CVLipids Flashcards
These proteins carry lipid to plasma, to distriubte cholesterol to system for membranes, hormones, and bile acid production?
Lipoproteins w/ APO100 LDL / VDL. 1. Made in liver. 2. APO100 bind to cell receptors
What are normal values for LDL, HDL, TGs
TG <150, HDL ,>40M, >50W, LDL <70, NON HDL <100
What do HDL do to prevent ASCVD?
Take cholesterol back to liver
Why do LDL increase as VLDL and TG decrease?
B/c LDL remants of both- Atherogenic, small dense
Besides, CHD, CAD, ASCVD, what is risk with HIGH TGs?
High chylomircons INC risk of pancreatis
How is inflammatin part of plaque?
LDL deposit in vessel, body attacks. MaC, Cytockine, TNF, CRP. Thins the cap. If cap ruptue occuldes or mobilizes. Occuldes-ischemia, MI, angina
Why is it important to take statins at night?
Liver makes cholesetol at night, circadian. Ideal for shorter t1/2
Why is ADE myopahy in statins?
Idopathic, maybe release myoglobin= rhabdo. STOP stain if on ABX erythromyocin or change to PRAVASTAIN
What is important when starting statins?
Monitor and Baseline LFTs
How shoud HCP rechallenge statins?
Get CK/CPK if myopathy, try low intensity statins
What is max for pitive and rouva?
4mg pitive, rouva 40mg. OTHER all 80mg.
How do statins work in dyslipidemia?
Blocks HMG CoA reductase, 1st step in making cholesterol. INC LDL catabolism via upregulation of LDL. DEC cholesterol, CHD mortality. Reduce CAD 2-3mo bc of inflammtory affect- reduce MACS, dilation NOx effect.
What coenzyme is used with Statins?
CYP3A4 +2C9,19
Which are the shorter halflives that need to be taken at night?
Lova, Prava, Fluva
What is the most potent statin?
Pitavastaint. Dose 1-4mg. Erythro and Rifampin give Less dose.
What are the LDL reduction rates with each statin?
1 HIGH-Rosu 20mg, Ator 40m mg-50%, 2. MOD Ator 10-20mg, Rosu 5-10, Sim 20-40mg-30-49%, 3. LOW Sim 10mg, Prava, Lova
When is the max benefit observed with Statins?
Main LDL difference is initial dose. INC dose only dec LDL by 5-6%. 4-6-8wks
Which drug is used for HIV pts?
Pravastatin bc no DI or CYP. IF on antifungals azoles- use Prava, Rosu
Asians should avoid which statin?
Rosuvastatin
When on Pitavastin, what should be monitored?
INR if on warfarin. CrCL adjust AVOID If <30
What inc risk of myalagis rare ADR in Statins?
ETOH, Asian, Hypothyroid, LOW BMI, F, Vit D Dfx, CYP3A4-clarithro, erythor, cyclosporin,Sima @80, Gemibrozil+Cerivastin
What risk do DM have w/ statins?
Elevated sugars
WHAT ARE THE DI WITH FUNGALS AND ABX?
3A4 INHIB AZOLES AND MAC-CLARI, ERYI, CYCLOSPORIN
How do the bile sequestrants work?
Resin that binds to bile, excreted via feces. Dec LDL from serum. DEC bile, Cholesterol will be removed from serum. DEC cholesterol. Granuel or tablets
Which bile sequestrant is AVOIDed if TG>400
Cholestyramin, Colesitpol, Colesevalam. They can INC TG
What needs to be monitored with bile sequestrants?
LFTs, LIVER ACTIVE
What inhibits FA mobilization from peripheral tissue via DEC syntheiss of VLDL, INC LPL which lead to DEC TG, DEC HDL catabolism, and anticlotting?
Niacin. VitB3LIVER metab.
What does Niacin indirectly affect?
DEC LDL, TG, TC. INC HDL
What is the unique SE for Niacin?
1.Flushing 20min- take night 2. AVOID gout Pt d/t uric acid levels inc. 3. INC BS avoid DM
Ms. Nike has DM, low HDL and HIGH TG, which agent is ideal?
