Atherosclerosis Rx Flashcards
How is LDL-c related to atherosclerosis
it is necessary and sufficient for cause
what is the mech of action of statins
competitive inhibition of HNG-CoA reductase, leads to increase in LDLR
which drugs works well in combo with statins
bile acid sequestrants
which drugs are the best for increasing HDL
Niacin
describe the dose response to statins
logarithmic. first dose could be 50% then you double and get 56%
What drugs interact with statins
cyclosporin, coumadin, genfibrozil
what are some potential statin side effects
myalgias, liver toxicity, elevated blood sugar (diabetes
which statins are fungal derivatives
lovastatin, simvastatin, pravastatin
which statins are synthetic
Fluvastatin, atorvastatin, cerivastatin, rosuvastatin, pitavistatin
which statin is not metabolized by p450’s
Pravastatin, its sulfated
which groups dont benefit from statins
end stage renal disease, end stage heart disease
what are some bile acid seqestrants
resins: cholestyramine, colestipol
Gel: colesevelam
what is the mech of ezemtimibe, and plant stanols/sterols
cholesterol absorption inhibition (micellar)
side effects of BAS
gi (constipation, etc)
mech of BAS
anion-exchangers that bind bile acids, interrupting enterohepatic circ. they decrease liver cholesterol and so increase ldlr’s
mechanism of niacin
inhibits GCPR action of lipolysis thereby decreasing FFA’s available to liver for VLDL production
Two unique actions of niacin
best for increasing HDL, only one to reduce Lp(a)
action of Fibrates
lower TG levels. Paradoxical increase in LDL-c b/c although you have fewer LDL particles, each particle is larger
name two fibrates
gemfibrozil, fenofibrate
action of omega 3 FA
lower TG levels, helps prevent pancreatitis
should you stop statin therapy for mild transaminase (ALT) increases (<3x)?
no
what can be added to statins to augment effect
bile acid sequestrants or niacin
what effect to BAS have in diabetics
lower A1c
mech of niacin (nicotinic acid)
blocks the breakdown in adipocytes and so you dont get FFA release.
niacin side effects
liver toxicity, gout, exacerbates DM
