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Clinical pharmacy 2024/2025 Level 3 Pharm D Pharmacology 1 (PO 502)

 DOC for hypercholesterolemia (Combination Therapy)

 For Hypercholesterolemia Combination therapy is used when

A) statin monotherapy and TLC did not achieve LDL-C goal Statins + Ezetimibe

B) Also, if the patient could not tolerate higher statin doses Statins + BAR

Fenofibrate + statin
 For Elevated LDL-C and TGs
Niacin + statin

 For Hypertriglyceridemia Fenofibrate + Niacin

 Statins + Niacin = increased effectiveness but high risk of myopathy

 Statins + resins = 20-30% greater reduction in LDL-C

 Statins + fibrates = useful when high LDL associated with high TG

 Atorvastatin and Rosuvastatin: max TG lowering effect

 Statin + resins + Niacin = 70% reduction in LDL-C

 Simvastatin + Ezetimibe = 60% reduction in LDL-C

 New Therapies

1- Alirocumab (Praluent): FDA-approved in 2015

PCSK9 inhibitors
 A human monoclonal antibody that ↓ degradation of LDL receptors
M.O. A
in the liver → ↑ the number of LDL receptors available to clear

LDL→↓ LDL-C levels in plasma

Indicated as adjunct to diet and maximally tolerated statin therapy

Adverse ➢ nasopharyngitis
effects ➢ injection site reactions

➢ Influenza

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