Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

competency 10/11 > cardio: HLD > Flashcards

cardio: HLD Flashcards

1
Q

statins that must be taken at night

A

lovastatin, simvastatin, pravastatin, fluvastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

statin that must be taken with food

A

lovastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

lipophilic statins

A

atorvastatin, pitavastatin, simvastatin, fluvastatin, lovastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

high intensity statin

A

atorvastatin 40-80mg, rosuvastatin 20-40mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

moderate intensity statin

A

atorvastatin 10-20mg, rosuvastatin 5-10mg, simvastatin 20-40mg

pravastatin 40-80mg, lovastatin 40-80mg, fluvastatin XL 80mg, fluvastatin 40mg BD, pitavastatin 1-4mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

low intensity statin

A

simvastatin 10mg

pravastatin 10-20mg, lovastatin 20mg, fluvastatin 20-40mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

statin potency

A

fluvastatin, pravastatin, lovastatin < simvastative < atorvastatin < rosuvastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

exogenous cholesterol pathway

A

chylomicrons transport TG and cholesterol from intestine to the tissues > subsequently stored, oxidized to bile acids or secreted in bile unchanged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

endogenous cholesterol pathway

A

cholesterol and newly synthesised TG are transported from liver as VLDL to muscle and adipose tissue > TG are hydrolysed and resulting fatty acids enter the tissues > during this process, lipoprotein particles become LDL > cells take up LDL by endocytosis via LDL receptors that recognise LDL apolipoproteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

are statins safe in pregnancy and lactation?

A

no!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SAMS: myalgias

A

muscle aches and pain, CK normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SAMS: myositis/myopathy

A

muscle pain and weakness interfering with daily activities, CK > 10xULN with concerning sx or objective weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SAMS: rhabdomyolysis

A

muscle breakdown, CK>40xULN + renal injury

  • occurs when damaged muscle tissue releases its proteins and electrolytes into the blood. These substances can damage the heart and kidneys and cause permanent disability or even death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SAMS: statin-associated autoimmune myopathy

A

HMGCR antibodies, incomplete resolution

  • very rare form of muscle damage caused by the immune system in people who take statin medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

risk factors for SAMS

A
  • age > 75yo
  • female
  • low BMI
  • Asian descent
  • impaired kidney function (CKD stage 3-5) or liver impairment
  • surgery with high metabolic demands, consider holding off before
  • acute infection
  • high level of physical activity
  • excess alcohol
  • drug abuse
  • dietary effects (excessive grapefruit, cranberry juice)
  • hypothyroidism: untreated or undertreated
  • genetic factors: CYP450 or drug transporter related mutations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

myoglobinuria

A

myoglobin (muscle proteins broken down) > goes to kidney and bound to renal tubules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

if no muscle sx present but CK is raised

A

consider checking thyroid function or muscle related
?clinical significance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

DDI with statins: amiodarone

A

do not exceed:
- simvastatin 20mg
- lovastatin 40mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DDI with statins: macrolide antibiotics

A

do not exceed:
- atorvastatin 20mg, with clarithromycin
- pravastatin 40mg, with clarithromycin
- pitavastatin 1mg, with erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

DDI with statins: amlodipine

A

do not exceed simvastatin 20mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

DDI with statins: colchicine

A

caution with lovastatin, simvastatin, fluvastatin, pitavastatin, pravastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

DDI with statins: gemfibrozil

A

CI with simvastatin
avoid with: L,P,P,A,F
do not exceed R 10mg (use only if needed, avoidance recommended)

23
Q

DDI with statins: other fibrates

A

caution with all statins

24
Q

DDI with statins: verapamil

A

do not exceed:
- simvastatin 10mg
- lovastatin 20mg

25
Q

niacin and fibric acid drugs can rarely cause rhabdomyolysis or liver failure when used alone, but…

A
  • combining them with statins incr risk of rhabdo or liver failure
  • gemfibrozil should not be combined with statins
  • other fibric acids and niacin are used, with caution, in combi with statins
26
Q

coadm of statins with bile salt binding resins, how is it done?

A

statins should be taken 1hr before or 4h after bile salt binding resins eg. cholestyramine
- bile salt binding resins bind statins in the intestine and reduce their absorption into the body

27
Q

statins and warfarin, ok?

