lipid lowering agents

Question 1

modifiable risk factors for CAD

Answer 1

smoking
sedentary lifestyle
stress
obesity
DM
gout
HTN

Question 2

unmodifiable risk factors for CAD

Answer 2

age
gender
genetics

Question 3

LDL

Answer 3

low density lipoproteins produced by liver
tightly packed cholesterol, triglycerides and lipids
carried by proteins that enter circulation
broken down for energy or stored for future use

Question 4

HDL

Answer 4

high density lipoproteins produced by liver
enter circulation as loosely packed lipids
used for energy
pick up remnants of fats and cholestrol left by LDL breakdown

Question 5

total cholestrol levels

Answer 5

normal <200
elevated 200-239
high >240

Question 6

LDL levels

Answer 6

optimal <100
normal 100-129
elevated 130-159
high 160-189
very high >190

Question 7

HDL levels

Answer 7

low <40

high >60

Question 8

triglyceride levels

Answer 8

normal <150
elevated 150-199
high 200-499
very high >500

Question 9

causes of hyperlipidemia

Answer 9

excessive intake of dietary fats
genetic alterations in fat metabolism
hypercholestrolemia, hypertriglyceridemia

Question 10

bile acid sequestrants

Answer 10

decrease plasma cholesterol levels

Cholestyramine (generic), colestipol (Colestid), Colesevelam (WelChol)

Question 11

bile acid sequestrants actions

Answer 11

binds bile acids in intestine
allows excretion in feces instead of reabsorption
causes cholesterol to be oxidized in liver and serum levels to fall

Question 12

bile acid sequestrants indications

Answer 12

primary hypercholesterolemia

pruritus 2/2 partial biliary obstruction

Question 13

bile acid sequestrants pharmacokinetics

Answer 13

not absorbed systemically

excreted through feces

Question 14

bile acid sequestrants contraindcations

Answer 14

allergy
completely biliary obstruction
abnormal intestinal function
pregnancy/lactation

Question 15

bile acid sequestrants adverse effects

Answer 15

headache
fatigue
drowsiness
GI irritation + constipation
increased bleeding times
vitamin A + E deficiencies

Question 16

bile acid sequestrants drug/drug interactions

Answer 16

malabsorption of fat soluble vitamins
thiazide diuretics
digoxin
warfarin
thyroid hormones
corticosteroids

Question 17

cholestyramine

Answer 17

bile acid sequestrant prototype

Question 18

HMG-CoA inhibitor action

Answer 18

early rate-limiting step in synthesis of cellular cholesterol involves the enzyme HMG-CoA reductase
HMG-CoA inhibitors block the enzyme and serum cholesterol and LDL level decrease
HDL level increases

Question 19

HMG-CoA inhibitor drugs

Answer 19

-statins

Atorvastatin (Lipitor) 
Fluvastatin (Lescol)
simvastatin (Zocor) 
rosuvastatin (Crestor)
Lovastatin (generic)

Question 20

HMG-CoA inhibitor indications

Answer 20

elevated cholesterol, triglycerides, and LDL

in pts with primary hypercholesterolemia, increases HDL-C

familial hypercholesterolemia

Question 21

HMG-CoA inhibitor pharmacokinetics

Answer 21

absorbed from GI tract
first pass metabolism by liver
excreted through urine/feces

Question 22

HMG-CoA inhibitor contraindications

Answer 22

allergy
active liver disease
pregnancy/lactation

Question 23

HMG-CoA inhibitor caution

Answer 23

impaired endocrine function

Question 24

HMG-CoA inhibitor adverse effects

Answer 24

GI: flatulence, abd pain, n/v, constipation
CNS: headache, dizziness, blurred vision, insomnia, fatigue
liver failure
rhabdomylosis

Question 25

HMG-CoA inhibitor drug interactions

Answer 25

erythromycin, cyclosporine, gemfibrozil, niacina digoxin, warfarin estrogen grapefruit juice

Question 26

Atorvastatin (Lipitor)

Answer 26

HMG-CoA inhibitor prototype ``` PO slow onset peak 1-2 h duration 20-30 h excreted in bile ```

Question 27

cholesterol absorption inhibitors

Answer 27

``` new class of drugs Exetimibe (Zetia) ```

Question 28

cholesterol absorption inhibitor (Zetia) actions

Answer 28

works in brush border of small intestine to inhibit the absorption of cholesterol

Question 29

cholesterol absorption inhibitor (Zetia) indications

Answer 29

homozygous familial hyperlipidemia homozygous sitosterolemia lowers serum cholesterol, sitosterol and campesterol levels

Question 30

cholesterol absorption inhibitor (Zetia) pharmacokinetics

Answer 30

absorbed in GI tract metabolized in liver excreted in urine/feces given PO, peaks 4-12 h

Question 31

cholesterol absorption inhibitor (Zetia) contraindications

Answer 31

allergy | pregnancy/lactation if combined with a statin

Question 32

cholesterol absorption inhibitor (Zetia) cautions

Answer 32

pregnancy/lactation (monotherapy) elderly pts liver disease

Question 33

cholesterol absorption inhibitor (Zetia) adverse effects

Answer 33

``` abd pain diarrhea headache dizziness fatigue muscle/back pain ```

Question 34

cholesterol absorption inhibitor (Zetia) drug interactions

Answer 34

cholestyramine, fenofibrate, gemfibrozil, antacids cyclosporine fibrates warfarin

Question 35

niacin

Answer 35

vitamin B3, inhibits release of free fatty acids from adipose tissue increases rate of triglyceride removal from plasma

Question 36

fenofibrates

Answer 36

inhibits triglyceride synthesis in liver to decrease LDL increased uric acid secretion may stimulate triglyceride breakdown

Question 37

gemfibrozil

Answer 37

inhibits peripheral breakdown of lipids reduced production of triglycerides and LDL increases HDL

Question 38

When caring for a pt taking an HMG-CoA inhibitor, what would be an appropriate intervention?

Answer 38

arrange for periodic opthalmic exams to monitor for cataract development