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Drugs for Final Pharm > dyslipidemia > Flashcards

dyslipidemia Flashcards

1
Q

dyslipidemia

A

elevated total or LDL

low HDL

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2
Q

major source of cholesterol

A

de novo syn in liver

most cholesterol is converted to bile acids

3 hydroxy 3 methyl glut aryl CoA to mevalonate

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3
Q

lipoproteins

A

VLDL
LDL
HDL
chylomicron (largest, TG)

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4
Q

exogenous

A

chylomicron in gut
transports dietary fats
degraded releasing TG and apoproteins
remnants cleared by liver

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5
Q

endogenous

A

VLDL formed in liver and helps TG transfer
remnants of VLDL and LDL
LDL number and size related to atherogenicity
LDL, app B-100 binds to LDL receptors on liver

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6
Q

statins

A

inhibit HMG-CoA reductase, dec hepatic stores of cholesterol
inc LDL rec number leading to dec plasma LDL

pravastatin (Renal)
lovastatin (grapefruit)
atorvastatin (grapefruit, any time)
rosuvastatin (renal)
simvastatin (grapefruit, drug int)
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7
Q

statin clinical pearls

A 
taken at night
1 mo for max effect
CONTRA pregnancy
RENAL
dec LDL, TG/ inc HDL
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8
Q

statin side effects

A

GI upset
myopathy-rhabdo (CPK)
hepatotoxicity (LFT)
decrease cholesterol (FLP)

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9
Q

fibric acid derivatives

A

reduce TG

fenobrate (renal, contra in allergy)
gemfibrozil ( 30 min prior to meal, renal, not with other statins

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10
Q

fabric acid derivative clinical pearls

A

several days for max
LIVER

LFTs
CPK
CBC
FLP

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11
Q

fibric acid derivatives side effects

A 
Dyspepsia
Abdominal pain
Cholelithiasis
Impaired hepatic function
Myopathy/rhabdomyolysis
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12
Q

Bile Acid Sequestrants

A

Decreasing bile pool which causes LDL receptor increase greater hepatic uptake of cholesterol from plasma

cholestyramine ( renal, use in hepatic dys, dec absorption of oral medication, TOOTH DISCOLORATION)

colestipol (dec aborptin of oral medication, ACIDOSIS)

colesevalam (DO NOT BOWEL)

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13
Q

Bile Acid Sequestrants clinical pearls

A 
Fallen out of favor due to tolerability
Decreases LDL
Interferes with fat-soluble vitamin absorption
Increases triglycerides and HDL
Monitor FLP
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14
Q

Bile Acid Sequestrants adverse effects

A

constipation

bleeding

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15
Q

Niacin (Vitamin B3)

A

Decreases release of fatty acids from fat stores, decreases hepatic uptake of
fatty acids, and reduces production of VLDL particles.
Raises HDL
Decreases triglycerides and LDL

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16
Q

Niacin (Vitamin B3) clinical pearls

A

Administer long-acting preparations at bedtime

Fallen out of favor

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17
Q

Niacin (Vitamin B3) side effects

A

Flushing
Decreased by taking with food, ASA 325 mg, or taking SR formulation
GI (n/v/d, dyspepsia, flatulence, and PUD)
Hyperuricemia
Hepatotoxicity
Hyperglycemia

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18
Q

Omega-3-Fatty Acids [fish oil]

A

Decreases hepatic synthesis of triglycerides via inhibition of esterification of
fatty acids

Used for hypertriglyceridemia

19
Q

Omega-3-Fatty Acids [fish oil] clinical pearls

A

Caution in patients with fish/shellfish allergy
Can be used in renal dysfunction
Monitor LFTs
Caution on patients prone to prolonged bleeding time
Do not freeze
OTC formulations do not contain same concentration as Rx

20
Q

Omega-3-Fatty Acids [fish oil] side effects

A 
GI
Diarrhea
Nausea
Abdominal pain
Eructation

Arthralgia
Prolonged bleeding time
Possible increase in atrial fibrillation (Afib) / atrial flutter incidence

