Prophylaxis of Atherosclerotic Cardiovascular Disease

Question 1

Atherosclerotic Cardiovascular Disease
(ASCVD)

Answer 1

thicken of artery
angina 1st symptom
damage to vessels result in MI or stroke; related to increasing LDL

Question 2

Cholesterol

Answer 2

component of all cell membranes and membranes of intracellular organelles; synthesis of the hormone, bile salts; from diet but mostly by LIVER (HMG-CoA reductase)

Question 3

Lipoproteins

Answer 3

HDL
LDL
VLDL

Question 4

HDL

Answer 4

high density
carry cholesterol
want high reduces the risk of ASCVD

Question 5

LDL

Answer 5

mostly cholesterol
delivery of cholesterol
want low; a lot is a big risk for atherosclerosis

Question 6

VLDL

Answer 6

triglycerides; deliver triglyceride; want low; if high risk of pancreatitis

Question 7

Triglycerides

Answer 7

store unused calories and provide your body with energy;

eat more calories than you burn, particularly “easy” calories like carbohydrates and fats, you may have high triglycerides

Question 8

ASCVD Risk Factors

Answer 8

Age, African American, HTN, smoking, low HDL, diabtets

Question 9

Non-Pharmacologic Methods for Cholesterol Reduction
(Therapeutic Lifestyle Changes)-FIRST LINE TX

Answer 9

Diet (reduce sat fat, cholesterol, trans fat; increase fiber)

exercise
weight control
smoking reduction
do with drugs

Question 10

Antihyperlipidemics

Answer 10

only if lifestyle changes didnt work; 
Bile Acid Sequestrants
Fibrates
Nicotinic Acid
HMG-CoA reductase inhibitors (Statins)
(LDL will go back if not taken meds)

Question 11

LDL-Lowering Drugs - Statins

Answer 11

lovastatin
atorvastatin
pravastatin
simvastatin

Inhibit the enzyme HMG CoA reductase cholesterol synthesis

reduce LDL increase HDL

Question 12

lovastatin
atorvastatin
pravastatin
simvastatin

Answer 12

so statins are most effective when taken in the evening (usually with dinner); improved clinical outcome

Question 13

side effects of statins

Answer 13

monitor liver (hepatoxicity)
eye exams for cataracts
MUSCLE ACHES
watch for Rhabdo
GI
memory
diabetes
pregnancy category X

Question 14

LDL-Lowering Drugs - Statins drug interactions

Answer 14

antibiotics, HIV meds, antifungals, and cardiac meds.

Question 15

LDL-Lowering Drugs – Bile Acid Sequestrants

Answer 15

LDL binds with bile acids prevent absorption and promote excretion;
Cholestyramine
Colesevelam

Question 16

Colesevelam - NEWER

Answer 16

does not impair vitamins; fewer drug interactions; can cause hypoglycemia; minimal GI symptoms

Question 17

Cholestyramine- OLDER

Answer 17

impair vitamin ADEK; may require supplements; space 1 hour before or 4 after; mix the powder with water juice soup applesauce (constipation)

Question 18

LDL-Lowering Drugs - Other

Answer 18

ezetimibe

blocks dietary cholesterol absorption and inhibits reabsorption in the small intestine

Question 19

ezetimibe

Answer 19

reduces LDL reduces triglycerides; slight increase HDLs; alone or with statin

Question 20

ezetimibe side effects

Answer 20

rhabdo
hepatitis pancreatitis
thrombocytopenia

Question 21

Triglyceride-Lowering Agents-Fibrates

Answer 21

increase risk of rhabdo with statins; 3rd line; reduce triglycerides, increase HDL no effect on LDLs

Gemfibrozil
fenofibrate

Question 22

Gemfibrozil

fenofibrate

Answer 22

GI, rash, gallstones, hepatotoxicity

if used with warfarin it increases anti coag effect monitor INR

Question 23

Antihyperlipidemic-Niacin

Answer 23

Reduces VLDL & LDL
Increases HDL

side effects: flush, warm, burning skin; decrease over time with aspirin