A

statins incr effect of warfarin
- monitor blood clotting ability carefully

28
Q

statins and red yeast rice, ok?

A

should not be combined!!!
- red yeast rice contains chemical that is similar to statins, can lead to serious side effects such as rhabdomyolysis

29
Q

ezetimibe MOA

A

selective inhibitor of cholesterol transoirt protein, Niemann-Pick-C1-like1 (NPC1L1) protein - in walls of GIT and decr uptake into body
BUT effective in absence of dietary cholesterol: can saturate and still block transporters that takes up biliary cholesterol!!!!!

30
Q

ezetimibe ADR

A

URTI, sinusitis, arthralgia, limb pain, diarrhea

31
Q

PCSK9i

A

Proprotein Convertase Subtilisin/Kexin type 9 inhibitors
- evolocumab, alirocumab

32
Q

PCSK9i MOA

A

bines plasma PCSK9, thus incr LDL receptors on the cell surface > incr cellular uptake of circulating LDL from plasma

33
Q

PCKSK9i adm

A

injectibles, every other week or monthly

34
Q

PCSK9i place in therapy

A

due to exorbitant costs, likely to be cost effective only in the very high-ASCVD

35
Q

evolocumab labelled for

A

homozygous familiar hypercholesterolemia

36
Q

PCSK9i adr

A

itching at site, flu-like sx, early concerns of neurocognitive function changes, incr DM risks shown not to be an issue

37
Q

can PCSK9i be used in pregnancy and lactation?

A

use with caution, unknown!

38
Q

concern with LT use of PCSK9i treatment?

A

autoantibodies

39
Q

cholestyramine MOA

A

bile-acid exchange resins, not absorbed or altered by digestive enzymes
- binds bile acid, prevents reabsorption of drug and cholesterol into body
-> large portion of bile acids removed from enterohepatic circulation
-> liver synthesises more hepatic cholesterol
-> incr hepatic demand for cholesterol
-> incr LDLR expression

40
Q

cholestyramine ADR

A

flatulence, constipation, dyspepsia, nausea: use small doses, ingest ample fluids, incr dose gradually
may cause incr TG

41
Q

niacin

A
  • incr HDL by stimulating production of ApoA1 production in liver
  • upregulate lipoprotein lipase resulting in incr catabolism of VLDL
    WITHDRAWN FROM SG
42
Q

cholestyramine must be adm ____ before and ____ after other drugs

A

4h, 1h

43
Q

metabolic syndrome

A
  • FBG > 5.6mmol/L
  • large waist size (central obesity)
  • high BP>130/85mmHg
  • TG>1.7mmol/L
  • low HDL
44
Q

hallmarks of familial hypercholesterolemia

A

fatty deposits around eye cornea, eye, feet, muscle joints

45
Q

heterogyenous familial hypercholesterolemia (HeFH)

A
  • typically develop CAD before 55yo (M) and 66yo (F)
  • risk for CAD is definite or probably and incr at least 10x
  • critical to diagnose early and treat appropriately
46
Q

homogynous familiar hypercholesterolemia (HoFH)

A
  • develop CAD by 20yo and die before 30yo
  • identification of these children is critical
  • treatment with statins/plasma apheresis
47
Q

what hyperlipidemia meds to use for pregnant women?

A

only bile acid sequestrants
- statins, fibrates, ezetimibe, niacin are ci
- no data with pcsk9i

48
Q

when should we stop statin relative to cessation of contraception?

A

4 weeks prior

49
Q

fibrates MOA

A

incr activity of lipoprotein lipase > incr peripheral clearance

50
Q

how often should we monitor for lipid profile?

A

8+/- 4 wks, after starting tx and after adjustment until goal is reached

51
Q

how often should we monitor for ALT?

A

8-12wks after starting and after dose incr
- routine ALT repeat not reco if on sttatin, consider if on fibrates
- annually will do

52
Q

how often should we monitor for ck?

A

routine monitoring not necessary, recheck if pt develops myalgia
- check for baseline, if ck>4xULN then do not start therapy, recheck

53
Q

how often should we monitor for hba1c?

A

regular checks for pt at high-risk of diabetes or high-dose statins

competency 10/11 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions