Hyperlipidemics

Question 1

Secondary disease

Answer 1

Risk factors
Diet
Drug induced (steroids, birth control, hormones, diuretics)

Question 2

Lipoproteins encompass these 5 things

Answer 2

Chylomicrons
VLDL
ILDL
LDL
HDL

Question 3

Total cholesterol should be under __ while triglycerides should be under __

Answer 3

200; 150

Question 4

Lifestyle changes to lower lipids

Answer 4

Dietary modification
Lose weight
Exercise
Quit smoking

Question 5

CHD risk factors

Answer 5

Men > 45 women > 55
DM
Family he of CHD
Smoking 
Low HDL

Obesity
Sedentary life
Poor diet

Question 6

MOA for statins

Answer 6

Block rate limiting step in cholesterol biosynthesis lowering LDL and TG levels; raise HDLs

Question 7

Statins are derived from

Answer 7

Red rice yeast

Question 8

CI for statins

Answer 8

Pregnancy
Breast feeding
Can cause congenital abnormalities
Active hepatic dz

Question 9

First line to reduce LDL

Answer 9

Statins

Question 10

ADRs of statins

Answer 10

Ototoxicity 
Hepatotoxicity
Nvd 
Rhabdomyolysis
Dec cognitive fxn

Question 11

Statin drug properties

Answer 11

Lipophilicity
High F
Limited protein binding
CYP 450 3A4 substrates

Question 12

Statins with least DDIs

Answer 12

Pravastatin and rosuvastatin

Question 13

What should be monitored with statins

Answer 13

Lipids- baseline, 4-8 wks later and 6-12 months later
LFTs
CPK

Question 14

Statin examples

Answer 14

Atorvastatin
Fluvastsatin 
Lovastatin 
Pravastatin 
Rosuvastatin 
Simvastatin
Pitavastatin

Question 15

Dosing statins

Answer 15

Give at bedtime

Have to get dose right initially

Question 16

Bile sequestering agents MOA

Answer 16

Binds to bike acids and forms complex that gets excreted so less bile acids are around to emulsify fats

Question 17

CI for bile sequestering agents

Answer 17

Hypertriglyceridemia

Question 18

ADRs for bile sequestering agents

Answer 18

GI effects

Question 19

DDIS for bile sequestering agents

Answer 19

Prevents absorption of most drugs so need to take I hr before or 4 hrs after

Question 20

When to use bile sequestering agents

Answer 20

Pt does not reach LDL a goal with statins or pt cannot tolerate statins

Question 21

Bile sequestering agents

Answer 21

Cholestyramine
Colestipol
Colesevelam

Question 22

MOA fibric acid derivatives

Answer 22

Activates peroxisome proliferator activator to dec triglycerides and inc HDLS

Question 23

Fibric acid derivatives used mostly for

Answer 23

Hypertriglyceridemia or marked HDL deficiency

Question 24

CI for fibric acid derivatives

Answer 24

Severe renal or hepatic failure

Biliary or gallbladder disease

Question 25

ADRs for fibric acid derivatives

Answer 25

GI, rash, urticaria, alopecia, impotence, myopathy

Question 26

Nicotinic acid MOA

Answer 26

Inhibits lipolysis dec TG synthesis

Question 27

DDIs for fibric acid derivatives

Answer 27

Compete with warfarin and sulfonylureas for protein binding sites

Question 28

Examples of fibric acid derivatives

Answer 28

Gemfibrozil | Fenofibrate

Question 29

ADRs for nicotinic acid

Answer 29

Flushing and pruritis-reduce by ASA pretreatment | GI upset, PUD, hepatic dysfunction hyperglycemia

Question 30

When to use nicotinic acid

Answer 30

Statins fail to lower LDL or pt cannot tolerate statins

Question 31

Ezetimibe MOA

Answer 31

Inhibits absorption of cholesterol at brush border of small intestine leading to dec delivery to liver and inc cholesterol clearance

Question 32

Combo products

Answer 32

``` Ezetimibe/simvastatin Nicotinic acid/ lovastatin Nicotinic acid/ simvastatin Amlodipine/ atorvastatin Pravastatin/Asa Ezetimibe/ atorvastatin ```

Question 33

Probuchol

Answer 33

Rarely used but lowers LDL and HDL

Question 34

Misc agents

Answer 34

``` Vitamin E Garlic Dietary supplements Alternative therapies Fish oil ```

Question 35

Primary disease

Answer 35

Familial disorder