Antihyperlipidemics

Question 1

What lipid levels is CVD most closely associated with

Answer 1

Elevated LDL

Decreased HDL

Question 2

If you decrease LDL by 30mg/dL how much does the RR of CHD decrease

Answer 2

30%

Question 3

Aside from lipid profile, what are the 4 other risk factors for CHD

Answer 3

Smoking
HTN
Obesity
Diabetes

Question 4

What are the 5 hyperlipidemia phenotypes

Answer 4

1 Hyperchylomicronemia
2A Hypercholesterolemia (LDL)
2B Combined hyperlipidemia (LDL and VLDL)
3 Dysbetalipoproteinemia (IDL)
4 Tryglyceridemia (VLDL)
5 Mixed hypertriglyceridemia (CM and VLDL

Question 5

Why is secondary hyperlipidemia more prevalent than primary

Answer 5

Sedentary lifestyle

Excess fats in diet

Question 6

What are the Statins (HMG-CoA Reductase inhibitors) in decreasing potency

Answer 6

Rosuvastatin	
Atorvastatin	
Simvastatin	
Fluvastatin	
Lovastatin	
Pravastatin

Question 7

Which is the only drug in the niacin class

Answer 7

Niacin

Question 8

What are the Fibrate Derivatives

Answer 8

Gemfibrozil

Fenofibrate

Question 9

What are the Bile Acid Binding Resins

Answer 9

Cholestyramine
Colestipol
Colesevelam

Question 10

What are the Cholesterol absorption inhibitors

Answer 10

Ezetimibe

Question 11

What are the omega-3 FAs

Answer 11

EPA
DHA
Lovasa

Question 12

DOC for LDL reduction

Answer 12

Statins

Question 13

Contraindicated in Pregnancy

Answer 13

Statins - Category X

Question 14

Given as Adjuvant with statins

Answer 14

Niacin

Question 15

DOC in pregnancy and children

Answer 15

Bile acid binding resins (Category B)

Question 16

What do statins do

Answer 16

Increase endothelial function

Decrease platelet aggregation, inflammation, plasma CRP and LDL

Question 17

How do statins work

Answer 17

Competitive inhibition of HMG-CoA Reductase
Decrease chol synth
Upregulate LDLr - More LDL clearance

Question 18

What can statins used for

Answer 18

Decrease CV mortality

Not as good for FH

Question 19

Statins are most effective when combined with

Answer 19

Resins
Niacin
Ezetimibe

Question 20

Main AE for Statins

Answer 20

Elevated Aminotransferases (LFTs 3x elevated)
Myopathy
Rhabdomyolysis
Myoglobinuria

Question 21

Statins combined with what increases the incidence of Myopathy and Rhabdomyolysis

Answer 21

Fibrate Derivatives

Question 22

What is the most effective drug at increasing HDL

Answer 22

Niacin

Question 23

What is the only drug that decreases Lp(a)

Answer 23

Niacin

Question 24

Which drug decreases VLDL, LDL and La(a)

Answer 24

Niacin

Question 25

Mechanism of Niacin action

Answer 25

``` Activate Gi Inhibit HSL, TAG synth, VLDL Activate LPL Decrease fibrinogen Increase tPa ```

Question 26

Main Niacin AE

Answer 26

``` Acanthosis nigricans Hepatotoxicity Hyperglycemia (insulin resistance) Cutaneous flush Pruritis, rash Gout ```

Question 27

What do fibrates do

Answer 27

Decrease TAGs Decrease VLDL Increase HDL

Question 28

What do Fibrates act on

Answer 28

Activate PPAR-alpha

Question 29

What do fibrates do in 2B

Answer 29

Increase LDL | Decrease TAG

Question 30

When do you give Fibrates

Answer 30

``` 3 Dysbetalipoproteinemia (IDL) 4 Tryglyceridemia (VLDL) ```

Question 31

Who gets myositis with fibrates

Answer 31

Renal insufficiency

Question 32

What can cause cholelithiasis

Answer 32

Fibrates

Question 33

Which class of drugs is completely excreted in feces

Answer 33

Bile acid binding resins

Question 34

Which class of drug is only useful in pts with isolated high LDL

Answer 34

Bile acid binding resins

Question 35

What is contraindicated if there is increased TAGs

Answer 35

Bile acid binding resins

Question 36

Which Bile acid binding resins has fewer AE

Answer 36

Colesevelam

Question 37

Which class of drugs may decrease fat soluble vit absorption

Answer 37

Bile acid binding resins

Question 38

What do you combine Bile acid binding resins with

Answer 38

Statins or Niacin

Question 39

How do Bile acid binding resins work

Answer 39

Bind anionic bile acids (prevent reabsorption) Decrease chol Increase LDLr Increase HDL

Question 40

What does Ezetimibe do

Answer 40

Inhibit chol absorption Decrease LDL Increase HDL

Question 41

How does Exetimibe work

Answer 41

Inhibit intestinal transport of chol Decrease CM Upregulate LDLr

Question 42

Ezetimibe AE

Answer 42

Impaired liver function Myositis Increase chol synth

Question 43

What drugs cause myositis

Answer 43

Gemfibrozil Fenofibrate Ezetimibe

Question 44

What drugs can increase HDL long term

Answer 44

Omega-3s

Question 45

How do omega-3s work

Answer 45

Decrease TAG | Increase FA oxidation

Question 46

When do you give omega-3s

Answer 46

Adults | >500mg/dL TAGs

Question 47

Omega-3 AEs

Answer 47

Increase total LDL