Exam 2 antihyperlipidemics- Kinder Flashcards Preview

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Flashcards in Exam 2 antihyperlipidemics- Kinder Deck (73):
1

What are statins

HMG-CoA reductase inhibitors

2

what are the fibrate drugs

fenofibrate
gemfibrozil

3

what are the bile acid sequesterants

cholestyramine
colesevelam
colestipol

4

what are the cholesterol absorption inhibitors

ezetimibe

5

vytorin is a comination of what drugs

simvastatin and ezetimibe

6

what are the new Tx out for homozygous familial hypercholesterolemia

lomitapide
mipomersen

7

what are the major components of chylomicrons

dietary TGs and cholesterol

8

where are chylomicrons synthesized

intestine

9

what is the mechanism of catabolism of chylomicrons

TG hydrolysis by LPL and remant uptake by liver

10

What is LDL make up of

cholesteryl esters

11

what is HDL made up of

phospholipids, cholesteryl esters

12

what lipoproteins are made in the liver

VLDL and HDL

13

which lipoprotein has the most protein

HDL

14

which lipoprotein has the most lipid

chylomicrons

15

how do plaques form, general path sequence

LDL retention in subendothelial space leading to oxidation that increases plasminogen inhibitor and inhibits NO
massive accumulation of cholesterol with increased inflammatory response

16

What are the targe LDL choesterol levels and what is considered very high

want 190 very high

17

what is the target for total cholesterol and what is considered high

want 240 high

18

what are the normal ranges of HDL

60 is high

19

What is the LDL goal for CHD or CHD risk eqivalent?
at what LDL level do you intiate drug therapy

goal LDL 130

20

what is the LDL goal for patients with 0-1 risk factors? when do you start Tx

goal 190

21

What are the risk equivalents for CHD

symtomatic carotid artery disease
peripheral arterial disease
AAA
diabetes

22

what are the risk factors for hyperlipidemia

age
family Hx of premature CHD
cigarette smoking
HTN
low HDL

23

what are non drug Tx options for HLD

lifestyle changes, diet, exercise, smokin cessation

24

what are the drug Tx options for HLD

MHG-CoA Reductase Inhibitors (statins)
Niacin, Vit B3
Fibric Acid dervatives (fibrates)
bile acid sequestrants (resins)
cholesterol absorption inhibitors

25

non drug Tx for HLD should not be used alone in what scenarios

severe hypercholestermia
known CHD
CHD risk equivalents
PVD

26

what are the dietary recs for HLD

total fat 20-25% calories
saturated fat <200 mg
carbs 50-60% total calories
dietary fiber 20-30 g

27

What parts of diet increase TGs?

alcohol, total fat, excess caloric intae

28

what parts of diet increase LDL

cholesterol, saturated and trans fats

29

What is HMG-CoA reductase

the rate limiting enzyme in cholesterol synthesis

30

which statins have longer half lives

atorvastatin and rosuvastatin

31

What statins use CYP3A4

lovastatin, simvastatin, atorvastatin

32

what stains use CYP2C9

fluvastatin and rosuvastatin

33

What are adverse reactions of statins

LFT elevation, CPK elevation, rhabdomyolysis, myopathy

34

what are contraindications for statins

pregnancy

35

What drugs cause bad interactions with statins

increase statin: CYP inhibitors, cyclosprine, ketoconozole fibrates
decrease statin: CYP inducers (phenytoin and rifampin)

36

How does niacin work

inhibits lipolysis of TG in adipose and reduces circulatin FFA

37

what are the affects of niacin on apoA1 and plasma HDL

decrease apoA1 clearance and increase plasma HDL

38

what are the affects of niacin on clotting factors

decrease fibrinogen levels and increase tpa

39

why do you have to dose constantly with nicotinic acid, niacin

extensive first pass. t1/2 is 60 minutes

40

what are the adverse ractions with niacin

cutaneous flush (PG mediated), pruritis, acanthosis nigricans, hepatotoxicity

41

what are the contraindications with niacin

hepatic disease, active PUD, caution DM

42

how do fibrates work

PPARalpha agonists that regulate expression of proteins involved in lipoprotein structure and function, increased expression LPL

43

what is the main result of fibrates

decreased TG levels

44

what are the adverse reactions with fibrates

GI, lithiasis, myositis, myopathy

45

what are the contraindications with fibrates

avoid in hepatic or renal dysfunction, pregnancy

46

what main anticoagulant has a drug interaction with statins

warfarin, increased risk of rhabdomyolysis if used with statins

47

how do bile acid sequestrants work

bind bile acids increasing excretion in stool. so ehnaced conversion of cholesterol to BA and increased LDL clearance

48

what are the adverse reactions with bile acid sequestrants (resins)

GI constipation and nausea, impaired ADEK absorption

49

what are the contraindications with resins

caution in diverticulitis, bowel disease and cholestasis

50

what are the drug interactions with resins

impairs drug absorption- separate admin

51

how does ezetimibe work

inhibits NPC1L1 inhibits absorption of cholesterol and plant sterols

52

what is adverse reaction with ezetimibe

diarrhea

53

what are the drug interactions with resins

have to separate time of administartion by at least 4 hours because resins will bind up drugs

54

what is the overall effect of statins on lipoproteins

decrease LDL

55

what is the overall effect of niacin on lipoproteins

increase HDL

56

what is the overall effect of resins on lipoproteins

decrease LDL

57

What is the main Tx course for atherosclerotic CV disease ASCVD

maximizing statin intesnsity reduces amount of events

58

What are the 4 statin benefit groups

1) ASCVD
2) primary elevation of LDL-C >190 mg
3) age 40-75 with DM and LDL-C 70-189 mg
4) No clinical ASCVD or DM who are 40-75 y/o and LDL-C 70-189 mg with ASCVD risk >7.5%

59

if patient is above 21 and has clinical ASCVD what Tx is first line

75 moderate intensity statin

60

patient does not have ASCVD but has LDL-C >190 Tx?

high intesnsity statin

61

patient does not have ASCVD or LDL-C >190 but has DM I or II and is 40-75. Tx?

moderate intensity
high if estimated 10 y risk is >7.5%

62

what does high intesnsity statin mean

daily dose lowers LDL-C by approx 50%

63

what does moderate intesnsity statin mean

daily dose lowers LDL-C by approx 30-<50%

64

what are the high intesnsity statins available and doses

atorvastatin 40-80 mg
rosuvastatin 20 mg

65

what cause homozygous familial hypercholesterolemia

defects in LDL R gene

66

What are Tx options for homozygous familial hypercholesterolemi

Mipomersen injection
Lomitapide

67

How does mipomersen lower cholesterol

inhibits apoB 100 synthesis by binding mRNA and reducing formation

68

what are adverse reactions to mipomersen

injection site reactions, flue like symtoms, HA, elevated liver transaminases

69

what are the contraindications for mipomersen

moderate or severe hepatic impairment, active liver disease

70

what is administration method for lomitapide

once dialy oral dosew

71

what is mechanism of lomitapide

binds and inhibits microsomal TG transfer protein, lcoated in lumen of ER. prevents assembly of apoB

72

what are adverse reactions to lomitapide

GI diarrhea, nausea, increased liver transaminases, hepatic fat accumulation

73

what are the contraindications of lomitapide

pregnancy