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Pharmacology Exam 2 > Hyperlipidemia > Flashcards

Flashcards in Hyperlipidemia Deck (51):
1

What are the 5 major risk factors for CVD?

smoking
hypertension (>140/90 or on meds)
low HDL (45, women >55)
Fam hx of early CHD
Age (men >45, women >55)

2

LDL goal - "high risk" (CHD)

<70)

3

LDL goal - "moderately high risk" (2+ risk factors)

<130

4

LDL goal - "moderate risk" (2 risk factors)

<130

5

LDL goal - "lower risk" (0-1 risk factors)

<160

6

Risks factors for metabolic syndrome

3 or more:
abdominal obesity (men >40, women >35)
tg >150
low HDL (men 130/>85)
fasting glucose >110

7

What is the treatment approach for hyperlipidemia?

1. initiate TLCs
2. Treat secondary causes (DM, meds, etc.)
3. Treat LDL to goal
4. When LDL is to goal, treat high tg (>200)
5. Attempt to increase HDL if <40

8

What are the TLCs (therapeutic lifestyle changes) for LDL lowering?

1. TLC diet (low fat, low cholesterol), plant stanols/sterols, fiber
2. weight reduction
3. increased physical activity

9

*What part of the cholesterol panel do statins mostly act on?

LDL reduction

10

*What part of the cholesterol panel do bile-acid resins mostly act on?

LDL reduction

11

*What part of the cholesterol panel do fibric acid derivatives mostly act on?

decrease triglycerides

12

*What part of the cholesterol panel do omega-3 fatty acids mostly work on?

decrease triglycerides

13

*Statins - MOA

inhibit HMG CoA reductase --> decrease in cholesterol production (up regulation of LDL receptors and enhanced clearance)
*only works if receptors are not defective

14

Statins - time of day to administer

usually at night so it peaks when cholesterol synthesis is the highest (2-4am)

15

Side effects are low with statins but include:

elevated liver enzymes
myopathy
rabdomyolysis

16

DDI - Statins (because of CYP450)

gembibrozil
Protease inhibitors
itraconazole/ketoconazole/voriconazole
emycin/clarithromycin

17

Which 2 statins reduce LDL the most?

Atorvastatin (Lipitor) 60%
Rosuvastatin (Crestor) 60+%

18

What level are we getting under control first in drug therapy for high cholesterol?

LDL

19

What level do we treat next after lowering LDL?

Triglycerides

20

What drug can reduce total cholesterol/LDL, Apo B, non-HDL or TG and increase HDL in patients where mono therapy is not adequate?

Niacin extended release/Simvastatin (Simcor)

21

As you increase the dose of statin, you increase the risk of _______.

Myopathy

22

What level is considered very high LDL?

>190mg/dl

23

What can be added to statins for very high LDL?

ezetimibe +/- nicotinic acid
bile acid sequestrates +/- nicotinic acid

24

What class are: cholestyramine (Questran), colestipol (Colestid) and Colesevelam (Welchol)?

bile acid binding resins

25

What time of day are bile acid binding resins given?

with meals (acts on bile acid that is present during digestion)

26

*Bile acid binding resins - side effects

GI (bloating, constipation, gas), increase in liver enzymes, increase in TG
*hard to tolerate*

27

Bile acid binding resins - DDI

fat soluble vitamins (binds)
give 1 hr before or 4 hrs after meal

28

What is the selective cholesterol absorption inhibitor?

Ezetimibe (Zetia)
combo agent simvastatin + ezetimibe (Vytorin)

29

What is the nicotinic acid derivative used for hyperlipidemia?

ER Niacin (Niaspan)
IR Niacin (available OTC)

30

Nicotinic acid derivative dosing considerations

start out low and titrate b/c of side effects
effective range 1500-2000 mg/day
take at night (b/c of flushing)
take ASA or NSAID 30 min before
avoid ETOH

31

*Nicotinic acid - side effects

flushing
hepatotoxicity (esp. at higher doses)
glucose homeostasis/insulin resistance
blurry vision
gout

32

Classification of serum TG

normal <150
borderline high 150-199
high 200-499
very high 500+

33

What is the secondary target of therapy for hyperlipidemia?

non-HDL (VLDL + LDL)

34

At what level do you treat TG?

>200

35

Treatment of triglycerides

1. treat underlying factors
2. niacin
3. fibric acid derivative "fibrates"
4. fish oil
5. therapeutic phlebotomy

36

What are the underlying factors for elevated triglycerides?

diet, ETOH, DM, hypothyroidism, antiretrovirals, steroids,

37

What is the treatment goal for very high triglycerides (>500)?

prevent acute pancreatitis

38

*What are the two formulations for fibrates?

Fenofibrates and Gemfibrozil
*Fenofibrates are favored b/c of dosing (no restriction with food timing)

39

*Fibrates - clinical issues

gall stones
Gemfibrozil can increase LDL and fenofibrates can decrease LDL

40

Fibrates - DDI

protein bound so can displace other meds: warfarin, ASA, glyburide, statins, niacin

41

Fibrates - ADE

contraindication: hepatic or renal dysfunction and preexisting gall bladder disease

42

How much fish oil is needed/day to reduce TG?

2-4 grams

43

Fish oils should be discontinued if what occurs?

acute bleeding episode such as hemorrhagic stroke

44

Causes of low HDL (<40 mg/d)

physical inactivity
type 2 diabetes
smoking
genetic

45

What med is the DOC for low HDL treatment?

Niacin

46

Red yeast rice - active ingredient

Monacolin K (comparable to Lovastatin)
can lower cholesterol

47

Red yeast rice - dosage

600 mg po bid

48

Risk factors for statin induced myopathy

female
65+
kidney disease
hypothyroidism

49

Red yeast rice - effects on levels

lowers TC, TG and LDL
increases HDL

50

Ezetimibe (Zetia) - MOA

(selective cholesterol absorption inhibitor)
blocks niemann Pick C1 like 1 peptide (NPC1L1) in the small intestine

51

At what level should triglycerides be treated before LDL?

>500