Exam 2

Question 1

What are the LDL lowering meds?

Answer 1

• Statins
• Ezetimibe
• Bile Acid Sequestrants
• PCSK9 Inhibitors
• Niacin

Question 2

What are the TG lowering meds?

Answer 2

• Omega 3s
• Niacin
• Fibric Acid Derivatives

Question 3

Statins (HMG-CoA Reductase Inhibitors) – MECHANISM OF ACTION & TARGET

Answer 3

Target → LDL

MOA → Competitive inhibitor of HMG-CoA Reductase which stops the endogenous production of LDL

Question 4

Statins (HMG-CoA Reductase Inhibitors) – ADVERSE EFFECTS

Answer 4

• Pregnancy category X
• Hepatic Dysfunction (AST/ALT monitoring)
• Headache
• Muscle Complication (myalgia, myopathy, rhabdomyolysis)

Question 5

Statins (HMG-CoA Reductase Inhibitors) – DDI

Answer 5

-CYP3A4 Substrates (ALS) → Atorvastatin, Simvastatin, and Lovastatin
→inhibitors increase concentration of statin which
causes muscle complications (grapefruit juice,
protease inhibitors, anti-fungal, warfarin)

• Binding Statin w/ other meds (bile acid sequestrants and calcium containing products)
• Simvastatin and Amlodipine (bc Aml causes Sim to break down fast causing muscle problems)

Question 6

Statins & Pleiotropic Effect

Answer 6

• Increase plaque stability (so parts of plaque doesn’t break off and cause stroke)
• Decrease platelet activation and aggregation
• Decrease vascular inflammation
• Decrease endothelial dysfunction

Question 7

Statins: Primary Prevention

Answer 7

-Moderate intensity
-No cardiac event
→LDL > 190
→Diabetes + age > 40
→Diabetes + age < 40 – with high ASCVD risk

Question 8

Statins: Secondary Prevention

Answer 8

• Clinically evident cardiac event

- Angina, STEMI, NSTEMI, Stroke, TIA, and Peripheral Artery Disease

Question 9

Statins – INTENSITY BY DOSE

Answer 9

HIGH (>50%) – most LDL clearance
→Atorvastatin
→Rosuvastatin

MODERATE (30-50%)
→Atorvastatin
→Rosuvastatin
→Simvastatin
→Pravastatin
→Lovastatin

LOW (<30%) -- used when have family hx
→Simvastatin
→Pravastatin
→Lovastatin
→Fluvastatin

Question 10

Statins (HMG-CoA Reductase Inhibitors) – DRUGS

Answer 10

→Rosuvastatin -- most potent, least muscle issues & DDIs
→Atorvastatin
→Simvastatin
→Lovastatin
→Pravastatin
→Fluvastatin --least potent

Ending in -STATIN

Question 11

Chylomicron → HDL Pathyway

Answer 11

Chylomicron → VLDL (via liver) → LDL (via adipose) → HDL (via other tissue)

Question 12

Low Density Lipoproteins (LDL)

Answer 12

• “Bad Cholesterol”
• Deposit extra cholesterol into vascular tissue → causing atherosclerosis
• Removed by the liver

Question 13

High Density Lipoproteins (HDL)

Answer 13

• “Good Cholesterol”
• Removes excess cholesterol from cells and brings them to liver to be excreted
• Removes cholesterol directly from artery walls
• Stops atherogenic lipoproteins from oxidizing

Question 14

Atherosclerosis

Answer 14

-Build up of plaque in arteries

→Ex: CAD, Angina, CKD, PAD

Question 15

The Lipid Panel

Answer 15

Total Cholesterol (<200)

LDL (<130)

HDL (>40)

TGs (<150)

Question 16

Dyslipidemia

Answer 16

-One or more abnormalities of any blood lipids (deficiency of HDL or overproduction of LDL/TGs)

• Hyperlipidemia → too much LDL
• Hypertriglyceridemia → too much TGs
• Familial Hypercholesterolemia → genetically defective LDL clearance

Question 17

Treatment of Dyslipidemias

Answer 17

#1 -- Diet
#2 -- Exercise
#3 -- Alcohol Avoidance/ Decreased Intake
#4 -- Smoking Cessation
#5 -- Lipid Lowering Meds

Question 18

Bile Acid Sequestrants – MECHANISM OF ACTION & TARGET

Answer 18

Target → LDL
MOA → Bind to bile acid in GI tract to increase secretion (get rid of bile acid) and then cholesterol is utilized to create more bile acids

Last line use from LDL lowering meds

Question 19

Bile Acid Sequestrants – ADVERSE EFFECTS

Answer 19

• Poorly Tolerated (isn’t absorbed by body, floats in the GI tract and causes GI issues)
• GI Side Effects (bloating, gas, constipation, abdominal pain)
• Potential increase in TGs

Question 20

Bile Acid Sequestrants – DDI

Answer 20

-Bind to many meds → making them ineffective
-Give med 1 HOUR BEFORE or 4 HOURS AFTER
→Warfarin
→Levothyroxine
→Digoxin
→Statins
-Contraindicated if patient has hypertriglycerides

Question 21

Bile Acid Sequestrants – DRUGS

Answer 21

→Cholestyramine -powder
→Colestipol -powder
→Colesevelam -tablet

Starting in CHOLE- or COLE-