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module 2a > 11/2 > Flashcards

11/2 Flashcards

1
Q

cholesterol absorption inhibitor

A

ezetimibe

can further dec LDL by 12-20% when combined with statin

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2
Q

fibrates

A

gemfibrozil, fenofibrate, fenofibric acid

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3
Q

fibrates SE

A

GI, rash, myalgia, dizziness

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4
Q

fibrates increase levels of

A

statins, ezetimibe, SUs, warfarin

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5
Q

CETP inhibitors

A

CETP (cholesterol ester transfer protein) turns HDL to LDL
increase HDL
anacetrapib and evacetrapib increase HDL up to 130% and decrease LDL 35-40%

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6
Q

PCSK9 inhibitors MOA

A

inhibit the binding of PCSK9 to LDL receptors and upregulate the recycling of LDL receptors resulting in a drastic decrease in LDL-C

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7
Q

PCSK9 inhibitors indication

A

adjunct to diet and statin to reduce LDL in familial heterozygous hypercholesterolemia or atherosclertic CVD

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8
Q

PCSK9 inhibitors

A

alirocumab and evolocumab
expensive (cheaper than heart attack)
reduce LDL 60-70%

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9
Q

red yeast rice

A

contains lovastatin

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10
Q

mipomerson

A

inhibits ApoB100 synthesis
adjunct to lipid-lowering medications and diet to reduce LDL-C, apoB, TC amd non-HDL-C on patients with HoFH
BBW of hepatotoxicity
200 mg SQ once weekly

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11
Q

lomitapide

A

microsomal TG transfer protein inhibitor indicated as an adjunct to a low-fat diet and other lipid-lowering treatments in pts w HoFH
BBW of hepatatoxicity
5-60 mg PO QD
blocks production of VLDL and chylomicron

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12
Q

ATP III

A

CHD and CHD risk equivalents greater than 20% 10 year risk: goal LDL less than 100 mg/dL
2+ risk factors and less than 20% 10-year risk: goal LDL less than 130 mg/dL
0-1 risk factors: goal LDL less than 160 mg/dL

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13
Q

ATP III risk factors

A
  • cigarette smoking
  • HTN (BP>140/90 or antiHTN med)
  • low HDL
  • FH of CHD (dad younger than 55, mom younger than 65)
  • age (men 45, women 55)
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14
Q

ATP III CV risk eqivalents

A
  • eqivalent of having a heart attack
  • CHD
  • symptomatic carotid artery disease
  • peripheral artery disease
  • AAA (abdominal aortic aneurysm)
  • DM
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15
Q

statin benefit groups

A
  • clinical ASCVD
  • LDL-C greater than 190 mg/dL
  • diabetes and 40-75 yo
  • ASCVD 10 year risk >7.5% and 40-75 yo
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16
Q

clinical ASCVD (ACC/AHA)

A
  • acute coronary syndrome (ACS)
  • hx of MI
  • stable or unstable angina
  • coronary or other arterial revascularization
  • stroke/TIA
  • peripheral artery disease (atherosclerotic origin)
17
Q

statin intensity (ACA/AHA) in benefit groups

A

clinical ASCVD: high if younger than 75, moderate if older than 75
LDL greater than 190: always high
DM and age 40-75: high if ASCVD risk is greater than 7.5% and moderate if ASCVD risk is less than 7.5%
ASCVD risk greater than 7.5% and age 40-75: mod-high

18
Q

who does NOT automatically get a statin (but may still get a statin)?

