Exam II miscellaneous Flashcards
What are the exercise recommendations for adults?
2hrs 30 mins/week moderate exercise OR 1 hr 15 mins aerobic activity (vigorous)
AND
resistance training 2x/week
4 Indications for statins (secondary/primary prevention)
- Clinical ASCVD
- LDL-C >190 mg/dL without secondary cause
Primary prevention - Diabetes, age 40-75 years, LDL-C 70-189 mg/dL
Primary prevention - No diabetes, age 40-75 years, LDL-C 70-189 mg/dL + 7.5% risk of CVD event in the next 10 years.
LDL = (formula)
LDL-C = Total Cholesterol – (HDL-C + TG/5)
A loss of function mutation in PCSK9 will (increase or decrease) LDL cholesterol?
decrease. LOF mutation is protective. GOF spikes LDL cholesterol to 200+
What is the receptor that “downloads” HDL from the macrophage (increase HDL levels)?
Mutations in this cause what inherited disorders?
ABCA1.
Tangier disease and familial hypoalphalipoproteinemia
Do elevated triglycerides increase risk of CAD?
NO. (LDL do, HDL are protective, but triglycerides don’t increase the risk, even when dramatically elevated.)
What is the main risk of very high (greater than 500) triglycerides?
Pancreatitis.
What is the function of the LDL receptor on a hepatocyte? How does PCSK9 change this functionality?
The LDL receptor captures LDL and degrades it. Under normal circumstances the receptor is recycled back to the surface to grab more LDL. PCSK9 binds the LDL/receptor complex resulting in degradation of the receptor. This increases LDL levels in the blood.
With each statin dose doubling, LDL-C falls by ____%
6%
What is the main limiting side effect of statin therapy?
Myopathy.
Myalgia (10-20%), Myositis (Increased CK 2%), and Rhabdo (Less than 0.1%)
~1% of the time, liver enzymes exceed 3x ULN
Name the high-intensity statins (with dose):
Atorvastatin (40mg)
Rosuvastatin (20mg)
High intensity statins reduce LDL by ___ %.
Greater than 50%
Name the mid-intensity statins
Atorvastatin (20mg) Rosuvastatin (10mg) Simvastatin (20-40mg) Pravastatin (40mg) Lovastatin (40mg) Fluvastatin (40mg BID)
What are three bile acid sequestrants?
What are the side effects?
Cholestyramine (liquid - more potent)
Colestipol (liquid - more potent)
Colesevelam (pill)
GI side effects (nausea, bloating, constipation)
Name 2 low-intensity statins:
Pravastatin (10-20 mg)
Lovastatin (20mg)
Administration of a bile sequestrant will do what to LDL, HDL, and triglyceride levels?
Decrease LDL-C 10%-35%
Increase HDL-C 3%-5%
Increase TG by 5-30%
Ezetimibe works by:
Indicated for?
Side effects?
Blocks cholesterol absorption at the intestinal brush border
Add-on therapy for statins.
No sfx.
What are alirocumab and evolocumab are indicated to treat? What is the MOA?
PCSK9 inhibitors.
Approved for familial hypercholesterolemia and existing coronary disease.
What is the MOA of statins?
Inhibit HMG CoA reductase
Decrease hepatic pool of free cholesterol
Increase expression of LDL receptors on cell membranes
Increase catabolism of VLDL and LDL
Decrease LDL-C concentrations
Statins are metabolized by _____
CYP3A4
So inhibitors (grapefruit juice, ketoconazole) will increase risk of myopathy.
Bile acid sequestrants’ mechanism of action is to____.
They are indicated for _____ or _____.
reduce the enterohepatic circulation of bile acids.
Add-on therapy to statins, pregnancy, or people who can’t tolerate statins.
What effect does niacin have on LDL, TG, and HDL?
Why won’t you prescribe it (probably)?
Niacin lowers LDL-C by 5-25%, decreases TG by 15-35%, and raises HDL-C by10-30%.
New trials show no CVD benefit. Also, sfx include flushing, rash, GI distress, hepatotoxicity, myopathy, glucose intolerance, hyperuricemia and gout.
