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Pharmacology > Hypercholesterolemia > Flashcards

Hypercholesterolemia Flashcards

1
Q

What is the most common cause of cardiovascular disability and death in the US

A

Coronary heart disease (CHD) or Coronary artery disease (CAD)

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2
Q

What is the most common cause of cardiovascular disability and death in the US

A

Coronary heart disease (CHD) or Coronary artery disease (CAD)

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3
Q

male vs. female risk of hypercholesterolemia less than 40 y.o.

A

males > females

8:1 ratio

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4
Q

male vs. female risk hyper cholesterolemia greater than 70 y.o.

A

equal male and female

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5
Q

Lifestyle modifications to reduce cholesterol

A
  1. diet
  2. exercise
  3. weight reduction
  4. reduction of excessive alcohol
  5. smoking cessation
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6
Q

What are the two major lipids

A

cholesterol and triglyceride

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7
Q

Cholesterol

A

major component of all cell membranes, steroid hormones, and bile products

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8
Q

Triglycerides

A

transfer energy from foot into the cells

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9
Q

What carries cholesterol

A

lipoproteins (LDL, HDL, VLDL)

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10
Q

What carries Tg

A

VLDL

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11
Q

Total cholesterol

A

LDL+HDL+VLDL

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12
Q

Goal for cholesterol

A
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13
Q

LDL is deposits cholesterol where

A

into the cells and arteries

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14
Q

HDL cholesterol function

A

Good cholesterol. Removes cholesterol from tissues and arteries

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15
Q

VLDL function

A

major carrier of triglycerides

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16
Q

High levels of VLDL is associated with what

A

pancreatitis

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17
Q

Low HDL is associated with what

A

CHD

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18
Q

High LDL is associated with what

A

CHD

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19
Q

What is secondary prevention

A

prevention M/M in pt with pre-existing CHD

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20
Q

High doses of what medications for secondary prevention

A

atorvastatin

rosuvastatin

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21
Q

What is primary prevention

A

preventing M/M in pt with risk factors for developing CHD

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22
Q

Moderate doses of what medication for primary prevention

A

various statin medicaitons

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23
Q

What are the risk factors associated with CHD

A
  1. Smoking
  2. HTN
  3. Low HDL 45 and women >55) (greater than or equal to)
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24
Q

male vs. female risk of hypercholesterolemia less than 40 y.o.

A

males > females

8:1 ratio

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25
Q

male vs. female risk hyper cholesterolemia greater than 70 y.o.

A

equal male and female

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26
Q

Lifestyle modifications to reduce cholesterol

A
  1. diet
  2. exercise
  3. weight reduction
  4. reduction of excessive alcohol
  5. smoking cessation
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27
Q

What are the two major lipids

A

cholesterol and triglyceride

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28
Q

symptomatic myopathy or myalgia

A

(up to 30%) muscle weakness, pain and other muscle related complaints WITHOUT elevated CK

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29
Q

Triglycerides

A

transfer energy from foot into the cells

30
Q

What carries cholesterol

A

lipoproteins (LDL, HDL, VLDL)

31
Q

What carries Tg

A

VLDL

32
Q

Total cholesterol

A

LDL+HDL+VLDL

33
Q

Goal for cholesterol

A
34
Q

LDL is deposits cholesterol where

A

into the cells and arteries

35
Q

HDL cholesterol function

A

Good cholesterol. Removes cholesterol from tissues and arteries

36
Q

VLDL function

A

major carrier of triglycerides

37
Q

High levels of VLDL is associated with what

A

pancreatitis

38
Q

Low HDL is associated with what

A

CHD

39
Q

Consider referring pt for further evaluation if

A
  1. soreness/fatigue does not resolve 48-72 hrs
  2. persistent weakness in several muscle groups not involved in strength training
  3. performance levels below age matched norms
  4. changes in MMT performance (dynamometer)
40
Q

What is secondary prevention

A

prevention M/M in pt with pre-existing CHD

41
Q

High doses of what medications for secondary prevention

A

atorvastatin

rosuvastatin

42
Q

What is primary prevention

A

preventing M/M in pt with risk factors for developing CHD

43
Q

Moderate doses of what medication for primary prevention

A

various statin medicaitons

44
Q

What are the risk factors associated with CHD

A
  1. Smoking
  2. HTN
  3. Low HDL 45 and women >55) (greater than or equal to)
45
Q

HMG-CoA Reductase Inhibitors (statins)

A 
Rosuvastatin
Atorvastatin
Pravastatin
Pitavastatin
Simvastatin
Lovastatin
Fluvastatin
SR lovastatin
46
Q

MOA HMG-CoA reductase inhibitors

A

inhibit cholesterol production by inhibiting enzyme HMG-CoA reductase (enzyme necessary for liver to make cholesterol)

47
Q

What are the beneficial actions of statins

A

Reduced M/M

Pleotropic effects: promote plaque stability

48
Q

What are pleotropic effects

A

Promote plaque stability, reduce inflammation at plaque site, improve vessel dilation, reduce risk of thrombosis

49
Q

Muscle myopathy

A

general term include of all muscle pathology

50
Q

symptomatic myopathy or myalgia

A

(up to 30%) muscle weakness, pain and other muscle related complaints WITHOUT elevated CK

51
Q

Myositis

A

symptomatic myopathy or myalgia + elevated CK

52
Q

Asymptomatic myopathy

A

elevated CK without symptoms

53
Q

Rhabdomyolysis

A

muscle cell destruction and deterioration of renal function. Usually in combination with elevated CK

54
Q

What happens if Rhabdo is untreated

A

kidney damage

55
Q

When are symptoms of muscle myopathy more apparent

A

during or after tenuous exercise

56
Q

Mild CK elevation

A
57
Q

Moderate CK elevation

A

> 10 X ULN but

58
Q

Marked CK elevations

A

> 50 X ULN (stop statins)

59
Q

How long do symptoms from statin CK elevation take to resolve

A

Can take up to 1-2 months to resolve

60
Q

T/F it is common to try 3-5 statins before assuming patient is intolerant

A

True

61
Q

Synergistic muscle myopathy if statins are taken with what

A
  1. fibrates (gemfibrozil) and niacin
62
Q

Increased statin blood levels and risk of myopathy if what is taken in conjunction with statins

A
  1. grape fruit juice
  2. certain antibiotics (erythromycin, clarithromyacin)
  3. Certain azole anti fungal drugs
  4. Ditlitazem, verapamil, amlodipine
63
Q

What drug causes itching and flushing of the face, neck, and ears

A

niacin

64
Q

Fibric acid derivative (fibrates)

A

Gemfibrozil

fenofibrate

65
Q

What happens if fibrates are mixed with statins

A

increased risk of muscle myopathy

66
Q

Bile Acid binding resins

A

Cholestyramine
colestiopl
colesevelam

67
Q

What happens if bile acid binding resins are taken orally

A

Not absorbed - binds to bile acids in intestines

68
Q

ADR for bile acid binding resins

A

constipation
heartburn
N/V
Gas, belching, bloating

69
Q

Dietary cholesterol absorption inhibitor

A

ezetimibe

70
Q

MOA dietary cholesterol absorption inhibitor

A

Works in gut wall to prevent cholesterol absorption through intestinal villi.
Wont absorb cholesterol from diet when taking this

Pharmacology (6 decks)

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