21
Q

Ezetimibe (Zetia®)

A

Selectively inhibits the absorption of cholesterol in the small intestine through the
NPC1L1 transporter

22
Q

Ezetimibe (Zetia®) side effects

A 
Diarrhea
Arthralgia
Myopathy
Liver dysfunction
Monitor LFTs
23
Q

Ezetimibe (Zetia®) clinical pearls

A

Fallen out of favor

Use with caution in hepatic/renal impairment

24
Q

class 1

A

no angina with normal act

angina with strenuous exertion

25
Q

class 2

A

limitation of ordinary act

worse after meals, cold, stress

26
Q

class 3

A

marked limitation of ordinary activity

27
Q

class 4

A

angina occurs at rest

28
Q

tissue markers for biomarkers

A

troponin (specific)
myoglobin
creatine kinase- MB

discriminate bt ischemia and infarction

29
Q

beta blocker

A

initial therapy in ALL pt with CAD
dec angina symptoms
dec mortality in post MI, and heart failure

B1 rec Anta on SA and AV node

30
Q

cardio selective beta blocker

A

Atenolol (Tenormin®)
Metoprolol tartrate/succinate (Lopressor®/Toprol XL®)
Bisoprolol (Zebeta®)

31
Q

non selective beta blocker

A

Carvedilol (Coreg®)
Propranolol (Inderal®)
Labetalol (Normodyne®)

32
Q

beta blocker side effect

A 
Hypotension
Bradycardia
AV block
Bronchospasm
Lethargy
Somnolence
Vivid dreams
Mask signs of hypoglycemia Except sweating
Erectile Dysfunction
33
Q

nitrates

A

Predominantly venodilation
Reduces myocardial demand by decreasing preload
Relax vascular smooth muscle in the systemic/coronary arteries
Provides symptomatic relief
No effect on mortality!!!

34
Q

short acting nitrates

A

SL nitroglycerin or nitroglycerin spray is recommended for immediate relief of
angina in patients with CAD
• Should be prescribed for ALL patients
• Nitromist®
• 1-2 sprays onto or SL
• Nitrostat®
• 0.4 mg SL nitroglycerin tablets
• Storage
• Must be kept in the manufacturer’s (original) bottle
• Discard after 6 to 12 months of opening the bottle
• Max of 1.2 mg within 15 minutes
• Take at 5 minute intervals • If no relief – CALL 911

35
Q

Short-acting nitroglycerin (NTG)

A

Sublingual (SL) – Nitrostat®

Spray - Nitromist®

36
Q

Long-acting nitrates (LAN)

A 
Isosorbide Mononitrate (Monoket®)
Isosorbide Mononitrate ER (Imdur®)
Isosorbide Dinitrate ER (Dilatrate SR®) 
Isosorbide Dinitrate (Isordil®)
NTG patch (Nitro-Dur®)
NTG paste (Minitran®)
37
Q

nitrates clinical pearls

A

avoid with PDE5 inh

hypotension

38
Q

nitrates side effects

A 
Dyspepsia
Headache
Flushing
Dizziness
Hypotension 
Tachycardia
39
Q

calcium channel blockers

A

limit Ca influx through L type Ca channels

negative inotropic effects (dec in myocardial oxygen

smooth muscle relaxation (dec vascular resistance)

provide symptomatic relief

NO effect on mortality

40
Q

CCB drugs

A

dihydropyridine
amlodipine
felodipine
nifedipine**

non dihydropyridine
diltiazem
verapamil

41
Q

CCB side effects of DHP

A 
Reflex tachycardia 
• Hypotension
• Dizziness
• Flushing
• GI effects
• Headache
• Lower extremity edema 
• Gingival hyperplasia
42
Q

CCP side effects NON DHP

A 
Bradycardia
• AV node block
• Hypotension 
• Dizziness
• Headache
• GI effects
• Constipation
• Exacerbation in HF patients 
• Gingival hyperplasia
43
Q

substitution of gingival hyperplasia

A

verapamil
isradipine

chlorhexidine gluconate

Drugs for Final Pharm (8 decks)

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