Niacin.
If Ms. Nike is on Niacin w/ a INC BMI and A1C, then what are the risk?
INC DM. Niacin has 5% inc in BS
What should gout pt, liver dz, PUD pts avoid?
Niacin
What should be AVOID in Pt with high LDL?
Fibric acid Dirivatives- NO LDL effect , 20-50% TGs, INC HDL 10-20%
Pt has INC TG, what should be taken?
Fibricic acid Direivatives-Gemfibrozil, Fenofibrate, Clofibrate
Pt specifically has High TG, normal LDL, which med is Ideal?
Gemfibrozil- DEC risk of CHD
What are cautions of fibric acid derives?
AVOID in Renal and Liver DZ 2. Taken w/ warfarin INC effects 3. INC riks of rhado if taken w/ statins
What inc LDL receptor synthesis, INC lipolysis of TG via LPL, DEC VLDL synthesis by binding to peroxisome prolifeator receptor alpha (ER liver and kidney?
Fibricic acid Direivatives
What drug is avoided in cancer Pts?
Clofibrate
What are ADE of fibric acid derives?
GI pain, cholelihaiasis, constipation, AFIB, myalgia Rhado w/ statin, Warfarin inhibitor
Which agent has low TC effects, 9% by inhibiting absorption of cholesterol in small intestine?
Ezetimibe- used of pt who can’t take statins. ADD W/ a statin LDL 18%, TC- 17%, TG 14%. NO HDLs
Is Ezetimibe tolerable?
Yes. DI- cholestyramine reduce EZ (BILE Sequest).
Mr. X has xanthomas on Achilles tendon, ring in corneal opague? What are ideal for them?
hypercholesteolemia (AD protein) MC inherited, xamthoma. Mipomerson-LIVer toxic BBW, Niacin, Lomitapide,- , new. PCSK9
Mrs. X has INC TG and INC LDL, What is drug approach?
Statin or Niacin
Mr. KFC TG are high, what should be offered?
Fibricic acid Direivatives, Niacin, MAYB Statin
What are diet suggestion for LDL?
INC fiber, Omega 3, garlic, HMB-hydroxy beta methlbutyric
IF pt has LDL 100 and MI? what intensity is recc?
Still HIGH, 50% will DEC w/in 4wks to 50 LDL. But pt still needs to stay on LDL bc w/ age LDL inc.
Why were Cholestry ester transfer protein inhib removed?
Hypertension. CETP high in DM
How do PCSK9s inhibitors work?
Block Binding to LDL receptor, reduce bodies ablity to clear LDL-c. INC LDL receptors in LIVER, thus signal LDL -C to come out of blood back to liver.
What are lifestyle mods 1st step?
Med diet, Active 150min/wk mod, resistance, 75-vigorous
What is highest lowering agent?
PCKS9 70%, $$$. -ocumabs
What is unigue about PCSK9s?
Protein, INJ. SQ 1x 2wk
What combos with statin are not approved?
Niacin and Fibrate
Calulate LDL w/ TC 220, HDL 30, TG 185?
220-(30+185/5)= 153, No direct measure of LDL. Error if TG >400
Calulate non HDL w/ TC 220, HDL 30, TG 185?
220-30= 190, NON HDL Cholesterol reflects cholesterol n VDL and LDL, APOB measures. More accurate for ASCVD
Can you measure direct LDL?
Only if pt not fasting, with HIGH TG.
Which MC drugs inc LDL?
Thiazides, Steroids, Fibric acids, Cyclosporin
Which MC drugs inc TGs?
Estorgens, Cyclosporins, BB, Antipyschoitcs, Bile acid
Who shoud be in high intensity statins?
> 45, FH CHD, smoking, HTN, Low HDL, Metobolic syndrome-TG,HDL, DM, Abdomen width, HTN,. PMH of ASCVD
Who shoud be in high intensity statins <75y or >75 w/ high LDL?
<75 yo to no risk prevent primary event. >75 MOD- Atorstatin or Rosuvastain
