Cardiac Dyslipidemic Flashcards
Microsomal triglyceride transfer protein (MTP) inhibitor
Decreases VLDL secretion and accumulation of LDL in plasma
Lomitapide
Lomitapide SE (2)
Inc TAG in liver
Inc transaminase
Antisense oligonucleotide targeting APOB-100 (liver)
Mipomersen
Mipomersen SE (2)
Mild to mod injection site reaction
Flu-like symptoms
Inhibits transporter that mediated GI uptake of cholesterol and phytosterol
Ezetimide
For hypercholesterolemia
Phytosterolemia
Ezetimibe SE
Hepatotoxicity if combined with HMG COA
Dec LDL cholesterol by 20% (monotherapy)
More effective when combined with HMG COA reductase inhibitors but inc hepatotoxicity
Ezetimibe
Activates signaling pathway that dec HORMONE SENSITIVE LIPASE activity
Dec plasma FA and TG level
Inc clearance of VLDL by lipoprotein lipase dec VLDL
Dec catabolic rate of HDL inc HDL
Niacin
For hypercholesterolemia
Hypertriglyceridemia
Low HDL CHOLESTEROL
Drug for hypertriglyceridemia and low HDL
Niacin
Niacin SE (2)
Cutaneous flushing - NSAID Hyperuricemia GI Pruritus Hepatotoxicity Hyperglycemia
Dec circulating fibrinogen
Inc tissue plasminogen activator
Niacin
Act as ligand for peroxisome proliferator-activated receptor alpha (PPAR-a) protein
Fibric acid
Gemfibrozil
Fenofibrate
For hypertriglyceridemia
Gemfibrozil
Fenofibrate SE
(5)
Inc risk of gallstone Inc risk of myopathy with statin Rashes gemfibrozil only Nausea Leukopenia, Anemia, Potentiate anticoag
Dec TAG, VLDL
Inc HDL
No effect on LDL
But inc LDL in patients with familial combined hyperlipoprotinemia
Fibric Acid derivatives
Gemfibrozil
Fenofibrate
Inhibits rate limiting step in cholesterol synthesis
HMG COA reductase inhibitors
Rate limting step in cholesterol synthesis
Conversion of hydroxymethylglutaryl coenzyme A to mevalonate
by
HMG COA reductase
Dec LDL dramatically Dec risk of coronary events and MI Dec risk of ischemic stroke Dec TAG and Inc HDL
Statins
Statin SE (4)
Hepatotoxicity (inc transaminase)
Inc Crea kinase
Rhabdomyolysis (severe pain)
Teratogenic
Statins do not work in hypercholes familial bec
They need functional LDL receptor to work which is impaired
Why is there risk for hepatotoxicity and rhabdomyolysis in statin
Bec it inhibits CYP450 inc conc of drugs
Large nonabsorbable polymers that bind bile acid and similar steroids in intestine and prevent their absorption
Diverts cholesterol to synthesis of new bile acid
Cholestyramine
Colestipol
Colesevelan
Bile Acid Binding Resins
For hypercholesterolemia
To dec pruritus in patients with cholestasis and bile salt accum
Cholestyramine
Colestipol
Colesevelam
Bile acid binding SE (4)
Impaired absorption of fat and vitamins
Unpleasant gritty taste
Bloating
Constipation
Dec LDL
Inc TAG and VLDL
No effect on HDL
Interferes with absorption of HMG COA reductase i
Bile acid binding resin
deficiency in LPL and apoC-II
inc chylomicron, VLDL
Primary chylomicronemia
Type I
Dec clearance of VLDL
Inc VLDL, chylomicrons
Inc VLDL, chylomicrons
Inc production VLDL
Familial hypertriglyceridemia severe
Moderate
Inc hepatic apoB and VLDL production
Inc VLDL, LDL
Familial combined hyperlipoproteinemia
Inc VLDL chylomicron remnants
Deficient apoE
Familial dysbetalipoproteinemia
Type III
Inc LDL
Defect in LDL receptors
Familial hypercholesterolemia
Type II
Statins are used in (3)
Familial combined hyperlipoproteinemia
Familial dysbetalipoproteinemia III
Familial hypercholesterolemia II
