drugs and lipids

Question 1

what is primary and secondary CV prevention

Answer 1

primary - prevent first heart attack

secondary - prevent second

Question 2

4 non midfiable risk factors

Answer 2

1. age
2. sex
3. fami. Hx
4. women after menospause

Question 3

5 modifiable

Answer 3

1. diabetes
2. smoking
3. hypertension
4. dyslipidmeia
5. obesity

Question 4

main apo of LDL and HDL

Answer 4

LDL - apoB

HDL - apoA-1

Question 5

what is key to mgmt

Answer 5

LDL reduction

Question 6

what is endogenous metabolism of lipoproteins

Answer 6

1. VLDL produced in liver and deliver to blood
2. VLDL hydrolized to IDL by LPL
3. IPL hydrolyzed to LPL by hepatic lipase
4. LDL can then be delver to tissues (or make plaques), or make be taken up by liver via LPL-r

Question 7

what is role of LDL in atherosclerosis

Answer 7

1. adhesion molecule allows it to stick
2. pulled into endothelium
3. macrophages scavenge
4. SMC cells migrate into wall

Question 8

what is FH

Answer 8

defect in LDL-R that means LDL not taken up by liver

Question 9

Sx of FH

Answer 9

high LDL, xanthomatas, tnedon thickening

Question 10

what are statins

Answer 10

HMG CoA reductase inhibitor - slows rate limiting step of chol. synthesis

Question 11

how does stain work (2)

Answer 11

1. inhbits HMG CoA reduct - stop chol syn

2. turns on gene that encodes for LDL-r - pulls in more LDL

Question 12

what is effect of lowering LDL by one mmol/L

Answer 12

drop CHD risk by 20%

Question 13

4 steps to lipid lowering

Answer 13

1. risk assessment
2. set treatment target
3. select best agent
4. monitor and encourage

Question 14

** what is total C calc?

Answer 14

Total = VLDLc +LDLc + HDLc

Question 15

what is calculation for VLDLc

Answer 15

TG/2.2

Question 16

** what is LDLc calc?

Answer 16

TC - HDLc - (TG/2.2 or VLDLc)

Question 17

what is high risk

Answer 17

framingham over 20%

Question 18

4 risk modifiers not in framingham

Answer 18

1. family (up to 2x)
2. metabolic (up to 2X)
3. genetic cause (FH)
4. high hsCRP

Question 19

what is rule of 6

Answer 19

after initial statin dose, will only get a 6% increase by doubling the dose

Question 20

what is ezetimibe

Answer 20

intestinal chol. absorption inhib

Question 21

what is ezitimibe eff?

Answer 21

18% reduction in LDL

Question 22

what is SEff for statins

Answer 22

skeletal myalgia
liver - transmintis
renal - safe

Question 23

what is moderate and high hypertriglyceridemia and what does it signal risk of

Answer 23

moderate - TG 3-10 - CHD

high > 10 - acute pancreatitis

Question 24

what is enzyme responsible for TG breakdown

Answer 24

LPL

Question 25

what can be given for hyperTG

Answer 25

fibrates -activate LPL

Question 26

what is often overlooked pattern in CHD

Answer 26

modest incr. in TG and modest drop in HDL

Question 27

what correlates with this picture

Answer 27

high visceral fats

Question 28

what is metabolic syndrome

Answer 28

central obesity + 2 of:
TG > 1.7
HDH in men < 1.03 women 130/85
fasting glucose > 5.6

Question 29

what is large waist

Answer 29

men > 94cm

women > 80

Question 30

steps to treat mixed dylipipdemia

Answer 30

1. assess risk with frame + metabolic adjustment
2. lifestyle measures with key being weight loss
3. use pharma is needed for CVD risk