Hyperlipidemia Pharma (Exam 1)

Question 1

HMG-CoA Reductase Inhibitors: MOA

Answer 1

-By blocking this pathway the liver does not produce cholesterol

-It will recognize this and start making more LDL receptors which will pull more LDL out of the blood (which we want)

Question 2

What should we try first for someone at high risk for atherosclerosis

Answer 2

-Try modifications to things like diet and exercise. Lifestyle changes.

-Try this for 6 months to see if these work at lower cholesterol

Question 3

HMG-CoA Reductase Inhibitors: What group of people do not do well with this increase in LDL receptors?

Answer 3

-People with familial hypercholerstoldieam

-They have issues with making LDL receptors. So they do not respond well

Question 4

HMG-CoA reductase inhibitors are commonly referred to as what class?

Answer 4

-Statins: Because they all have statin in their name.

Question 5

What can statins help with

Answer 5

-Decrease number of Heart Attacks and CVA’s. Reduces the risk of disability from nonfatal stroke

-Reduce the total mortality with history of prior ASCVD event

-Primary and Secondary prevention

Question 6

4 groups that benefit from Statins

Answer 6

1. With clincial ASCVD
2. With primary elevation LDL
3. 40-75 years of age with DM with LDL
4. Without clinical ASCVD or DM, 40-75 years of age with LDL-C and estimated 10-year ASCVD risk

Question 7

Clinical ASCVD

Answer 7

-Acute coronary syndrome. Umbrella term, blood supply to heart is suddenly blocked.

-History of myocardial infarction

-Stable or unstable angina

-Coronary revascularization (any procedure to open vessel back up)

-Stroke or TIA

-Peripheral arterial disease or revasculariation (PAD) lower extremity

Question 8

If you fall into a category of ASCVD

Answer 8

You would benefit greatly from use of statin to prevent hyperlipodemia

Question 9

HMG-CoA Reductase Inhibitors: MOA

Answer 9

-Work by inhibiting HMG-CoA reductase

-Less cholesterol is produced by liver

-Liver makes more LDL receptors

-More LDL is removed from the blood

-Not a permanent drop in levels. Need to take the drug for a long term effect

-Stabilize plaque and decrease inflammation

Question 10

HMG-CoA Reductase Inhibitors: Effect

Answer 10

-Decrease in LDL 21-63%

-Decrease in TG 6-43%

-Increase in HDL 5-22%

Question 11

HMG-CoA Reductase Inhibitors: Adverse Reactions

Answer 11

-Myopathy (Muscle Weakness)

-Rhabdomyolysis (Breakdown of muscle fibers) (Acute Kidney Failure)

-Hepatotoxicity: Liver damage if being treated for a year or more

Question 12

HMG-CoA Medications

Answer 12

atorvastatin

simvastatin

rosuvastatin

-Takes about 2 weeks to begin to see effect

-May take with food if GI discomfort

Question 13

Which statins need to be taken at night?

Answer 13

Simvastatin and Rosuvastatin (Short half life)

Because liver makes more cholesterol at night

Question 14

Statin: Drug interactions

Answer 14

-Avoid drugs that increase risk of myopathy or rhabdo

-Avoid alcohol

Question 15

Cholesterol Absorption Inhibitor

Answer 15

ezetimibe

-Blocks absorption of cholesterol in jejunum. (Dietary) (Cholesterol secreted in bile)

-2nd line therapy to statins

Question 16

Cholesterol Absorption Inhibitor in combination with HMG-CoA Reductase Inhibitor =

Answer 16

-15-20% greater LDL descrease

-ezetimibe + simvastatin

Question 17

Prior to medication

Answer 17

-Fasting lipid panel
-ALT and AST (Liver function)
-CK (Creatine Kinase)
-Consider secondary causes of lipodemia

(AVOID GRAPEFRUITS)

Question 18

Secondary Causes of Hyperlipidemia

Answer 18

-Diet

-Drugs

-Diseases

-Disorders/metabolism