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Cardiovascular > EXAM #1: DYSLIPIDEMIA II > Flashcards

EXAM #1: DYSLIPIDEMIA II Flashcards

1
Q

What is the MOA of the statins?

A

Block conversion of HMG-CoA to mevalonic acid

*Many pleiotropic effects as well

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2
Q

What are the effects of statins on lipid levels?

A
  • Lowered LDL
  • Lowered TG
  • Increased HDL

*Note a primary therapy to increase HDL

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3
Q

What should you do for a patient with ASCVD?

A

High intensity statin therapy

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4
Q

What should you do for a patient with primary elevations of LDL-C more than 190 mg/dL?

A

High intensity therapy

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5
Q

What should you do for a diabetic, 40-75 y/o, with a LDL-C between 70 and 189 mg/dL?

A

Moderate intensity therapy

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6
Q

What should you do for a patient without DM, but with a 10-year CVD risk greater than 7.5% tat is also between 40 and 75 y/o with a LDL-C between 70 and 189 mg/dL?

A

Moderate to high intensity therapy

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7
Q

What are the adverse effects associated with statins?

A

1) Muscle complaints (spectrum of myalgia to rhabdomyolysis)
2) Liver Disease
3) DM/ insulin resistance

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8
Q

What drug is specifically contraindicated with statin therapy because of an increased risk of muscle related adverse effects?

A

Gemfibrozil

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9
Q

Why do you get muscle related symptoms with statins?

A

Depletion of CoQ10 in muscle mitochondria in the pathway of cholesterol synthesis

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10
Q

What is myositis?

A

Muscle inflammation that is tender to the touch

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11
Q

What lab is associated with myositis and myonecrosis?

A

CK elevation

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12
Q

How should you treat a statin related muscle complaint?

A

1) R/o complicating condition
2) Treat with CoQ10 supplement
3) STOP and rechallenge with alternate statin
4) Alternate agent

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13
Q

What is statin triggered autoimmune myopathy?

A

Weakness that resolve and elevated CK from HMG-CoA Reductase autoantibody

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14
Q

What are the non-statin lipid lower therapies?

A

1) Bile acid sequestrants
2) NIacin
3) Fibric acids
4) Ezetimibe

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15
Q

What is the MOA of the bile acid sequestrants?

A
  • Reduce reabsorption of bile acids/ cholesterol
  • More cholesterol needs to be output from liver for basal function
  • Cholesterol levels lower
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16
Q

What effects do the bile acid sequestrants have on lipid levels?

A
  • Lower LDL
  • Raise HDL

May INCREASE TG

17
Q

What is the contraindication of bile acid sequestrant administration?

A

High TG

18
Q

What effects does Niacin have on lipid levels?

A
  • Lower LDL
  • Raises HDL
  • May REDUCE LP(a)
19
Q

What are the contraindications to Niacin?

A

Liver disease
Gout
Peptic ulcer

20
Q

Should Niacin be added to statin therapy?

A

No

21
Q

What major adverse effect is seen with Niacin

A

Flushing

22
Q

What is the primary clinical indication for Fibric Acids?

A

Hypertriglyceridemia

23
Q

What is the major effect of the fibric acids on lipid levels?

A

Lowered TG

24
Q

What adverse effect is specifically associated with the fibric acids?

A

Gallstones

25
Q

Do fibric acids show increased theraputic benefit with coadministration with statins?

A

No

26
Q

What is the MOA of Ezetimibe?

A

Impairs dietary cholesterol absorption

27
Q

Should Ezetimibe be added to Statin therapy?

A

YES–increased efficacy when added to statin therapy

28
Q

What is the major lipid effect of fish oil?

A

Lowers TGs

29
Q

What is the function of CETP?

A

Converts HDL into VLDL and LDL

30
Q

What was the hypothesized effect of CEPT inhibitors?

A

CETP inhibitors would increase HDL

Good theory, haven’t worked in clinical trials

31
Q

What are the two drugs that are uniquely indicated for Familial Hyperlipidemia?

A

1) Mipomersen

2) Lomitapide

32
Q

What is the MOA of mipomersen?

A

Blocks the production of apoB mRNA so that the liver doesn’t make VLDL or LDL

33
Q

What is the MOA of Lomitapide?

A

Oral MTP inhibitor, which is needed for Apo B lipoproteins

34
Q

What is the function of PCSK 9?

A

Regulates the expression of LDL receptors

35
Q

What is the MOA of PCSK 9 inhibitors?

A
  • Monoclonal antibody
  • Locks LDL and LDLR together
  • Destroys LDL and LDLR

Cardiovascular (38 decks)

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