low hdl levels or a question might present a patient with sky-high triglycerides the answer to these vignettes and more to come continuing with statins in the statue stands work by inhibiting the enzyme hmg co-reductase which is represented here by the
Inscription at the foot of the statue while generally well tolerated statins have two notable side effects that you will see regularly in clinical practice the first is myopathy represented by the wimpy inflamed muscles in his thighs and arms patients will complain of muscle aches and weakness fib rates and niacin two other drugs we will introduce in the scene also
Have the same side effect of causing myopathy so patients are at increased risk when taking combinations of these for increased effect in practice patients are usually switched between various statins until a tolerable one is found a second less common side effect of statins is hepatotoxicity which is represented here by the inflamed and bulging liver patients must
Be monitored for elevated liver enzymes to recap with statins you want to remember that they primarily affect ldl levels by inhibiting the hmg-coa reductase enzyme in the liver and that the side effects are my op a–they and liver toxicity moving on to fib rates we will draw a big pile of fibers next to the statue examples of fib rates include gem fib brazil clove
The bright bass afib rate and phenol fabray the main clinical effect commonly tested is that fib rates reduced triglycerides represented here by three glistening orbs the mechanism of action of fib rates is increased lipoprotein lipolysis which is why this assistant has big fat lips also he’s reaching up to feed his pet parakeet which is perched on high fib rates
Activate the ppar alpha receptor for an increase in hdl synthesis hence the parakeet up high like statins fib rates can also have the side effect of myopathy which is why this artist has wimpy red inflamed muscles like the statue when you have a patient on both statins and fib rates expect muscle pain this artist is also standing on a stone platform to represent
A second notable side-effect of fib rates gall stones a question might present a patient with normal ldl and hdl levels but elevated triglycerides what do you prescribe fib rates next up niacin let’s draw sunlight streaming in from window sunlight niacin like most windows this one is up high that’s because niacin is known to improve high-density lipoprotein levels
Look closely and you’ll notice that by some weird quirk physics there are exactly three beams of sunlight that’s to help you remember that niacin is also called vitamin b3 hence three beams of sunlight shining in from up high a question might ask a patient presents with a normal ldl level but decreased hdl level what medication would bring that hdl level up niacin
On denies ins mechanism of action let’s draw a chubby assistant with a belt tightly squeezing his fat waist this belt has two effects first niacin inhibits lipolysis and adipose tissue which is why his lips are bulging second niacin inhibits hepatic vldl synthesis indicated by his liver bulging his liver is not red and inflamed to indicate damage here it is the
Normal brownish color but it’s just inhibited by this very tight belt now let’s start drawing another assistant who will demonstrate important side effects first note that his face is red and flushed a symptom often encountered upon administration you can prophylaxis this by combining niacin with aspirin which is why his ass is so red along with flushing niacin
Causes vasodilation which decreases blood pressure next we see that this assistant is eating a candy lollipop which will give him hyperglycemia finally look at his joints especially that big toe enlarged and red that’s gout from hyperuricemia induced by niacin moving on to bile resins let’s draw a stone fireplace off to the side with a big lump of coal bile resin
Agents include cholestyramine coley stipple and coley civilan hence why we drew coal let’s draw another rotund assistant snacking on raisins specifically bile raisins and gross he’s puking his guts out patients complain that bile rison’s tastes terrible bile resins work by blocking intestinal reabsorption of bile let’s have him holding his stomach as you can imagine
Mucking with intestinal absorption has the side effect of some abdominal discomfort see those three glistening orbs above the fireplace triglycerides bile resins slightly increased triglycerides effect sometimes tested because it’s a bit counterintuitive since we usually want to lower them however file resins are useful when the patient’s triglycerides are well
Controlled and we want to lower ldl levels we drew a stone fireplace remember what we use stones to represent when introducing fib rates gall stones are also a side effect of bile resins like cholestyramine the last drug is easy to map and we’re going to use a zebra for this we’ll have the zebra entering the studio because acetamide blocks cholesterol absorption
At the intestinal and terra sites notice that our zebra is blocked from entering too far what’s that coming out of this zebras rear end it looks like diarrhea a common side effect that’s all the lipid lowering medications now remember that questions often test the notable effect of each to summarize we have the statue representing statins in the lower left because
They lower ldl levels fib rates a pile of fiber are also low in the scene because they lower triglycerides three glistening orbs niacin as sunlight the three beams of sunlight coming through the window hdls bile resins as a yucky snack and the acetamide zebra blocked from entering the studio because zetas my blocks cholesterol absorption at the intestinal and
Terror sites as you look back you’ll notice that each of these drug groups has a different mechanism of action each affected a different part of cholesterol metabolism because of this these drugs are often given in combination for additional effect well that’s it for the lipid lowering medications thank you for listening
Transcribed from video
Statins, Fibrates, Niacin, etc. – Easy Pharm for USMLE Step 1 By Pharm 450
