CVLipids

Question 1

These proteins carry lipid to plasma, to distriubte cholesterol to system for membranes, hormones, and bile acid production?

Answer 1

Lipoproteins w/ APO100 LDL / VDL. 1. Made in liver. 2. APO100 bind to cell receptors

Question 2

What are normal values for LDL, HDL, TGs

Answer 2

TG <150, HDL ,>40M, >50W, LDL <70, NON HDL <100

Question 3

What do HDL do to prevent ASCVD?

Answer 3

Take cholesterol back to liver

Question 4

Why do LDL increase as VLDL and TG decrease?

Answer 4

B/c LDL remants of both- Atherogenic, small dense

Question 5

Besides, CHD, CAD, ASCVD, what is risk with HIGH TGs?

Answer 5

High chylomircons INC risk of pancreatis

Question 6

How is inflammatin part of plaque?

Answer 6

LDL deposit in vessel, body attacks. MaC, Cytockine, TNF, CRP. Thins the cap. If cap ruptue occuldes or mobilizes. Occuldes-ischemia, MI, angina

Question 7

Why is it important to take statins at night?

Answer 7

Liver makes cholesetol at night, circadian. Ideal for shorter t1/2

Question 8

Why is ADE myopahy in statins?

Answer 8

Idopathic, maybe release myoglobin= rhabdo. STOP stain if on ABX erythromyocin or change to PRAVASTAIN

Question 9

What is important when starting statins?

Answer 9

Monitor and Baseline LFTs

Question 10

How shoud HCP rechallenge statins?

Answer 10

Get CK/CPK if myopathy, try low intensity statins

Question 11

What is max for pitive and rouva?

Answer 11

4mg pitive, rouva 40mg. OTHER all 80mg.

Question 12

How do statins work in dyslipidemia?

Answer 12

Blocks HMG CoA reductase, 1st step in making cholesterol. INC LDL catabolism via upregulation of LDL. DEC cholesterol, CHD mortality. Reduce CAD 2-3mo bc of inflammtory affect- reduce MACS, dilation NOx effect.

Question 13

What coenzyme is used with Statins?

Answer 13

CYP3A4 +2C9,19

Question 14

Which are the shorter halflives that need to be taken at night?

Answer 14

Lova, Prava, Fluva

Question 15

What is the most potent statin?

Answer 15

Pitavastaint. Dose 1-4mg. Erythro and Rifampin give Less dose.

Question 16

What are the LDL reduction rates with each statin?

Answer 16

1 HIGH-Rosu 20mg, Ator 40m mg-50%, 2. MOD Ator 10-20mg, Rosu 5-10, Sim 20-40mg-30-49%, 3. LOW Sim 10mg, Prava, Lova

Question 17

When is the max benefit observed with Statins?

Answer 17

Main LDL difference is initial dose. INC dose only dec LDL by 5-6%. 4-6-8wks

Question 18

Which drug is used for HIV pts?

Answer 18

Pravastatin bc no DI or CYP. IF on antifungals azoles- use Prava, Rosu

Question 19

Asians should avoid which statin?

Answer 19

Rosuvastatin

Question 20

When on Pitavastin, what should be monitored?

Answer 20

INR if on warfarin. CrCL adjust AVOID If <30

Question 21

What inc risk of myalagis rare ADR in Statins?

Answer 21

ETOH, Asian, Hypothyroid, LOW BMI, F, Vit D Dfx, CYP3A4-clarithro, erythor, cyclosporin,Sima @80, Gemibrozil+Cerivastin

Question 22

What risk do DM have w/ statins?

Answer 22

Elevated sugars

Question 23

WHAT ARE THE DI WITH FUNGALS AND ABX?

Answer 23

3A4 INHIB AZOLES AND MAC-CLARI, ERYI, CYCLOSPORIN

Question 24

How do the bile sequestrants work?

Answer 24

Resin that binds to bile, excreted via feces. Dec LDL from serum. DEC bile, Cholesterol will be removed from serum. DEC cholesterol. Granuel or tablets

Question 25

Which bile sequestrant is AVOIDed if TG>400

Answer 25

Cholestyramin, Colesitpol, Colesevalam. They can INC TG

Question 26

What needs to be monitored with bile sequestrants?

Answer 26

LFTs, LIVER ACTIVE

Question 27

What inhibits FA mobilization from peripheral tissue via DEC syntheiss of VLDL, INC LPL which lead to DEC TG, DEC HDL catabolism, and anticlotting?

Answer 27

Niacin. VitB3LIVER metab.

Question 28

What does Niacin indirectly affect?

Answer 28

DEC LDL, TG, TC. INC HDL

Question 29

What is the unique SE for Niacin?

Answer 29

1.Flushing 20min- take night 2. AVOID gout Pt d/t uric acid levels inc. 3. INC BS avoid DM

Question 30

Ms. Nike has DM, low HDL and HIGH TG, which agent is ideal?

