Atherosclerosis Rx

Question 1

How is LDL-c related to atherosclerosis

Answer 1

it is necessary and sufficient for cause

Question 2

what is the mech of action of statins

Answer 2

competitive inhibition of HNG-CoA reductase, leads to increase in LDLR

Question 3

which drugs works well in combo with statins

Answer 3

bile acid sequestrants

Question 4

which drugs are the best for increasing HDL

Answer 4

Niacin

Question 5

describe the dose response to statins

Answer 5

logarithmic. first dose could be 50% then you double and get 56%

Question 6

What drugs interact with statins

Answer 6

cyclosporin, coumadin, genfibrozil

Question 7

what are some potential statin side effects

Answer 7

myalgias, liver toxicity, elevated blood sugar (diabetes

Question 8

which statins are fungal derivatives

Answer 8

lovastatin, simvastatin, pravastatin

Question 9

which statins are synthetic

Answer 9

Fluvastatin, atorvastatin, cerivastatin, rosuvastatin, pitavistatin

Question 10

which statin is not metabolized by p450’s

Answer 10

Pravastatin, its sulfated

Question 11

which groups dont benefit from statins

Answer 11

end stage renal disease, end stage heart disease

Question 12

what are some bile acid seqestrants

Answer 12

resins: cholestyramine, colestipol
Gel: colesevelam

Question 13

what is the mech of ezemtimibe, and plant stanols/sterols

Answer 13

cholesterol absorption inhibition (micellar)

Question 14

side effects of BAS

Answer 14

gi (constipation, etc)

Question 15

mech of BAS

Answer 15

anion-exchangers that bind bile acids, interrupting enterohepatic circ. they decrease liver cholesterol and so increase ldlr’s

Question 16

mechanism of niacin

Answer 16

inhibits GCPR action of lipolysis thereby decreasing FFA’s available to liver for VLDL production

Question 17

Two unique actions of niacin

Answer 17

best for increasing HDL, only one to reduce Lp(a)

Question 18

action of Fibrates

Answer 18

lower TG levels. Paradoxical increase in LDL-c b/c although you have fewer LDL particles, each particle is larger

Question 19

name two fibrates

Answer 19

gemfibrozil, fenofibrate

Question 20

action of omega 3 FA

Answer 20

lower TG levels, helps prevent pancreatitis

Question 21

should you stop statin therapy for mild transaminase (ALT) increases (<3x)?

Answer 21

no

Question 22

what can be added to statins to augment effect

Answer 22

bile acid sequestrants or niacin

Question 23

what effect to BAS have in diabetics

Answer 23

lower A1c

Question 24

mech of niacin (nicotinic acid)

Answer 24

blocks the breakdown in adipocytes and so you dont get FFA release.

Question 25

niacin side effects

Answer 25

liver toxicity, gout, exacerbates DM