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Cardiovascular Diseases > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

statin-indicated conditions

A
  1. clinical atherosclerosis (MI, stroke, TIA, stable angina, ACS, PAD)
  2. abdominal aortic aneurysm (aorta > 3 cm or past aneurysm surgery)
  3. DM - > 40 y/o or > 15 years of DM + > 30 yo, or microvascular complications
  4. CKD (ACR > 3, or eGFR <60)
  5. LDL > 5 mmol/L (w/ familial hypercholesterolemia)
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2
Q

treatment targets for LDL

A
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3
Q

Primary prevention - when to start with statin

A
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4
Q

Non-statin drugs to treat cholesterol

A

ezetimibe
fibrates
bile acid sequestrants (cholestyramine)
PCSK9 inhibitors
omega3 fatty acids

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5
Q

Most common cholesterol-transporting lipoproteins

A

LDL
HDL
Triglycerides

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6
Q
A
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7
Q

LDL-Lowering drugs

A

statins
bile acid seq.
cholesterol absorption inhibitors
PCSK9 inhibitors

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8
Q

Triglyceride lowering drugs

A

omega 3
fibrates

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9
Q

Combined LDL + TG lowering drugs

A

niacin

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10
Q

Statin MoA

A

HMG-CoA reductase inhibitor

HmgCoA red. is involved in converting Hmg-CoA to cholesterol in hepatocytes

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11
Q

Drug interactions with statins

A

reduce dose if patient is also taking: cyclosporine, antifungals (cyp3a4 inhibitors), macrolide antibiotics, danazol

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12
Q

how are statins excreted?

A

1/5 - urine
rest - bile

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13
Q

Which drugs interact with cyp3a4 inhibitors like grapefruit?

A

simvastatin, atorvastatin, lovastatin

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14
Q

statin toxicity can lead to?

A

myopathy due to high concentrations
rhabdomyolysis - medical emergency

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15
Q

What is the best drug to enhance HDL levels and reducing TG?

A

niacin (vitamin b3)

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16
Q

MoA of fibrates

A

Activates PPAR-Alpha (peroxisome) –> increases fatty acid oxidation = reduces amount of substrates that can form TGs and VLDL

17
Q

AEs of fibrates

A

GI upset
gemfibrozil- +eczema and headache

18
Q

which fibrate should be completely avoided in combo with a statin?

A

gemfibrozil = reduces efficacy of statin, increases risk of myopathy due to statin

19
Q

MoA of cholestryramine

A

bile acid binding resin - large, water insoluble, binds to negatively charged bile acids. reduces LDL levels. drug not absorbed in intestines. they get flushed away after binding.

20
Q

Side effects of cholestyramine

A

GI: bloating, constipation, diarrhea
heartburn
-malabsorption of fat-soluble vitamins (like vit D)

21
Q

Cholesterol absorption inhibitor (Ezetimibe) MoA

A

inhibits cholesterol transport protein in intestine
-no effect on TG
-if added to statin, slight improvement in reducing CV risk

22
Q

why should ezetimibe be avoided with cholestyramine?

A

cholestyramine (a bile acid binding resin) will reduce ezetimibe absorption

23
Q

PCSK9 inhibitor examples and MoA

A

ex. evolocumab, alirocumab
-normally, PCSK9 binds to LDL receptor and promotes its degradation.
WE WANT more receptors on hepatocytes for LDL absorption into cells (from plasma).
-this drug will stop the degradation of ldl receptors

24
Q

indication for icosapent ethyl (omega3 FA)

A

severe hypertriglyceridemia

25
Q

who should be SCREENED for dyslipidemia? (lipid profile)

A
  1. children with family history of CVD or dyslipidemia
  2. men 40+ y/o
  3. women 40+ y/o and postmenopausal
  4. South Asian, First Nations, recent immigrants
26
Q

medications that can cause hyperlipidemia (2ary causes)

A

-Beta Blockers without ISA or alpha blocking activity
-Corticosteroids
-HAART (anti-retroviral)
-HRT
-COC
-thiazide diuretics

27
Q

primary CVD prevention and statins

A

start at low dose and titrate to target dose

28
Q

secondary CVD prevention + statins

A

max dose of a high-intensity statin is used

29
Q

Low-intensity statin therapy (LDL reduction < 30%)

A

Fluvastatin 20-40 mg
Lovastatin 20 mg
Pravastatin 10-20 mg
Simvastatin 5-10 mg

30
Q

Moderate-intensity LDL therapy with statin (reduces by 30-50%)

A

atorva 10-20 mg
fluva 80 mg
lovastatin 40-80 mg
rosuvastatin 5-10 mg
simvastatin 20-40 mg

31
Q

high-intensity statin therapy (LDL reduction > 50%)

A

atorva 40-80 mg
rosuva 20-40 mg

Cardiovascular Diseases (6 decks)

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