Hyperlipidemia

Question 1

First line tx for hyperlipidemia?

Answer 1

Lifestyle modification

Question 2

What disease has an LDL receptor deficiency (due to gene mutation) leading to increased levels of LDLs?

Answer 2

Familiar hypercholesterolemia

Question 3

Why do you chest cholesterol levels after pt has undergone weight loss and not during their weight loss?

Answer 3

B/c cholesterol levels are low during weight loss and stabilize for one month after

Question 4

Lovastatin, Simivastatin, Atorvastatin are what dug class?

Answer 4

HMG-CoA Reductase inhibitors

-statins

Question 5

MOA for Lovastatin, Simivastatin, Atorvastatin?

Answer 5

Inhibit HMG-CoA reductase to increase high affinity LDL receptors (more LDL into cells to reduce serum LDL levels)

Question 6

DOC for lowering LDLs?

Answer 6

Statins (most effective when LDL is elevated)

Also lower TGs and increase HDL and stabilize plaques

Question 7

What size dose of Atorvastatin do you give in high risk in atherosclerosis CVD pts?

Answer 7

High dose (stabilize plaques)

Question 8

What two statin drugs are pro drugs?

Answer 8

Lovastatin and simvastatin

Question 9

What drug class interacts w/ P450s-CYP3A4?

Answer 9

Statins

Question 10

At what time of day should statins be taken?

Answer 10

Before bed (peak cholesterol synthesis at night)

Question 11

What can Atorvastatin be taken at anytime of day?

Answer 11

Longer half life

Question 12

What drug class increases serum levels of aminotransferase (LFTs)?

Answer 12

Stains (metabolized in liver)

May cause liver damage in pts w/ established liver disease or alcoholics

Question 13

Myopathy, increased serum creatine kinase (due to exercise) and rhabdomyolysis are adverse effects of what drug class?

Answer 13

Statins

Question 14

What two populations are statins contraindicated?

Answer 14

Pregnant, Active liver disease

Question 15

Do P450 inhibitors increase or decrease plasma concentration of statins?

Answer 15

Increase

EX: grapefruit, ,macrolides, ketoconazole, ritonavir

Question 16

Do P450 activators increase or decrease plasm concentration so statins?

Answer 16

Decrease

EX: Barbiturates, Rifampin, griseofulvin, phenytoin

Question 17

Cholestyramine is what class of meds?

Answer 17

Bile acid binding resins

Question 18

MOA for Cholestyramine?

Answer 18

Bind bile acids and prevent their intestinal reabsorption (increased LDL receptors –> increased LDL absorption –> decreased LDL levels

Question 19

Does cholestyramine have any effect on homozygous familial hypercholesterolemia?

Answer 19

No

Question 20

What makes Cholestyramine a safe drug?

Answer 20

It is not absorbed by the body.

Safe in pregnancy

Question 21

When should cholestyramine be taken?

Answer 21

With meals b/c needs bile production to be effective

Question 22

Most common side effects of Cholestyramine?

Answer 22

Bloating and constipation

Question 23

Cholestyramine may impair the absorption of what drugs?

Answer 23

Acids or fat soluble drugs like: Digitalis, thiazides, statins, tetracylines, thyroxine, aspirin

Question 24

What is the MOA for Niacin?

Answer 24

Lowers plasma VLDL and LDL by inhibiting VLDL secretion

Also inhibits hepatic cholesterolgenesis

Question 25

Niacin is a combo of what?

Answer 25

nicotinic acid and Vit. B3

Question 26

Will Niacin increase or decrease levels of HDL?

Answer 26

Increase (most effective agent to do so) | - Used in pts who can't exercise

Question 27

Cutaneous vasodilation, feeliing like "on fire" is a side effect of what drug?

Answer 27

Niacin | TX w/ prostaglandin aspirin beforehand

Question 28

Why should Niacin be avoided in DM pts?

Answer 28

Impairs glucose tolerance

Question 29

Gemfibrozil is what drug class?

Answer 29

Fibric acid derivative

Question 30

MOA for Gemfibrozil?

Answer 30

Up regulates lipoprotein lipase activity (increases catabolism of VLDL) and turns on genes to involved in fatty acid oxidation via nuclear receptor

Question 31

What does Gemofibrozil lower?

Answer 31

VLDLs, TGs, Cholesterol

Question 32

DOC for hypertriglyceridemia?

Answer 32

Gemfibrozil (fibrates)

Question 33

What meds will increase LFTs and incidence of cholelithiasis/gallstones?

Answer 33

Gemfibrozil (fibrates)

Question 34

What class of drugs lowers LDLs the most?

Answer 34

Statins (HMG-CoA reductase inhibitors)

Question 35

What drug blocks intestinal absorption of cholesterol?

Answer 35

Ezetimibe

Question 36

What drug has no effect on CV endpoints?

Answer 36

Ezetimibe

Question 37

Ezetimibe is often combinesdwith what drug for synergistic effects?

Answer 37

Statins Ezetimibe can only be used in combo therapy

Question 38

Alirocumab and Evolocumab are what drug class?

Answer 38

PCSK9 Inhibitors

Question 39

MOA for Alirocumab and Evolocumab

Answer 39

Antibodies that inhibit PCSK9 from binding to LDL Receptor | PCSK9 binds to LDLR on hepatocyte surface --> LDLR degradation

Question 40

How are Alirocumab and Evolocumab administered?

Answer 40

Monthly subQ injections