Chapter 50: prophylaxis of atherosclerotic CV disease Flashcards by Hailey Steele

Q

drugs are only employed when what two things are tried first?

A

diet and exercise

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Q

lipoproteins serve as carriers for what two things in the blood?

A

cholesterol and triglycerides

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Q

what two lipoproteins contribute to arthersclerosis?

A

VLDL and LDL

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Q

the goal of therapy should be to do what?

A

decreases VLDL and LDL levels

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Q

what lipoprotein should be increased?

A

HDL

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Q

why do we want HDL levels to be increased?

A

it helps protect against atherosclerosis

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Q

what do all lipoproteins that deliver cholesterol and triglycerides to non hepatic tissues contain?

A

apolipoprotein B-100.

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Q

drug therapy alone is not enough to achieve the LDL goal which is to keep the level below what

A

less than 100 mg/dl

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Q

what are the two primary goals of treating dyslipidemia?

A

reducing the risk of atherosclerotic disease and reducing the risk of type 2 diabetes.

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Q

what are the most effective antilipedics?

A

statins

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Q

when being treated with a statin, one must avoid drinking what?

A

grapefruit juice, a cytochrome p-450 inhibitor

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Q

what class is the suffix “statin” for?

A

HMG-CoA Reductase Inhibitor

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Q

how does atorvastatin lower the blood cholesterol levels?

A

increase HDL, decrease LDL, decrease triglycerides

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Q

when are statins most effective

A

in the evening

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Q

why are statins most effective in the evening?

A

the drug will peak at the time that the most cholesterol is being synthesized

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Q

what else can statin drugs do other than lipid effects?

A

stabilize plaque within blood vessels to prevent emboli

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Q

what do statins decrease the risk of and how?

A

thrombus by inhibiting platelet deposition/aggregation and suppressing production of thrombin.

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Q

how do statins enhance the ability of blood vessels to dilate?

A

improving abnormal vascular endothelium

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Q

how do statins decrease LDL cholesterol?

A

increasing the number of LDL receptors on hepatocytes

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Q

what does increasing LDL receptors lead to?

A

increase of LDL being removed from the blood

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Q

what role does HMG-CoA reductase play in the cholesterol biosynthesis?

A

it is the final step in converting cholesterol

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Q

statins lower VLDL levels by decreasing the production of what protein?

A

apolipoprotein in B-100

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Q

the potential for statins to promote bone formation by enhancing activity of osteoblasts which will reduce the risk of what

A

osteoporosis

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Q

what are the 2 serious adverse effects of the statins?

A

hepatotoxicity, rhabdomyolysis

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what two components are released from injured or inflamed muscles?

creatinine kinase and myoglobin

what is defined as muscle disintegration and marked elevated levels of CK

rhabdomyolysis

the elevation of CK is how many times the upper normal limit

greater than 10

what can result from the muscle leaking myoglobin?

renal failure

how often should liver function tests be done when using statins?

before starting treatment and every 6-12 months thereafter

when should you discontinue a statin?

when AST levels rise 3 times above the UNL.

what other lipid-lowering drug increases the risk of rhabdomyolysis when given concurrently with statins?

fibrates

what is a B3 vitamin that lowers LDL and triglyceride levels?

Nicotinic acid (Niacin)

what increases HDL levels better than any other drug?

Nicotinic Acid

The OTC dose to correct Niacin deficiency is the 25x the amount to reduce what?

reducing lipoprotiein levels

intense flushing of the face, neck and chest when taking statins is due to what?

peripheral vasodilation

how can you minimize the intense flushing?

taking 325 mg of Aspirin 30 minutes before each dose of a statin. or by using an XR form instead of an IR formulation.

what organ is nicotinic acid toxic to?

the liver

what two serum levels should be monitored since they are increased when taking nicotinic acid?

uric acid and glucose

what lipoprotein do bile acid sequestrates decrease?

LDL

bile acids contain a significant amount of what

cholesterol

what is bile acid cholesterol used to do?

emulsify fats

along with fat soluble vitamins, what else can bile acid sequestreants reduce?

iron, folic acid, B12

where do bile acid sequestrates work?

GI tract

what is the main ADR of bile acid sequestrates

constipation

what do bile acid sequestrates bind to

bile acid-->form large complexes which cannot be absorbed or recycled

what do bile acid sequestrates promote?

promote excretion via the feces

oral medications known to interact with bile acid sequestrates should be taken when

either 1 hour before or 4 hours after the sequestrate

what are the three main drugs that interact bile acid sequestrates?

digoxin, warfarin, and thiazide diuretics

where does ezetimibe block cholesterol absorption

small intestine

what can taking ezetimibe with a fibrate cause

increased risk of gallstones

what 2 other ADRS (besides liver issues) can ezetimibe cause?

pancreatitis and thrombocytopenia

what are the most effective drugs at lowering triglycerides?

fibrates

what effect do vibrates have on LDL levels?

little to no effect

how does gemfibrozil increase plasma TG levels?

lowering VLDL levels which transport TG

how does gemfibrozil increase the risk of gallstones

increases biliary cholesterol saturation

who should not take gemfibrozil

people who have pre-existing gall bladder diseases

what drug does gemfibrozil displace from albumin causing more free drug to be available in the body

warfarin

vibrates increase the synthesis of the enzyme lipoprotein lipase which does what

increase the breakdown and elimination of triglycerides

vibrates increase the production of what which in turn facilitates the production of HDL

both A-I and A-II

what prescription drug has been FDA approved as an Omega-3 fatty acid

Lovaza

what does Lovaza reduce

triglycerides

lovaza can also be purchased as what?

OTC fish oil

how is Pcska inhibitors administered?

SQ

pcska inhibitors are a class of drug that is used as what

an adjunct therapy when maximal amounts of statins have been reached.

why could someone develop antibodies against a pcska inhibitor

because it is composed of proteins

who is pcska inhibitors usually used for?

people with familial hypercholesteremia