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Pharmacology > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

Lipoproteins

A

Chylomicrons, VLDL, LDL and HDL

  • Chylomicrons & VLDL: triglyceride rich
  • LDL is cholesterol rich
  • HDL is protein rich
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2
Q

Chylomicrons

A

Contain large amount of lipid and very little protein

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3
Q

HDL

A

More protein and small amount of lipid (good lipid)

  • Picks up extra cholesterol from tissue
  • helps remove LDL preventing it from building up in arteries
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4
Q

Lipoproteins

A

Are large carriers proteins to help transport (water soluble)

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5
Q

Etiology

A
  • Two types: Primary/Familial or secondary
  • Primary/Familial: genetic defect that can cause increase or decrease in lipoproteins.
  • Secondary: Diet, drugs, disorder, disease
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6
Q

ASVCD Risk

A
  • LDL: Dominant atherogenic cholesterol, delivers cholesterol to the cells
  • VLDL: Main carrier of TG to the cells
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7
Q

Statin Benefit Groups

A
  • clinical ASCVD, LDL-c >190mg/dL
  • Diabetes, age 40-75 with LDL-C 70-189
  • Primary prevention-no ascvd or diabetes with LDL-C 70-189 mg/dL and 10 yr ASCVD risk >7.5%
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8
Q

Total cholesterol

A

measures the combination of LDL, HDL and VLDL (VLDL is a precursor of LDL)

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9
Q

LDL

A

Low density lipoproteins

  • Most of the cholesterol in the blood is carried by LDL
  • LDL combines with other substances clogging arteries
  • High saturated fat and trans fat diets increase LDL cholesterol
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10
Q

LDL score

A

-For most people, an LDL score below 100 is healthy, but people with heart disease may need to aim lower

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11
Q

Total Cholesterol Score

A

-Score of under 200 is considered healthy

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12
Q

HDL score

A

higher the level of HDL cholesterol the better. Too little-more likely to develop heart disease

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13
Q

Triglycerides

A
  • Body converts excess calories, sugar, and alcohol into triglycerides
  • Causes of high triglycerides
  • -Obesity
  • -smoking
  • -physical inactivity
  • -drugs (steroids, protease inhibitors, estrogen)
  • genetics
  • excess alcohol
  • high carb diets
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14
Q

Triglyceride Scores

A

Normal <150 mg/dL
Borderline high 150-199
High 200-499
Very high >500

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15
Q

Very high trigylcerides

A

turns first to prevention of acute pancreatitis, more likely to occur when triglycerides are >1000 mg/dL.

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16
Q

Triglyceride lowering agents

A
  • Fibrate or nicotinic acid

- First line therapy: although statins can be used to lower LDL cholesterol to reach the LDL goal

17
Q

Priorities for tx of diabetic dyslipidemia:

1. LDL cholesterol lowering

A
  • Lifestyle interventions
  • HMG CoA reductase inhibitor (statin)
    others:
  • -Bile acid binding resin (resin), cholesterol absorption inhibitor, fenofibrate or niacin
18
Q

Priorities for tx of diabetic dyslipidemia:

2. HDL cholesterol raising

A
  • Lifestyle modifcations

- Nicotinic acid or fibrates

19
Q

Priorities for tx of diabetic dyslipidemia:

3. Triglyceride lowering

A
  • Lifestyle modifcations
  • Glycemic control
  • fibric acid derivative
  • Niacin
  • High dose statins
20
Q

Priorities for tx of diabetic dyslipidemia:

4. Combined hyperlipidemia

A
  • First choice (improved glycemic control plus high dose statin)
  • Second choice (improved glycemic control plus statin plus fibric acid derivative)
  • Third choice (improved glycemic control plus statin plus nicotinic acid)
21
Q

Non-Statins

A
  • Cholesterol absorption inhibitor (Ezetimibe)
  • Bile acid sequestrants
  • PCSK9 inhibitors
  • Nicotinic acid (niacin) (trig lowering)
  • Fibric acid derivatives (trig lowering)
22
Q

Statin drugs

A 
Atorvastatin
Fluvastatin
Lovastatin
Pravastatin
Rosuvastatin
Simvastatin
23
Q

Statins

A
  • Drug of choice for elevated LDL
  • Prevents cardiovascular and cerebrovascular events
  • Contraindicated in active or chronic liver disease, pregnancy, and lactation
  • Adverse effects include myopathy and increase in liver transaminases
24
Q

Side effects of Statin Therapy

A

-Myalgias, myopathy and rhabdomyolysis
-Elevated creatine kinase (CK) levels may indicate statin-induced muscle damage (myopathy/rhabdo)
-Muscle weakness/pain without CK elevation
may indicate statin-induced muscle damage (myalgias)

25
Q

Ezetimibe

A
  • Non-statin
  • Safe and effective adjunct to statins when further LDL lowering is required
  • Contraindicated in patients with active liver disease or unexplained persistent transaminase elevations
  • Adverse effects include GI complaints
26
Q

PCSK9 Inhibitors

A
  • Evolocumab (Repatha) & Alirocumab (Praluent)
  • Lowers LDL
  • Expensive
  • Injectable monoclonal antibody
  • High risk prevention secondary prevention of ASCVD
  • Familial hypercholesterolemia
27
Q

Niacin

A

Non statin
-Uniquely effective in atherogenic dyslipidemia
Useful in nearly all dyslipidemias and adjunctive therapy for mixed dyslipidemias
Contraindicated in chronic liver disease, severe gout, active peptic ulcer disease
Adverse effects: flushing, hyperglycemia, hyperuricemia, hepatotoxicity

28
Q

Bile Acid Sequestrants

A
  • Non-statin
  • Colesevelam, cholestyramine, colestipol
  • Indicated for moderate hypercholesterolemia, in younger patients with elevated LDL, and women with elevated LDL who are considering pregnancy
  • Adverse effects include constipation, flatulence and decreased absorption of other drugs like digoxin, warfarin, HCTZ, beta blockers, thyroxine and penicillin G
29
Q

Fibrates

A
  • Non-statin
  • Gemfibrozil, Fenofibrate, Clofibrate
  • Indications: hypertriglyceridemia, atherogenic dyslipidemia
  • Contraindications: severe hepatic or renal dysfunction, primary biliary cirrhosis and gall bladder disease
30
Q

Fibrate Safety

A

Before initiation check serum creatinine; impaired renal function is present, prescribe gemfibrozil (unless taking a statin), or a lower starting dose of fenofibrate (48 mg is most commonly available). Routine monitoring of creatinine is not required.

31
Q

Omega-3 Fatty Acids

A

Fish oils

-Major use: Hypertriglyceridemia greater than 500

32
Q

Key concepts

A

-First-line therapy: therapeutic lifestyle changes
-Statins are drug of choice for first line treatment due to potency and cost-effectiveness.
Non-statins, which include cholesterol absorption inhibitors, niacin, bile acid sequestrants, fibrates, and omega-3 fatty acids, probably help improve patient outcomes, although strong evidence remains lacking.
Triglycerides are now considered an independent risk factor ASCVD.

Pharmacology (24 decks)

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