Coronary Artery Disease & Dyslipidemia Flashcards

Question

Calcium Channel Blockers

Answer 1

- not recommended for routine use - no effect on mortality - if necessary for arrhythmia control, consider verapamil or diltiazem

Answer 2

Isosorbide comes in mononitrate (ER) form and dinitrate (IR) form which are given 2 and 3x daily respectively, whereas nitro is taken when patient is actively experiencing angina.

Answer 3

B-Blockers decrease HR to increase oxygen supply CC-Blockers decrease vasospasms to increase oxygen supply

Answer 4

thickening of coronary arteries that may lead to MI or stroke

Answer 5

Synthesized by our own liver AND from diet (animal products)

Answer 6

LDL is deposited in the endothelium, leading to inflammation and the recruitment of immune cells. LDL is ingested by immune cells, lipid accumulates into a "fatty streak" and the inflammation recruits platelets Activated platelets deposit on top of the fatty streak, creating a prothrombotic environment that results in a fibrous plaque. Some cells may die, releasing cell debris and lipid, as well as creating a necrotic core. If there is destabilization, the plaque may rupture completely

Answer 7

*Most effective drugs for lowering cholesterol, typically the first-line therapy. Commonly know as "statins" ``` Atorvastatin Rovustatin Lovastatin Pravastatin Simvastatin ``` Mech: Inhibit HMG-CoA reductase enzyme which is needed for cholesterol synthesis Indications: - hypercholesterolemia - Primary and secondary prevention - Post-MI therapy - Diabetes DDI's: other lipid lowering drugs, drugs that inhibit CYP3A4 (this drug is metabolized by that enzyme, so a lack of it may lead to toxicity) Adverse Reactions: headache, rash, GI upset, hepatotoxicity Counseling points: take medication in evening at bedtime, max effects seen in 4-6 weeks, lifelong treatment,

Answer 8

LFT (liver function test) because this medication is metabolized in the liver and is inhibiting an enzyme of the liver

Answer 9

Mech: bind to bile acids to lessen cholesterol reuptake into the blood Colesevelam Cholestyramine Colestipol Indication: decrease LDL Adverse Effects: constipation, nausea, bloating Counseling Points: take 4 hours before other drugs, so that they do not bind. Take with food and water to lessen GI symptoms

Answer 10

statins inhibit an enzyme, bile acid inhibit reuptake Statins are also generally more effective than bile acid sequestrants

Answer 11

Decrease absorption

Answer 12

They are more effective at night because the cholesterol-making enzyme (HMG-CoA) is more effective at night.

Answer 13

No, but it works similarly in that is decreases absorption of cholesterol.

Answer 14

Mech: decreases absorption of cholesterol in the small intestine Indication: decrease LDL Adverse Effects: typically well-tolerate, but may cause myopathy, rhabdomyolysis, hepatitis DDI's: statins, fibrates (increased risk of gallstones), bile acid sequestrants

Answer 15

Third line agent for lowering lipid levels Gembibrozil Fenofibrate Fenofibric Acid Mech: stimulate lipoprotein lipase via activation of PPAR-alpha Indication: adjunct therapy for patients with significant LDL, primary hypertryglicidemia Adverse Effects: GI upset, gallstones, myopathy, livery injury DDI's: increased risk of myopathy when combined with a statin

Answer 16

fibric acid derivatives

Answer 17

Mech: prevent the binding of PCSK9 to LDLR and enhances clearance of LDL Alirocumab Evolocumab Adverse Effects: hypersensitivity reactions, immunogenicity (body developing antibodies against drug itself)

Answer 18

Vitamin = not regulated by FDA Previously thought to decrease LDL and TG levels, but this has not been shown. *OUTDATED THERAPY Adverse Effects: flushing

Answer 19

Goal: have 1 gram/day min. of beneficial oils to maintain healthy heart ``` Docosahexaenoic acid (DHA) Eicosapentaeonic acid (EPA) ``` Brand Names: Vascepa an Lovaza Effective for lowering TG levels, 20-50% Counseling points: freeze to prevent fishy burps