Coronary Artery Disease

Question 1

Moderately High Risk patient LDL lowering drugs

Answer 1

<130 mg/dL

Question 2

IHD patients high risk LDL levels target

Answer 2

< 100 mg/dL

Question 3

Bile acid resins

Answer 3

Cholestyramine
Colestipol
Colesevelam

Mechanism: anion exchange resins (non absorbable, insoluble) bind bile acids within intestines & prevent them from being reabsorbed.

For lowering LDL-C

Should be taken before meals
GI tolerance, dyspepsia common

Question 4

Statins

HMG CoA reductase Inhibitors

Answer 4

Inhibits HMG-CoA reduces cholesterol production

Lower LDL & triglycerides increase HDL

Question 4

Statins

HMG CoA reductase Inhibitors

Answer 4

Inhibits HMG-CoA reduces cholesterol production

Lower LDL & triglycerides increase HDL

Question 5

Statins precautions

Answer 5

GI effects
Elevatte LFT values alanine aminotransferase ALT
Aspartate aminotransferase AST
Myopathy lovastatin simvastatin
Elevate Creatin Kinase >10 times the upper limit with pravastatin

Cerivastatin removed from market for 31 patients rhabdomyolysis. Alone or in combo with gemfibrozil

Question 6

Rhabdomyolysis monitoring in statins

Answer 6

Muscle symptoms check before therapy
Evaluate after 6 to 12 weeks after therapy

Muscle soreness tenderness pain should be immediately reported

Con current therapy with 
Cyclosporine
Macrolide antibiotics
Azole antifungal
Niacin
Fibrates
Nefazodone
Increases risk

Question 7

Fibric acid derivative

Answer 7

Gemfibrozil
Fenofibrate

Inhibit cholesterol synthesis lower LDL-C and bile acids
Lower triglycerides & VLDL (very effective)

Gi adverse effects
LFT increase value
Increase CK
Rhabdomyolysis monitor

Question 8

Niacin

Answer 8

Lower LDL-C triglycerides through participation in tissue respiration oxidation reduction reaction which decrease hepatic LDl & VLDL production
Inhibition of adipose tissue liploysis, decrease triglycerides esterification
Increase lipoprotein lipid activity

Niacin controlled release (Niaspan, Slo- Niacin)
Niacor (immediate release)

Question 9

Niacin adverse effects

Answer 9

GI
Flushing itching skin
Liver toxicity

LFT should be performed

Question 10

Ezetimibe

Zetia

Answer 10

Selectively inhibit intestinal absorption of cholesterol and related phytosterols

Adjunct therapy and dietary measures or in combo with statins

Dose 10 mg per day orally

With combo statins. LFT enzymes ALT may be increased (3 times)