Drugs to Treat HLD pt.2 Flashcards
What is lovastatin?
HMG-CoA reductase inhibitor, low med subclass, first in class
What is an adverse effect of fish oil?
Belching
Consumption of alcohol raises what?
triglyceride levels
What is the function of lipoproteins?
transport water insoluble TAG and cholesterol/cholesterol esters in the plasma
What is a very common adverse effect of niacin?
Flushing, can be diminished by taking it with food or 30min after aspirin
What is the percentage of LDL-C lowering seen with atorvastatin and rosuvastatin?
Med high
What is another example of a PCSK9 inhibitor?
Alirocumab
What is hypertriglyceridemia?
means triglyceride levels are >200; a reason to initiate or increase dose of statins if levels are >500
What is the leading cause of death?
Heart disease; risk can be estimated with online tools such as ASCVD risk estimator
What is a positive risk factor for atherosclerotic CVD?
Age
What is atorvastatin?
HMG-CoA reductase inhibitor, med high subclass, most prescribed drug in US in 2019
What is a general term for adverse effects that are common among drugs used to treat hypercholesterolemia and/or hypertriglyceridemia?
GI distress
What is an example of the few things that are permitted by a triglyceride lowering diet?
Legumes, provided no salt added and they have not been ultra processed into meat alternatives
What is the principal component of LDL?
cholesterol ester
What are triglycerides?
Main constituents of natural fats and oils; store energy; beta blockers, thiazides, loop diuretics, and bile acid sequestrants are among the agents that increase their circulating levels in plasma; a diagnostic criteria for metabolic syndrome if elevated
What is the borderline range for total cholesterol in adults?
200-239
New onset of DM is common in those with what?
risk factors for when statins are used to lower plasma cholesterol levels, similarly for niacin but doesnt appear to be associated with PCSK9 monoclonal Ab; potentially worsened by fish oils
Diabetes is associated with both hypercholesterolemia and what?
hypertriglyceridemia; its onset has been associated with the use of statins but not PCSK9 inhibitor s
What adverse event led to the withdrawal of the first fibrate from the market?
Gallstones; still associated with this class but seems to be less of a problem with gemifibrozil and fenofibrate
What are fibrates?
drug class widely used to lower plasma triglyceride levels but recent data has failed to provide evidence that they are actually lowering atherosclerotic coronary vascular disease
What are the effects of exercise?
Lack of exercise lowers HDL but not increasing it has minimal impact on LDL; it can lower plasma levels of triglycerides
What is APOE?
Synthesized by liver and various other cells; it integrates into lipoproteins because of its high avidity for their phospholipid coat where it then serves as a ligand for lipoprotein remnant uptake by the liver
Lysosomes serve as a degradation site for what?
LDL and PCSK9 LDL-R complex
What is a hormonal cause of increases in LDL and triglycerides?
hypothyroidism
If waist circumference is elevated it counts toward diagnosis of what?
metabolic syndrome
Many people with hypercholesterolemia lack what?
symptoms and are unaware
The pt needs to have a prominent role in decisions regarding what?
the prevention of atherosclerotic CVD
What is the 2nd FA in fish oil?
Eicosapentaeinoic acid
What is simvastatin?
HMG-CoA reductase inhibitor, most prescribed among the low med subclass
What is HDL?
initially created as empty vessels to scavenge free cholesterol from the periphery; there are predominately protein
What is LDL-R?
Recognizes B100 molecule on the surface of its lipoprotein target; cell surface expression of this is increased on hepatocytes when their ability to synthesize new cholesterol and/or delivery of dietary cholesterol is impaired and when bile acids are lost in the stool rather than recycled
What is the fate of LDL-R in the absence of PCSK9 binding?
recycled
What hormone lowers HDL?
Androgens
What is NPC1L1?
Transport protein in the apical membrane of SI enterocytes and the canalicular membrane of hepatocytes; it absorbs cholesterol and plant sterols
What is a common adverse effect of statins in association with normal Cr kinase levels?
Myalgia; incidence increases by age, female sex, low BMI, various drugs and comorbidities, alcohol and high levels of physical activity or trauma
What is pravastatin?
HMG-CoA reductase inhibitor
Which vitamins are not absorbed well if bile acid sequestrants (especially cholestyramine or colestipol) are administered?
fat soluble vitamins
What is an absolute contraindication for statins?
Pregnancy
what is rosuvastatin?
HMG-CoA reductase inhibitor, med high subclass
LDL cholesterol that is >190 is what?
very high
What is a major challenge when treating pts for HLD?
adherence
What is ezetimibe?
NPC1L1 inhibitor; generally well tolerated with some experiencing HA, runny nose and/or sore throat
What is the normal range for total cholesterol in adults over the age of 20?
135-200
What is the largest lipoprotein and what is their function?
Chylomicrons; formed in the enterocytes to transport fats absorbed from the diet
What ancestry increases the risk of myalgia in those using stains?
asian
Which drug is the preferred alternative for those unable to tolerate statins?
Ezetimibe; and the preferred add on if greater LDL-C lowering is needed despite statin use
What behavior lowers HDL?
smoking
what is a common adverse effect of niacin?
Pruritus; possible reason for use of bile acid sequestrants if caused by cholestasis
What is the range for high cholesterol?
160-189 in adults
What is B48?
apolipoprotein that is characteristic of chylomicrons and their remnants
