Exam II miscellaneous

Question 1

What are the exercise recommendations for adults?

Answer 1

2hrs 30 mins/week moderate exercise OR 1 hr 15 mins aerobic activity (vigorous)

AND

resistance training 2x/week

Question 2

4 Indications for statins (secondary/primary prevention)

Answer 2

1. Clinical ASCVD
2. LDL-C >190 mg/dL without secondary cause
   Primary prevention
3. Diabetes, age 40-75 years, LDL-C 70-189 mg/dL
   Primary prevention
4. No diabetes, age 40-75 years, LDL-C 70-189 mg/dL + 7.5% risk of CVD event in the next 10 years.

Question 3

LDL = (formula)

Answer 3

LDL-C = Total Cholesterol – (HDL-C + TG/5)

Question 4

A loss of function mutation in PCSK9 will (increase or decrease) LDL cholesterol?

Answer 4

decrease. LOF mutation is protective. GOF spikes LDL cholesterol to 200+

Question 5

What is the receptor that “downloads” HDL from the macrophage (increase HDL levels)?

Mutations in this cause what inherited disorders?

Answer 5

ABCA1.

Tangier disease and familial hypoalphalipoproteinemia

Question 6

Do elevated triglycerides increase risk of CAD?

Answer 6

NO. (LDL do, HDL are protective, but triglycerides don’t increase the risk, even when dramatically elevated.)

Question 7

What is the main risk of very high (greater than 500) triglycerides?

Answer 7

Pancreatitis.

Question 8

What is the function of the LDL receptor on a hepatocyte? How does PCSK9 change this functionality?

Answer 8

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.

Question 9

With each statin dose doubling, LDL-C falls by ____%

Answer 9

6%

Question 10

What is the main limiting side effect of statin therapy?

Answer 10

Myopathy.

Myalgia (10-20%), Myositis (Increased CK 2%), and Rhabdo (Less than 0.1%)

~1% of the time, liver enzymes exceed 3x ULN

Question 11

Name the high-intensity statins (with dose):

Answer 11

Atorvastatin (40mg)

Rosuvastatin (20mg)

Question 12

High intensity statins reduce LDL by ___ %.

Answer 12

Greater than 50%

Question 13

Name the mid-intensity statins

Answer 13

Atorvastatin (20mg)
Rosuvastatin (10mg)
Simvastatin (20-40mg)
Pravastatin (40mg)
Lovastatin (40mg)
Fluvastatin (40mg BID)

Question 14

What are three bile acid sequestrants?

What are the side effects?

Answer 14

Cholestyramine (liquid - more potent)
Colestipol (liquid - more potent)
Colesevelam (pill)

GI side effects (nausea, bloating, constipation)

Question 15

Name 2 low-intensity statins:

Answer 15

Pravastatin (10-20 mg)

Lovastatin (20mg)

Question 16

Administration of a bile sequestrant will do what to LDL, HDL, and triglyceride levels?

Answer 16

Decrease LDL-C 10%-35%
Increase HDL-C 3%-5%
Increase TG by 5-30%

Question 17

Ezetimibe works by:

Indicated for?

Side effects?

Answer 17

Blocks cholesterol absorption at the intestinal brush border

Add-on therapy for statins.

No sfx.

Question 18

What are alirocumab and evolocumab are indicated to treat? What is the MOA?

Answer 18

PCSK9 inhibitors.

Approved for familial hypercholesterolemia and existing coronary disease.

Question 19

What is the MOA of statins?

Answer 19

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

Question 20

Statins are metabolized by _____

Answer 20

CYP3A4

So inhibitors (grapefruit juice, ketoconazole) will increase risk of myopathy.

Question 21

Bile acid sequestrants’ mechanism of action is to____.

They are indicated for _____ or _____.

Answer 21

reduce the enterohepatic circulation of bile acids.

Add-on therapy to statins, pregnancy, or people who can’t tolerate statins.

Question 22

What effect does niacin have on LDL, TG, and HDL?

Why won’t you prescribe it (probably)?

Answer 22

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.