Answer 30

Niacin.

Question 31

If Ms. Nike is on Niacin w/ a INC BMI and A1C, then what are the risk?

Answer 31

INC DM. Niacin has 5% inc in BS

Question 32

What should gout pt, liver dz, PUD pts avoid?

Answer 32

Niacin

Question 33

What should be AVOID in Pt with high LDL?

Answer 33

Fibric acid Dirivatives- NO LDL effect , 20-50% TGs, INC HDL 10-20%

Question 34

Pt has INC TG, what should be taken?

Answer 34

Fibricic acid Direivatives-Gemfibrozil, Fenofibrate, Clofibrate

Question 35

Pt specifically has High TG, normal LDL, which med is Ideal?

Answer 35

Gemfibrozil- DEC risk of CHD

Question 36

What are cautions of fibric acid derives?

Answer 36

AVOID in Renal and Liver DZ 2. Taken w/ warfarin INC effects 3. INC riks of rhado if taken w/ statins

Question 37

What inc LDL receptor synthesis, INC lipolysis of TG via LPL, DEC VLDL synthesis by binding to peroxisome prolifeator receptor alpha (ER liver and kidney?

Answer 37

Fibricic acid Direivatives

Question 38

What drug is avoided in cancer Pts?

Answer 38

Clofibrate

Question 39

What are ADE of fibric acid derives?

Answer 39

GI pain, cholelihaiasis, constipation, AFIB, myalgia Rhado w/ statin, Warfarin inhibitor

Question 40

Which agent has low TC effects, 9% by inhibiting absorption of cholesterol in small intestine?

Answer 40

Ezetimibe- used of pt who can't take statins. ADD W/ a statin LDL 18%, TC- 17%, TG 14%. NO HDLs

Question 41

Is Ezetimibe tolerable?

Answer 41

Yes. DI- cholestyramine reduce EZ (BILE Sequest).

Question 42

Mr. X has xanthomas on Achilles tendon, ring in corneal opague? What are ideal for them?

Answer 42

hypercholesteolemia (AD protein) MC inherited, xamthoma. Mipomerson-LIVer toxic BBW, Niacin, Lomitapide,- , new. PCSK9

Question 43

Mrs. X has INC TG and INC LDL, What is drug approach?

Answer 43

Statin or Niacin

Question 44

Mr. KFC TG are high, what should be offered?

Answer 44

Fibricic acid Direivatives, Niacin, MAYB Statin

Question 45

What are diet suggestion for LDL?

Answer 45

INC fiber, Omega 3, garlic, HMB-hydroxy beta methlbutyric

Question 46

IF pt has LDL 100 and MI? what intensity is recc?

Answer 46

Still HIGH, 50% will DEC w/in 4wks to 50 LDL. But pt still needs to stay on LDL bc w/ age LDL inc.

Question 47

Why were Cholestry ester transfer protein inhib removed?

Answer 47

Hypertension. CETP high in DM

Question 48

How do PCSK9s inhibitors work?

Answer 48

Block Binding to LDL receptor, reduce bodies ablity to clear LDL-c. INC LDL receptors in LIVER, thus signal LDL -C to come out of blood back to liver.

Question 49

What are lifestyle mods 1st step?

Answer 49

Med diet, Active 150min/wk mod, resistance, 75-vigorous

Question 50

What is highest lowering agent?

Answer 50

PCKS9 70%, $$$. -ocumabs

Question 51

What is unigue about PCSK9s?

Answer 51

Protein, INJ. SQ 1x 2wk

Question 52

What combos with statin are not approved?

Answer 52

Niacin and Fibrate

Question 53

Calulate LDL w/ TC 220, HDL 30, TG 185?

Answer 53

220-(30+185/5)= 153, No direct measure of LDL. Error if TG >400

Question 54

Calulate non HDL w/ TC 220, HDL 30, TG 185?

Answer 54

220-30= 190, NON HDL Cholesterol reflects cholesterol n VDL and LDL, APOB measures. More accurate for ASCVD

Question 55

Can you measure direct LDL?

Answer 55

Only if pt not fasting, with HIGH TG.

Question 56

Which MC drugs inc LDL?

Answer 56

Thiazides, Steroids, Fibric acids, Cyclosporin

Question 57

Which MC drugs inc TGs?

Answer 57

Estorgens, Cyclosporins, BB, Antipyschoitcs, Bile acid

Question 58

Who shoud be in high intensity statins?

Answer 58

>45, FH CHD, smoking, HTN, Low HDL, Metobolic syndrome-TG,HDL, DM, Abdomen width, HTN,. PMH of ASCVD

Question 59

Who shoud be in high intensity statins <75y or >75 w/ high LDL?

Answer 59

<75 yo to no risk prevent primary event. >75 MOD- Atorstatin or Rosuvastain