Dyslipidemia Flashcards
Low Risk FRS _____
LDL _______
<10%
5 mmol/L
Intermediate Risk FRS _____
LDL _______
10-19.9%
>3.5 mmol/L
High Risk FRS _____
LDL _______
> 20%
There is not threshold for LDL
What is Lp(a)
LDL covalently bonded to Apo A
highly genetic predisposition
What is another name for statin?
HMG-CoA reductase inhibitor
MOA of stains
stops the intracellular synthesis of cholesterol
What is the primary site for statins?
hepatic cells
What are the two major statins?
rosuvastatin
atorvastatin
What are the goals for LDL for DB or CKD?
LDL > 2
What is the goal for LDL for ASCVD?
LDL >1.8
What is the level of triglycerides for ASCVD?
1.5-5.6
What is the goal for low risk pt?
LDL >2.5
What is second line if you do not reach goal?
Add ezetimibe or PCSK9 inhibitor
What are the clinical benefits to statins?
lowering LDL
lowering all lipids but more
lowering in risk for benefits
What are some things that studies prove about statins?
statins decrease the rate of major vascular events
higher potency statins will provide greater benefits
lowering LDL decrease risk of ischemic events
What are some effects on other plasma lipids from statins?
HDL increase 5-10%
TG decrease up to 30%
benefits are unclear
What are some controversial thoughts on statins?
low risk pt being on statins as primary prevention
does have some reduction of risk if they already have evidence of CHD
What is the guidelines for statin dosing?
highest potency that they can tolerate
What are some exception of high dose statins?
intolerance
DI
pt. preference
MOA of PCSK9
promotes degradation of LDL receptor
monoclonal antibodies
MOA of ezetimibe
decrease the absorption in the small intestine
do not use as monotherapy
What level of affect does eze and PCSK9?
Eze decrease 17%
PCSK9 decreases 55%
What are some nuisance side effects from statins?
GI upset
fatigue
What are some concerning side effects from statins?
DB –> small risk
cognitive impairment (memory loss)
muscle effects (pain)
What are the levels of muscle pain?
myopathy
myalgia
myositis
rhabdomyolysis
What is the difference between the level of muscle pain?
the level of Cr, level of muscle damage
What are some pharmacokinetics of statins?
3A4 enzyme
it contracts with grapefruit juice
hepatic metabolism
What are some other drugs used instead of statins?
Niacin
Fibric Acid
Omega-3 FA
MOA of niacin
B vit
increase HDL by decreasing Apo AI
MOA of fibric acid
bind to PPARa
decrease TG
MOA of Omega -3 FA
decreased VLDL TG’s
