Hyperlipidemia/Hypertriglyceridemia

Question 1

Cholesterol

Answer 1

steroid, component of cell membrane, precursor for bile acids required for fat absorption, adrenal steroids and sex hormones, 40-60% is endogenous rest is from diet

Question 2

Phospholipids

Answer 2

lipid containing phosphoric acid residues in addition to fatty acids and alcohol, main lipid constituent of membranes and nerve tissue

Question 3

Chylomicrons

Answer 3

formed in intestines, transport dietary fat to peripheral cells and liver, taken up by cells of vessel walls, utilizing macrophages with the end results of generation of foam cells

Question 4

Chylomicrons transport what to where

Answer 4

fats from intestinal mucosa to liver

Question 5

LDL carries what to where

Answer 5

fat and cholesterol to the body’s cell

Question 6

High density lipoproteins carry what to where

Answer 6

fat and cholesterol back to liver for excretion

Question 7

What happens when oxidized LDL cholesterol gets high

Answer 7

atheroma formation in the walls of arteries occurs, causing atherosclerosis

Question 8

Causes of hyperlipidemia

Answer 8

diet, hypothyroidism, nephrotic syndrome, anorexia, liver disease, obesity, diabetes, pregnancy, lupus, AIDS, HEREDITARY, antipsychotics

Question 9

Familial hypercholesterolemia

Answer 9

codominant genetic disorder, occur in heterozygous form, 1 in 500, mutation in LDL receptor, result in elevated levels of LDL at birth and throughout life, high risk for atherosclerosis

Question 10

Familial combined hyperlipidemia

Answer 10

autosomal dominant, increased secretions of VLDL

Question 11

HMG CO-A Reductase inhibitors

Answer 11

Atrovastatin (Lipitor), Simvastatin (Zocor) Pravastatin (Pravachol), Rosuvastatin (Crestor), Pitavastatin (Livalo), Lovastatin (Mevacor), Fluvastatin (Lescol)

Question 12

MOA of Statins

Answer 12

inhibitor of enzyme HMG CO-A, which is a rate limiting enymes in the synthesis of cholesterol

Question 13

Clinical uses of statins

Answer 13

hypercholesterolemia, prevention and secondary prevention, familial, nonfamilial, mixed, ACS, CAD, Stroke, also Cancer, infection, Alzheimer’s, antiinflammatory etc

Question 14

ADRs of statins

Answer 14

increased LFT, myopathies, sparks muscle breakdown

Question 15

Statins pearls

Answer 15

improved efficacy when given at bedtime (simvastatin, prevastatin, NOT atorvastatin or rosuvastatin)

Question 16

Contraindication of Statins

Answer 16

pregnancy category X

Question 17

Monitoring

Answer 17

baseline renal function, liver function, CK, regular LFTs, educate patient S/SZ of myopathy

Question 18

DIs of statins

Answer 18

Simvastatin has several di’s, less with rosuvastatin, pravastatin is best option for none

Question 19

Statin safety recommendations

Answer 19

select approp. dose, keep potential ADRs and DIs in mind, if high or moderate intensity dosing not tolerated, settle for maximum dose tolerated, consider dec. dose for 2 consecutive LDL

Question 20

Bile acid sequestrants

Answer 20

Cholestyramine (Questran), Colestipol (Colestid), Colesevelam (Welchol)

Question 21

MOA of Bile acid sequestrants

Answer 21

binds bile in GI tract for excretion to stop enterohepatic cycling, decreases plasma LDL concentration

Question 22

Clinical uses of Bile acid sequestrants

Answer 22

Hypertriglyceridemia, Diarrhea

Question 23

ADRs of bile acid sequestrants

Answer 23

GI, can increase TG

Question 24

DIs of bile acid sequestrants

Answer 24

can decrease absorption of several other drugs because it’s a chelator, take 1 hour before, 4 hours after other meds, and before meals

Question 25

Niacin

Answer 25

Vit. B3, inhibits VLDL synthesis and hepatic secretion and release of FFAs from adipose, immediate and slow release, Increases HDL*, facial flushing, monitor LFT, glucose and uric acid

Question 26

Fibric acid derivatives

Answer 26

inhibit synthesis of VLDL and incr VLDL removal, management of hypergllyceridemia and prevent heart disease in pt with high LDL/low HDL, mainly reduction in TG, no pregnancy, GI and myopathy ADRs

Question 27

Types of fibric acid derivatives

Answer 27

Fenofibrate (Tricor etc) and gemfibrozil

Question 28

Ezetemibe (Zetia)

Answer 28

inhibits absorption of intestinal cholesterol, adjunct with statins, bad study done on it, well tolerated, but abd pain/diarrhea, contraindicated mild hepatic disease, avoid for serious hepatic

Question 29

Simvastatin+ezetemibe combo

Answer 29

Vytorin

Question 30

Best for dec LDL

Answer 30

statins

Question 31

Best for incr HDL

Answer 31

Niacin

Question 32

Best for decr TG

Answer 32

Niacin and fibric acid

Question 33

4 major statin benefit groups

Answer 33

pt with clinical ASCVD, LDL>190, DM 40-75 YO with LDL 70-189 and no ASCVD, pt without ASCVD or DM with LDL 70-189 and esimated 10 year ASCVD risk >7.5%