Drugs to Treat HLD Flashcards
What is the normal range for HDL cholesterol in men and women over the age of 20?
> 40 for men and >50 for women; diagnostic criteria for metabolic syndrome if low
What are negative risk factors for CAD?
if HDL is >60
Which agent is the best choice for increasing HDL cholesterol?
Niacin
What is the appearance of plasma after a high fat meal?
Milky due to chylomicrons (i.e. their density)
What is the role of VLDL?
Synthesized and secreted by the liver to deliver TAG and cholesterol/cholesterol ester to the periphery
Why is niacin no longer recommended for treating dyslipidemia?
Because of the fact that CHD mortality was not decreased by niacin in some large clinical trials
What keeps systemic levels of statins low while those in the liver high enough to exert their effects?
Enterohepatic circulation
How is sitosterolemia treated?
A rare condition where the body stores plant sterols and its homozygous form is treated with Ezetimibe
What is the 5th leading cause of death?
Stroke and its risk is increased by high cholesterol levels
What adverse GI side effect is caused by bile acid sequestrants cholestyramine and colestipol?
Severe constipation
What is Fluvastatin?
HMG-CoA reductase inhibitor, low med subclass
What is a noteworthy cause of hypetriglyceridemia?
Drugs
What is the percentage of LDL-C lowering seen with drugs such as simvastatin and lovastatin?
Low med
Elevated glucose levels while fasting is a diagnostic criteria for what?
metabolic syndrome
What FA is in fish oil?
Docosahexaenoic acid
Feces has increased levels of bile acids when drugs such as what are used to lower plasma cholesterol levels?
Colesevelam
What is the role of PCSK9?
synthesized by the liver and is secreted; it can then bind to LDL-R on the hepatocytes surface to trigger their destruction when endocytosed
What drug class competitively blocks the formation of mevalonate (the first and RLS of cholesterol synthesis) aka HMG-CoA reductase inhibitors?
Statins
Which fibrate exerts its effects in part via activation of PPAR-alpha?
Fenofibrate
An apple physique is used to describe people with what condition?
metabolic syndrome
What is common with injections of monoclonal Abs?
injections reactions; seem to be more frequent for alirocumab than evolocumab
Polygenic characterizes most instances of hereditary hypercholesterolemia other than those commonly referred to as what?
familial
Colesevelam is a bile acid sequestrant with fewer what than others in this class?
Adverse effects
Which drug should never be used with a statin?
Gemfibrozil (fibrate that exerts its effects in part via activation of PPAR alpha)
What is PPAR-alpha?
transcriptional activator that mediates some if not most of the beneficial effects observed with fibrate therapy of hypertriglyceridemia
Consuming fish oil can help lower what?
plasma triglyceride levels via inhibition of hepatic VLDL synthesis
What is a rare inherited disorder that would preclude the use of colesevelam to lower plasma cholesterol levels?
Phenylketonuria
What formation of niacin was associated with the more severe instances of hepatotoxicity?
Sustained release
what is the process by which cholesterol enters the cell?
Endocytosis facilitated by a clarthin coat
What is an unqualified reason to administer fibrates to a pt?
acute pancreatitis; risk for this condition is increased by hypertriglyceridemia especially when plasma levels exceed 1000
Why are lornitapide and mipomersen classified as orphan drugs?
Because of their use to treat rare homozygous familial hypercholesterolemia
What transports chylomicrons to the bloodstream?
lymph
What can help lower plasma triglyceride levels?
weight loss
What is an example of snack that should be avoided to lower plasma cholesterol levels?
chocolate
Which apolipoprotein is added to VLDL?
B100 and serves as a ligand for LDL receptor
What is the role of lipoprotein lipase?
Located in the peripheral capillaries and stimualted by apo-CII; converts triglycerides to FFA for uptake by peripheral cells
Common varieties of what food should be avoided to lower cholesterol?
Cheese
What is an adverse effect associated with the use of gemifibrozil and statins?
myopathy; not observed when fenofibrate is used with statins
What hormone raises triglyceride levels in women?
estrogens
Which class of agents can help raise triglyceride levels?
Bile acid sequestrants; contraindicated if triglyceride levels are already significantly elevated (>400)
What drug class is first choice when treating pts with hypercholesterolemia?
statins
What is an example of a PCSK9 inhibitor?
Evolocumab
LDL cholesterol is normally what value?
<100 in adults over the age of 20
