Cardiology 2

Question 1

Cholesterol Medications

Answer 1

Lifestyle changes are very important

Diet/Exercise/No smoking/Weight Control/very moderate ETOH

Question 2

Medications STATINS
HMG-CoA Reductase Inhibitors

Reduction of Ca–due to decreased inflammatory response of med.

Answer 2

Blocks synthesis of cholesterol in liver
Atorvastatin- Lipitor/Simvastatin-Zocor
Many drug to drug interactions P450 3A4 Pravastatin/Rosuvastatin/Pitavastatin
less drug to drug interactions

Question 3

Statin

Answer 3

reduces cholesterol 25-63 %
prevents additional plaque formation
upregulates LDL receptors on cells (70% in liver)–removes cholesterol from blood.

Question 4

Statin …other advantages

Answer 4

> bone formation
< 5yr mortality s/p CAD or MI

<risk of autoimmune disease.

Question 5

Statin SE
Potentiates Coumadin (3A4 reaction)

Pregnancy X category
Do not prescribe max doses of both amlodipine and zocor

Answer 5

Rhabdomyolysis
Muscle pain 30%--
  1change to different statin
  2 avoid drug to drug interaction
  3 dose QOD
  4 check for hypothyroidism
  5 monitor correct CK levels -10 x normal level -stop med
hepatotoxicity- check preadministration (& prn pain) liver panel--->to 3x normal level, refer to GI
short term temp memory loss

Question 6

Cholesterol Medications

Niacin
Contraindicated insulin interference
Gout
use with statin
liverdisease, PUD, recent MI
labwork needed
liverpanel, uric acid,glucose (a1c), ? homocysteine

Answer 6

Niacin (Niaspan ER) nicotinic acid
HDL
SE- intense flushing and hot flash (not good choice ) hepatotoxicity, dysrythmias (A fib)
Not beneficial to add to statin
.homocysteine levels

Question 7

Cholesterol Medications
Bile Acid Sequesterants
***pregnancy safe B category
Interacts with fat soluable vitamins

Labs needed
LFT, iron, fat soluble vitamins

Answer 7

good when not tolerating statin
adjunct to statin
Questran (welchol) 625 mg Ac TID (saperate from all other meds)
LFT
  complete bile duct obstruction

Question 8

Cholesterol Medication
Fibric Acid

Contrindications
pregnancy
liver disease

Answer 8

Gemfibrozil (Lopid)
fenofibrate 
Tricor
Trilipix-Only 1 apporved in combo C statin
  ***5.5 fold > risk of Rhabdo
<triglycerides

Question 9

Fibric Acid SE

Answer 9

chloelithiasis, >LFT (check enzymes), HA.dizziness, <uric acid?

Question 10

cholesterol medications
Zetia
Vytorin

Answer 10

Inhibits absorption of cholesterol
only effects LDL–<20%
Adjunct with statin–however outcomes are no better with combo–used only in complicated cases
Dose at night -due to synthesis of cholesterol in gut at night

Question 11

Increasing HDL

Answer 11

EXercise
eat fish
eat nuts (except peanuts)
eat seeds
use olive/canola oil