Chapter 50: prophylaxis of atherosclerotic CV disease

Question 1

drugs are only employed when what two things are tried first?

Answer 1

diet and exercise

Question 2

lipoproteins serve as carriers for what two things in the blood?

Answer 2

cholesterol and triglycerides

Question 3

what two lipoproteins contribute to arthersclerosis?

Answer 3

VLDL and LDL

Question 4

the goal of therapy should be to do what?

Answer 4

decreases VLDL and LDL levels

Question 5

what lipoprotein should be increased?

Answer 5

HDL

Question 6

why do we want HDL levels to be increased?

Answer 6

it helps protect against atherosclerosis

Question 7

what do all lipoproteins that deliver cholesterol and triglycerides to non hepatic tissues contain?

Answer 7

apolipoprotein B-100.

Question 8

drug therapy alone is not enough to achieve the LDL goal which is to keep the level below what

Answer 8

less than 100 mg/dl

Question 9

what are the two primary goals of treating dyslipidemia?

Answer 9

reducing the risk of atherosclerotic disease and reducing the risk of type 2 diabetes.

Question 10

what are the most effective antilipedics?

Answer 10

statins

Question 11

when being treated with a statin, one must avoid drinking what?

Answer 11

grapefruit juice, a cytochrome p-450 inhibitor

Question 12

what class is the suffix “statin” for?

Answer 12

HMG-CoA Reductase Inhibitor

Question 13

how does atorvastatin lower the blood cholesterol levels?

Answer 13

increase HDL, decrease LDL, decrease triglycerides

Question 14

when are statins most effective

Answer 14

in the evening

Question 15

why are statins most effective in the evening?

Answer 15

the drug will peak at the time that the most cholesterol is being synthesized

Question 16

what else can statin drugs do other than lipid effects?

Answer 16

stabilize plaque within blood vessels to prevent emboli

Question 17

what do statins decrease the risk of and how?

Answer 17

thrombus by inhibiting platelet deposition/aggregation and suppressing production of thrombin.

Question 18

how do statins enhance the ability of blood vessels to dilate?

Answer 18

improving abnormal vascular endothelium

Question 19

how do statins decrease LDL cholesterol?

Answer 19

increasing the number of LDL receptors on hepatocytes

Question 20

what does increasing LDL receptors lead to?

Answer 20

increase of LDL being removed from the blood

Question 21

what role does HMG-CoA reductase play in the cholesterol biosynthesis?

Answer 21

it is the final step in converting cholesterol

Question 22

statins lower VLDL levels by decreasing the production of what protein?

Answer 22

apolipoprotein in B-100

Question 23

the potential for statins to promote bone formation by enhancing activity of osteoblasts which will reduce the risk of what

Answer 23

osteoporosis

Question 24

what are the 2 serious adverse effects of the statins?

Answer 24

hepatotoxicity, rhabdomyolysis

Question 25

what two components are released from injured or inflamed muscles?

Answer 25

creatinine kinase and myoglobin

Question 26

what is defined as muscle disintegration and marked elevated levels of CK

Answer 26

rhabdomyolysis

Question 27

the elevation of CK is how many times the upper normal limit

Answer 27

greater than 10

Question 28

what can result from the muscle leaking myoglobin?

Answer 28

renal failure

Question 29

how often should liver function tests be done when using statins?

Answer 29

before starting treatment and every 6-12 months thereafter

Question 30

when should you discontinue a statin?

Answer 30

when AST levels rise 3 times above the UNL.

Question 31

what other lipid-lowering drug increases the risk of rhabdomyolysis when given concurrently with statins?

Answer 31

fibrates

Question 32

what is a B3 vitamin that lowers LDL and triglyceride levels?

Answer 32

Nicotinic acid (Niacin)

Question 33

what increases HDL levels better than any other drug?

Answer 33

Nicotinic Acid

Question 34

The OTC dose to correct Niacin deficiency is the 25x the amount to reduce what?

Answer 34

reducing lipoprotiein levels

Question 35

intense flushing of the face, neck and chest when taking statins is due to what?

Answer 35

peripheral vasodilation

Question 36

how can you minimize the intense flushing?

Answer 36

taking 325 mg of Aspirin 30 minutes before each dose of a statin. or by using an XR form instead of an IR formulation.

Question 37

what organ is nicotinic acid toxic to?

Answer 37

the liver

Question 38

what two serum levels should be monitored since they are increased when taking nicotinic acid?

Answer 38

uric acid and glucose

Question 39

what lipoprotein do bile acid sequestrates decrease?

Answer 39

LDL

Question 40

bile acids contain a significant amount of what

Answer 40

cholesterol

Question 41

what is bile acid cholesterol used to do?

Answer 41

emulsify fats

Question 42

along with fat soluble vitamins, what else can bile acid sequestreants reduce?

Answer 42

iron, folic acid, B12

Question 43

where do bile acid sequestrates work?

Answer 43

GI tract

Question 44

what is the main ADR of bile acid sequestrates

Answer 44

constipation

Question 45

what do bile acid sequestrates bind to

Answer 45

bile acid–>form large complexes which cannot be absorbed or recycled

Question 46

what do bile acid sequestrates promote?

Answer 46

promote excretion via the feces

Question 47

oral medications known to interact with bile acid sequestrates should be taken when

Answer 47

either 1 hour before or 4 hours after the sequestrate

Question 48

what are the three main drugs that interact bile acid sequestrates?

Answer 48

digoxin, warfarin, and thiazide diuretics

Question 49

where does ezetimibe block cholesterol absorption

Answer 49

small intestine

Question 50

what can taking ezetimibe with a fibrate cause

Answer 50

increased risk of gallstones

Question 51

what 2 other ADRS (besides liver issues) can ezetimibe cause?

Answer 51

pancreatitis and thrombocytopenia

Question 52

what are the most effective drugs at lowering triglycerides?

Answer 52

fibrates

Question 53

what effect do vibrates have on LDL levels?

Answer 53

little to no effect

Question 54

how does gemfibrozil increase plasma TG levels?

Answer 54

lowering VLDL levels which transport TG

Question 55

how does gemfibrozil increase the risk of gallstones

Answer 55

increases biliary cholesterol saturation

Question 56

who should not take gemfibrozil

Answer 56

people who have pre-existing gall bladder diseases

Question 57

what drug does gemfibrozil displace from albumin causing more free drug to be available in the body

Answer 57

warfarin

Question 58

vibrates increase the synthesis of the enzyme lipoprotein lipase which does what

Answer 58

increase the breakdown and elimination of triglycerides

Question 59

vibrates increase the production of what which in turn facilitates the production of HDL

Answer 59

both A-I and A-II

Question 60

what prescription drug has been FDA approved as an Omega-3 fatty acid

Answer 60

Lovaza

Question 61

what does Lovaza reduce

Answer 61

triglycerides

Question 62

lovaza can also be purchased as what?

Answer 62

OTC fish oil

Question 63

how is Pcska inhibitors administered?

Answer 63

SQ

Question 64

pcska inhibitors are a class of drug that is used as what

Answer 64

an adjunct therapy when maximal amounts of statins have been reached.

Question 65

why could someone develop antibodies against a pcska inhibitor

Answer 65

because it is composed of proteins

Question 66

who is pcska inhibitors usually used for?

Answer 66

people with familial hypercholesteremia