Lec 17 Antihyperlipidemic Drugs Flashcards Preview

Cardio Exam 1 > Lec 17 Antihyperlipidemic Drugs > Flashcards

Flashcards in Lec 17 Antihyperlipidemic Drugs Deck (34):
1

What is major regulator of serum LDL?

hepatocyte LDL receptors

2

What is action of statins?

HMG CoA reductase inhibitors --> block cholesterol production in liver --> stimulates SREBP [sterol regulatory element binding protein] which upregulate LDL receptors on hepatocytes

3

What is comparative efficacy:
atorvastatin
rosuvastatin
lovastatin
simvastatin

rosuvastatin > atorvastatin > simvastatin > lovastatin

double doses to get same efficacy
rosuvastatin 1/2 the dose of atorvastatin

lovastatin needs 4x simvastatin

4

What is rule of 6?

double dose of statin to get another 6% lowering

5

What is atorvastatin basic dose to use to calculate needed dosages?

10 mg atorvastatin = 35% reduction

6

What is HDL in men vs women?

45 in men
55 in women

7

What is goal for HDL?

HDL > 60

8

Which 2 statins are capable of 50% LDL reduction?

- atorvastatin
- rosuvastatin

9

What dietary changes to reduce LDL?

- less saturated fat, cholesterol, trans fatty acids

10

What are side effects of statins?

- myalgias
- rhabdomyalisis
- high AST/ALT

11

Is there still increased benefit from decreasing LDL below 100?

linear increase benefit with lower LDL

12

Whats up with grapefruit and statins?

- statins inhibit CYP450 in gut
- grapefruit inhibits cyp450
- if have lots of grapefruit --> more statin absorbed, higher plasma levels of statin

13

What is action of ezetimibe?

blocks receptor in intestinal brush border to block cholesterol absorption from gut --> decrease hepatocyte intracellular cholesterol conc --> more LDL receptors in liver

14

What happens if give ezetimibe monotherapy?

decrease LDL and triglycerides

15

What happens if you give statin and ezetimibe?

its like doubling the statin dose 3 times = get huge decrease LDL and TG

= greater LDL reduction than atorvastatin 20 or 40 alone

16

What are side effects of ezetimibe?

rare myalgias

17

Does ezetimibe improve outcomes?

decreases LDL but unproven yet to lower ischemic CV events

18

What is effect of statins? [on LDL/HDL/TG/outcomes]

- decrease LDL by a lot
- increase HDL
- decrease TG
- decrease risk of poor outcome [death/MI]

19

What is effect of ezetimibe? [on LDL/HDL/TG/outcomes]

- decrease LDL
- not really affect HDL and TG
- not known whether it decreases risk of poor outcome

20

What is effect of bile acid binders [on LDL/HDL/TG/outcomes]

- 15-20% decrease LDL
- slightly increase HDL and TG
- decrease CHD events within 3 yrs

21

Fibrates [on LDL/HDL/TG/outcomes]

- decrease LDL a little
- increase HDL
- decrease TG a lot
- prevent ischemic CV disease

22

Niacin [on LDL/HDL/TG/outcomes]

- decrease LDL
- increase HDL a lot [#1 choice]
- decrease TG
- decrease CV risk

23

What is difference cholestyramine vs colesevalam?

cholestyramine = first gen; anion binder = lots of drug interactions b/c binds other medications

colesevalam = docking site more specific for bile acid --> less drug interactions

24

What are side effects of bile acid binders [colesevalam and cholestyramine]?

difficult to take = large pills
constipation
decrease absorption other drugs

25

What normal TG level?

normal < 150
high >200

26

When do chylomicrons appear?

at TG > 1000 --> can lead to pancreatitis

27

What is risk with high TG?

independent risk factor for CHD especially with low HDL < 40

28

Which meds can you use to lower TG?

- statins
- fibric acids
- niacin
- fish oils

29

Which meds can you use to lower LDL?

d

30

Which meds can you use to increase HDL?

- niacin is best
- fibrates

minor effect: statins, bile acid binders

31

What is mech of action fish oil?

inhibits VLDL formation so less VLDL secreted

good for treating high TG

32

What is action of fibrates on HDL/TG/LDL?

HDL: increases Apo A-I/II --> incraese HDL production

TG: decrease TG synthesis --> decreased VLDL synthesis; increase LPLipase --> increase VLDL clearance

LDL: decrease # of LDL particles

33

Does fish oil decrease CV events?

no

34

Does niacin added to statins bring extra benefit?

nope