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Cardiovascular > 04.07 - Lipids (Elam) > Flashcards

04.07 - Lipids (Elam) Flashcards

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1
Q

Defect in Primary Chylomicronemia

A

Defective removal of CM (apoCII, LPL defect)

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2
Q

(according to elam) what drug to give if hyper-tg-emic

A

Statins

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3
Q

(According to firecracker) To decrease TG’s, use:

A

Fibrates (and Niacin)

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4
Q

2 Fibrates

A

Gemfibrozil, Fenofibrate

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5
Q

3 AE’s of Statins

A

Teratogen, Muscle, GI distress, (and neuro)

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6
Q

3 drugs that lower TG and raise HDL

A

Fibrates, Niacin, Fish Oil

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7
Q

4 potent inhibitors of CYP3A4

A

Macrolides, CCBs, Azoles, HIV protease inhibitors

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8
Q

Advantage of Pravastatin

A

Not p450, so fewer interactions

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9
Q

Adverse Effects of Fibrates

A

GERD, Diarrhea; Fenofibrate increases creatinine, paradoxical HDL lower

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10
Q

AE’s of Niacin besides flushing

A

Liver, GI, Gout, Eye, Insulin Resistance

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11
Q

Best LDL-lowering class of drugs

A

Statins

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12
Q

Better tolerated formation of Niacin (nicotinic acid)

A

ER formulation

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13
Q

Common mechanism of Cholesterol Lowering Drugs

A

Increase LDL receptors

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14
Q

Contraindications of Bile Acids Seqs

A

Hyper-TG-emia; Complex regimens, Constipation

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15
Q

Defect in Familial Combined Hyperlipidemia

A

Overproduction of ApoB (VLDL)

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16
Q

Defect in Familial Dysbetalipoproteinemia

A

Defective Metabolism of VLDL, Chylomicrons, ApoE defects

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17
Q

Defect in Familial Hypercholesterolemia

A

LDL receptor, ApoB defect; Decreased receptor-mediated removal of LDL from plasma

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18
Q

Defect in Familial Hypertriglyceridemia

A

Defective metabolism of VLDL (LPL defect)

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19
Q

Defective metabolism of VLDL (LPL defect)

A

Defect in Familial Hypertriglyceridemia

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20
Q

Defective Metabolism of VLDL, Chylomicrons, ApoE defects

A

Defect in Familial Dysbetalipoproteinemia

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21
Q

Defective removal of CM (apoCII, LPL defect)

A

Defect in Primary Chylomicronemia

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22
Q

Desirable HDL for men

A

> 40

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23
Q

Desirable HDL for women

A

> 50

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24
Q

Drug interactions of Bile Acid Seqs

A

Prevents absorption of other drugs: Digoxin, BB’s, Thyroxine, Coumadin

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25
Drugs that inhibit p-glycoprotein-mediated intestinal reabsorption
Cyclosporine, Grapefruite Juice
26
Effect of Colestipol on Pancreatitis
May make worse
27
Effect of Niacin on HDL, LDL, TG
HDL up, LDL down, TG down
28
Effects of Bile Acid Seqs on LDL, HDL, TG
Dec LDL, Modest HDL, No change or inc. TG!
29
Effects of N-3 Fatty Acids on TG, HDL, LDL
Reduce TG, Little-no effect on HDL, LDL
30
Elevated Cholesterol and TG; Plasma has creamy top layer with clear infranate
Primary Chylomicronemia
31
Gallstones
Fibrates
32
General MOA of Ezetimibe
Prevents absorption of dietary cholesterol
33
General MOA of Niacin
Reduces VLDL synthesis
34
HDL Cholesterol level ranges
High >60 (Desirable: >40 for men, >60 for women)
35
High Potency Statins
Atorvastatin, Rosuvastatin
36
How do Bile Acid Sequestrants work
Positively charged, so bind negatively charged bile acids in gut
37
How do stains increase number of LDL receptors
Promote ER to Golgi transport and cleavage of SREBP-2
38
How is Ezetimibe used?
Adjunct to Statin, not by itself; or in statin-intolerant patients
39
If existing heart disease, what type of stains do you want to use
high-intensity: Atorvastatin over Pravastatin, (Rosuvastatin too)
40
Increased creatinine, paradoxical HDL lowering
Fenofibrate
41
LDL Cholesterol level ranges
Desirable less than 130, high greater 160
42
LDL for use of high intensity statin for >21 yo patients
>190
43
LDL receptor, ApoB defect; Decreased receptor-mediated removal of LDL from plasma
Defect in Familial Hypercholesterolemia
44
Lipoprotein effects of Fibrates
VLDL down, HDL up, TG down, LDL unchanged
45
Main beneficial effects of N-3 Fatty Acids
Reduced plasma TG
46
Metabolism of Fibrates
Gemfibrozil and Fenofibrate by liver
47
MOA of Fibrates
Ligand-activation of PPARalpha nulcear receptor
48
MOA's of Niacin
Inhibits moblization of FFA from adipocytes; Reduces hepatic TG synthesis and ApoB (VLDL) synthesis
49
Most common muscle syndrome on statins
Myalgia (10%), no rise in CPK
50
Overproduction of ApoB (VLDL)
Defect in Familial Combined Hyperlipidemia
51
PRIMARY tx to reduce risk of recurrent Coronary Disease Events?
Rosuvastatin
52
Principal dietary components that increase LDL-C
Cholesterol, Saturated and Trans-saturated fats
53
Promote ER to Golgi transport and cleavage of SREBP-2
How do stains increase number of LDL receptors
54
Pros of Bile Acid Seqs
Liver Disease OK, Powder and Pill, non-systemic
55
Statin metabolized by sulfation
Pravastatin
56
Statins metabolised by CYP3A4
Atorvastatin, Lovastatin, Simvastatin
57
Statins metabolized by CYP2C9
Fluvastatin, Rosuvastatin
58
T/F: Adverse effect of Ezetemibe is inhibiting absorption of fat soluble vitamins
FALSE
59
T/F: Statins are cleared almost completely first-pass?
TRUE
60
T/F: There are proven CV benefits of adding TG lowering drugs to statins
False, uncertain
61
TG level ranges
Desirable less than 120, High greater than 200
62
To Decrease LDL, use
Statins, can add Ezetimibe
63
To Increase HDL, use
Niacin
64
Total Cholesterol level ranges
Desirable less than 200, high greater 240
65
Type of fats that are recommended
Cis-mono unsaturated fats
66
Unique feature of Niacin
Reduces Lipoprotein(a)
67
What can limit use of Bile Acid Seqs
GI side effects (bloating, constipation)
68
What causes GI irritation in Niacin use
Release of Histamine in gut --> Increase gastric acid --> irritation
69
What does SREBP bind
sterol-regulatory-element 1
70
What drug causes insulin resistance
Niacin
71
What is side effect of immediate release niacin
flushing
72
What is SREBP-2
Binds to sequence in LDL promoter that is sterol-responsive --> transcribe LDL receptor
73
What should not be used with hx of Peptic Ulcer Disease
Niacin
74
What type of statin do you use in high risk ASCVD patients
High intensity if under 75, moderate if over
75
Which class is teratogenic
Statins
76
Which Fibrate can be given with renal disease
Gemfibrozil
77
Which Fibrate cannot be given with renal disease
Fenofibrate (renal excretion)
78
Which fibrate cannot be given with statins and why
Gemfibrozil is metabolized in liver by UGT1A1, same as statins
79
Which fibrate is excreted by Kidney
Fenofibrate

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