Antihyperlipidemics

Question 1

what are the two major lipids?

Answer 1

cholesterol and triglyceride

Question 2

what do lipoproteins do?

Answer 2

transport cholesterol and triglycerides in blood

Question 3

chylomicrons are made of mostly ____

Answer 3

triglycerides

Question 4

VLDLs are made of mostly ___

Answer 4

triglycerides

Question 5

LDLs are made of mostly ____

Answer 5

cholesterol

Question 6

HDLs are made of mostly ___

Answer 6

proteins

Question 7

Apo A-1

Answer 7

in HDL, reverse cholesterol transport

Question 8

Apo B-100

Answer 8

in VLDL, IDL, LDL - is LDL receptor ligand and bad

Question 9

Apo B-48

Answer 9

in chylomicrons - produced in intestine

Question 10

Apo E

Answer 10

reverse cholesterol transport with HDL

Question 11

Apo CII

Answer 11

in chylomicrons and VLDL
binds LPL to enhance TG lipolysis

Question 12

LPL does what

Answer 12

breaks VLDL to LDL

Question 13

HL does what

Answer 13

IDL to LDL

Question 14

cholesterol synthesis pathway

Answer 14

acetoacetyl coa - HMG Coa - mevalonate - cholesterol

Question 15

what ratio is key in assessing risk of CVD

Answer 15

total cholesterol to HDL
greater than 4.5 is increased risk CVD

Question 16

hyperlipoproteinemia diseases

Answer 16

atherosclerosis, premature CAD, stroke

Question 17

hypertriglyceridemia diseases

Answer 17

pancreatitis, xanthomas, CHD

Question 18

MOA of bile acid resins

Answer 18

inhibit reabsorption of bile acids from intestine , up regulate LDL receptors in liver

Question 19

bile acid resins side effects

Answer 19

constipation and bloating

Question 20

bile acid resins drug interactions

Answer 20

acetaminophen, thiazides, ezetimibe, oral contraceptives, warfarin, digoxin, fibrates, TZDs, steroids

Question 21

ezetimibe mechanism of action

Answer 21

inhibits cholesterol absorption from diet, inhibits NPC1L1

Question 22

ezetimibe adverse effects

Answer 22

well tolerated, low incidence of muscle pain

Question 23

statin mechanism of action

Answer 23

competitively inhibit HMG-CoA reductase the rate limiting step in cholesterol biosynthesis, upregulate LDL receptors so more hepatic uptake of LDL

Question 24

HMG-CoA reductase inhibitors indications

Answer 24

hypercholesterolemia and after MI

Question 25

prodrug statins

Answer 25

lovastatin and simvastatin

Question 26

statin CYP 3A4 substrates

Answer 26

lovastatin, simvastatin, atorvastatin

Question 27

statin CYP 2C9 substrates

Answer 27

fluvastatin, rosuvastatin

Question 28

statin sulfation metabolism

Answer 28

pravastatin

Question 29

pitavastatin undergoes ____

Answer 29

enterohepatic recirculation

Question 30

statin adverse effects

Answer 30

skeletal muscle effects, rhabdomyolysis, hepatotoxicity, increased incidence of type 2 diabetes

Question 31

bempedoic acid is used for ___

Answer 31

adjunct to statins, heterozygous familial, ASCVD

Question 32

bempedopic acid side effect

Answer 32

gout

Question 33

PCSCK9 MOA

Answer 33

inhibits degradation of PCSK9 receptors in liver increase LDL-R and reduce LDL levels

Question 34

PCSK9 inhibitors directions

Answer 34

injection subq every 2 weeks

Question 35

inclisiran MOA

Answer 35

hybridizes PCSK9 mRNA and directs degradation

Question 36

incliserin used for

Answer 36

adjunct to statins in HeFH and ASCVD

Question 37

Apo B lipoprotien inhibitors use

Answer 37

homozygous familial

Question 38

apo B lipoprotein inhibitors drugs

Answer 38

lomitapide, mipomersen, evinacumab

Question 39

lomitapide MOA

Answer 39

inhibits assembly apo B by inhibiting MTTP, interferes with chylomicron and VLDL making

Question 40

lopitamide indication and warning

Answer 40

homozygous familial liver damage risk - Rx program

Question 41

does lopitamide MOA require LDL-R

Answer 41

no

Question 42

mipomersen MOA

Answer 42

anti-sense oligonucleotide inhibitor of apo B100

Question 43

mipomersen indication and warning

Answer 43

homozygous familial liver damage (hepatic steatosis)

Question 44

evinacumab indication and MOA

Answer 44

homozygous familial increases LPL

Question 45

does evinacumab require LDL-R

Answer 45

no

Question 46

fibric acid MOA

Answer 46

PPAR-alpha activators must undergo activation reduce serum triglycerides

Question 47

fibric acid side effects

Answer 47

skeletal muscle / rhabdo - caution with statins

Question 48

fibric acid drug interaction

Answer 48

warfarin, increase effects

Question 49

niacin mechanism

Answer 49

reduce serum triglycerides, increase HDL

Question 50

niacin targets and actions

Answer 50

decrease fatty acid transport to liver decrease triglyceride export via VLDL increase HDL and reverse transport decrease cholesterol via HDL transport

Question 51

niacin use

Answer 51

raising HDL

Question 52

niacin adverse effects

Answer 52

prostaglandin mediated vasodilation and flushing/itching treat with ibuprofen or aspirin

Question 53

omega 3 indications

Answer 53

TGs over 500

Question 54

adverse effects omega 3

Answer 54

can increase LDL

Question 55

Friedwald Equation

Answer 55

calculates LDL-c LDL = TC - HDL - TG/5

Question 56

high intensity statins

Answer 56

atorvastatin 40-80 mg rosuvastatin 20-40 mg

Question 57

low intensity statins

Answer 57

simvastatin 10 mg pravastatin 10-20 mg lovastatin 20 mg fluvastatin 20-40 mg

Question 58

hydrophilic statins

Answer 58

rosuvastatin and pravastatin

Question 59

simvastatin contraindications

Answer 59

-onazole, -omycin, gemfibrozil, danazol

Question 60

do not exceed 10mg simvastatin

Answer 60

verapamil diltiazem

Question 61

do not exceed 20mg simvastatin

Answer 61

amiodarone amlodipine

Question 62

fibrates contraindications

Answer 62

hx gallbladder disease dialysis persistent liver disease

Question 63

PCSK9 inhibitors adverse effects

Answer 63

influenza, injection site reaction