Chem path 7 - lipid update Flashcards
What is the optimal medial treatment in people with coronary heart disease?
Intensive lifestyle modification
Aspirin
High dose statin (Atorvastatin PO 40-80mg OD)
Optimal BP control - THIAZIDE DIURETICS!!
Assessment for probable T2DM
What was the main finding of the SPRINT research study?
Furhter reducing the BP of someone with BP of 140/80 –> 120/80 greatly reduced deaths
What are the drug options for patients with statin intolerance?
Ezetimibe (prevents absorption of cholesterol into intestines)
Plasma exchange
Evolocumab (PCSK9 monoclonal antibody)
What is the function of PCSK9 and how can it be regulated?
PCSK9 regulates levels of LDL-R expression. A loss of function mutation –> high LDL-R on liver and thus lower plasma LDL. Gain of function mutation –> low LDL-R on liver and thus higher plasma LDL. Therefore, you want to inhibit PCSK9.
What did the Fourier study reveal about evolocumab?
In patients with established CVS disease, it reduced major cardiovascular events but had nO effect on mortality. THe NNT is high, v expensive, so it is reserved only for high risk patients.
How long does it take for the benefiical effects of good glucose control to become apparent?
15 years
What is the legacy effect?
Patient on UKPDS study who reverted back to poor glucose control after ~20years aggressive control, swiftly achieved similar Hba1c levels to their counterparts in the convential treatment arm , HOWEVER mortality in the intensive treatment group remained lower.
What did the Accord trial find?
Both the ACCORD and ADVANCE study looked at patients who had some sort of CVS complication. Hba1c 6%. They found that suddenly aggressively controlling the blood glucose of people with previous poor control reduced complications but INCREASED mortality.
What did the ADVANCE trial find?
Hba1c 6.5% reduced mortality.
How do SGLT2 inhibitors work?
They inhibit glucose re-uptake in the kidneys and result in glycosuria –> reduced glucose AND BP but v expensive
What is the worry with canagliflozin?
Some studies have shown increased amputation risk
What is the function of GLP-1?
Signals the pancreas to secrete insulin
Direct effect on appetite and gastric emptying
(responsible for incretin effect)
What are some examples of GLP-1 analogues?
Exenatide
Liraglutide
semaglutide
How is GLP-1 broken down and what drug class is based on this?
GLP-1 is broken down by DPP4, DPP4 inhibitors aka gliptins
What class of medication is metformin?
biguanide
