Dyslipidemia Flashcards
Why are bile acids (produced in the liver) needed?
to absorb lipids and fat-soluble vitamins
The process of enterhepatic recycling can
affect drugs
elevated cholesterol increases the risk of
atherosclerosis (formation of plaque)
Atherosclerosis is asymptomatic, but can lead to
atherosclerotic cardiovascular disease (ASCVD)
How can cholesterol be decreased in the body?
-reducing formation (statins)
-blocking absorption ( ezetimibe)
-blocking enterohepatic recirculation of bile salts (colesevelam)
Three major types of lipoprotein in total cholesterol
-Low- density lipoprotein (bad)*
- High- density lipoprotein (good)*
- very- low density lipoprotein
What are the non- HDL that contribute to ASCVD risk ?
- LDL
-VLDL
-TG
strong radiators of ASCVD
High HDL ____ ASCVD risk.
lowers
TG ≥ 500 mg/dL can cause
acute pancreatitis
Friedewald equation equation (LDL)
LDL = TC - HDL - (TG/5)
Do do not use friedewald equation when
TG >400 mg/dL
Falsely low LDL calc
desirable HDL
≥ 40 mg/dL men
≥ 50 mg/dL women
desirable LDL
< 100 mg/ dL
Very High LDL
≥ 190 mg/dL
desirable TG
< 150 mg/ dL
abnormal lipoprotein levels are called
dyslipidemia
Familial hypercholesterolemia is caused by genetic defects that result in
severe cholesterol elevations
why is an online ASCVD risk calculator used
estimate the risk of first cardiovascular event during the next 10 years
risk sore is not needed for patients with
clinical ASCVD, diabetes or LDL ≥ 190 mg/dL
bc the all should be started on a statin
coronary artery calcium score
helpful in deciding if satins should be initiated in those with ASCVD risk of 7.5-19.9%
CAC ≥ 100 agatston units
natural products
red yeast rice lowers LDL
OTC fish oils lowers TG
drug of choice for high LDL
statins
add ezetimibe and/or PCSK0 mab
cholesterol- lowering drugs that cause liver damage
- niacin
- fibrates
- potentially statins and ezetimibe
avoid if AST or ALT is 3x the upper limit of normal
statins inhibit
HMG-CoA reductase (rate limiting step)
statins are grouped by
intensity based on LDL lowering ability
high- intensity
atorvastatin 40 - 80
rosuvastatin 20- 40
most common adverse effect of statins
muscle damage
- usually symmetrical within 6 weeks
rhabdomyolysis
muscle symptoms with a very high CPK (>10,000 IU/L) plus protein in the urine can lead to acute renal failure
which state have less drug interactions
rosuvastatin
pravastatin
what drugs can increase the risk of myopathy and rhabdomyolysis
Fibrates (gemfibrozil)
Niacin
do not use statins with
Gemfibrozil
amlodipine can increase concentration of
atorvastatin
lovastatin
simvastatin
initial non- stain therapies
ezetimibe and PCSK9 mabs
other treatment options for HLD
- bempedoic acid
- inclisiran (intracellular inhibitor of PCSK9 production)
what are used to target high triglycerides ?
fish oils, fibrates
MOA of ezetimibe
inhibits absorption of cholesterol in the small intestines
PCSK9 monoclonal antibodies MOA
blocks the ability of PCSK9 to bind to the LDL receptor
SE of statins
myalgia/myopathy
SE of ezetimibe
myalgia
SE of PCSK9 mab
injection site reaction
know to decrease LDL effectively
statins, ezetimibe, and PCSK9 mab
MOA of Bile acid sequestrants /bile acid binding resins
bind bile acids in the intestine, forming a complex that is excreted in the feces
SE Bile acid sequestrants
constpatio, abdominal pain, cramping, bloating, gas, increase TG
Bile acid sequestrants /bile acid binding resins treatment option for pregnancy
colesevelam
Fewer drug interactions
Bile acid sequestrants /bile acid binding resins can _____ TG
increase