A
  • age 21-39 without ASCVD and LDL less than 190
  • age >75 without ASCVD and LDL less than 190
  • ASCVD risk less than 5% and LDL 70-189
  • hemodialysis or NYHA class III or IV HF
19
Q

high-intensity statins

A

daily dose lowers LDL-C >50%

  • atorvastatin 40-80 mg
  • rosuvastatin 20-40 mg
20
Q

mod intensity statins

A

daily dose lowers LDL 30-50%

  • atorvastatin 10-20 mg
  • pravastatin 40-80 mg
  • rosuvastatin 5-10 mg
  • simvastatin 20-40 mg
  • lovastatin 40 mg
  • fluvastatin 80 mg
  • pitavastatin 2-4 mg
21
Q

low intensity statin

A 
daily dose lowers LDL by 30%
-simvastatin 10 mg
-pravastatin 10-20 mg
-lovastatin 20 mg
fluvastatin 20-40 mg
-pitavastatin 1 mg
22
Q

ASCVD risk factors (NLA)

A

age: male older than 45, female older than 55
FH of early CHD: dad younger than 55 or mom younger than 65
smoker
HTN: BP >140/90 or current use of BP med
low HDL-C: male less than 40 or female less than 50

23
Q

NLA risk categories

A
  • very high: clinical ASCVD or DM with 2 or more risk factors or end organ damage
  • high: DM with 0-1 risk factors, CKD stage 3B or 4, LDL greater than 190, 3 or more major risk factors, 2 major risk factors and high 10 year risk score (ATP III framingham greater than 10% or pooled cohort greater than 15%)
  • moderate: 2 major risk factors and 10yr risk 5-15%
  • low: 0-1 major risk factors
24
Q

NLA risk assessment

A

identify very high or high risk patients
count major ASCVD risk factors (0-1 and no other indicators = low; 3 or more = high)
if 2 major ASCVD risk factors, calculate ASCVD risk to decide between mod and high

25
Q

NLA target

A

primary: non-HDL-C and LDL-C
secondary: ApoB

26
Q

NLA target goals

A

low-high risk: non-HDL-C less than 130, LDL-C less than 100, ApoB less than 90
very high risk: non-HDL-C less than 100, LDL-C less than 70, ApoB less than 80

27
Q

lifesytle modifications to reduce TG

A

5-10% weight loss
restrict alcohol, sugar and refined carbs
moderate or higher intensity physical activity (at least 150 min/week)

28
Q

classification of TG levels

A

less than 150: normal
150-199: borderline high
200-499: high
greater than 500: very high

29
Q

ACC/AHA management of TG

A

lifestyle management, rule out medications as cause of elevated TG, use TG-lowering medications to prevent pancreatitis in those with TG > 500

30
Q

NLA management of TG

A
  • high (200-499): replace dietary carbs with unsaturated fats and proteins to dec TG and non-HDL-C, non-HDL-C and LDL-C still primary goal; treat w statins, may add TG lowering agent if non-HDL-C not met on max statin dose
  • very high (500-999): TG is primary target; use TG lowering agent or statin (if no hx of pancreatitis)
  • very high (greater than 1000): TG is primary target to prevent pancreatitis; treat w fibrates (2-4 g/day), omega 3 FA or niacin
31
Q

non-HDL-C ACC/AHA vs NLA

A

ACC/AHA - role undefined in treatment decision-making, no RCTs designed to assess titrated drug therapy to achieve specific non-HDL-C goals
NLA - better primary target than LDL-C, more predictive of ASCVD mobidity/mortality, practical advantages (universal, non-fasting, valid w high TGs)

32
Q

LDL-C ACC/AHA vs NLA

A

ACC/AHA - no RCTs designed to assess titrated drug therapy to achieve specific LDL-C goals, used as factor to determine 4 statin benefit groups, de-emphasis on frequent monitoring, monitoring to evaluate adherence and response to statin therapy
NLA - co-primary target w non-HDL-C, relegated to less importance

33
Q

ApoB ACC/AHA vs NLA

A

ACC/AHA - role undefined, not endorsed due to limited evidence
NLA- optional secondary target, more predictive of ASCVD morbidity/mortality than LDL-C but not consistently more predictive than non-HDL-C, may remain elevated in some patients who have reached non-HDL-C and LDL-C goals, measurement of levels not necessary until patients have reached non-HDL-C and LDL-C goals

module 2a (13 decks)

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