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Cardio Exam 1 > Lec 17 Antihyperlipidemic Drugs > Flashcards

Lec 17 Antihyperlipidemic Drugs Flashcards

1
Q

What is major regulator of serum LDL?

A

hepatocyte LDL receptors

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2
Q

What is action of statins?

A

HMG CoA reductase inhibitors –> block cholesterol production in liver –> stimulates SREBP [sterol regulatory element binding protein] which upregulate LDL receptors on hepatocytes

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3
Q 
What is comparative efficacy:
atorvastatin
rosuvastatin
lovastatin
simvastatin
A

rosuvastatin > atorvastatin > simvastatin > lovastatin

double doses to get same efficacy
rosuvastatin 1/2 the dose of atorvastatin

lovastatin needs 4x simvastatin

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4
Q

What is rule of 6?

A

double dose of statin to get another 6% lowering

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5
Q

What is atorvastatin basic dose to use to calculate needed dosages?

A

10 mg atorvastatin = 35% reduction

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6
Q

What is HDL in men vs women?

A

45 in men

55 in women

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7
Q

What is goal for HDL?

A

HDL > 60

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8
Q

Which 2 statins are capable of 50% LDL reduction?

A
  • atorvastatin

- rosuvastatin

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9
Q

What dietary changes to reduce LDL?

A
  • less saturated fat, cholesterol, trans fatty acids
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10
Q

What are side effects of statins?

A
  • myalgias
  • rhabdomyalisis
  • high AST/ALT
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11
Q

Is there still increased benefit from decreasing LDL below 100?

A

linear increase benefit with lower LDL

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12
Q

Whats up with grapefruit and statins?

A
  • statins inhibit CYP450 in gut
  • grapefruit inhibits cyp450
  • if have lots of grapefruit –> more statin absorbed, higher plasma levels of statin
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13
Q

What is action of ezetimibe?

A

blocks receptor in intestinal brush border to block cholesterol absorption from gut –> decrease hepatocyte intracellular cholesterol conc –> more LDL receptors in liver

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14
Q

What happens if give ezetimibe monotherapy?

A

decrease LDL and triglycerides

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15
Q

What happens if you give statin and ezetimibe?

A

its like doubling the statin dose 3 times = get huge decrease LDL and TG

= greater LDL reduction than atorvastatin 20 or 40 alone

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16
Q

What are side effects of ezetimibe?

A

rare myalgias

17
Q

Does ezetimibe improve outcomes?

A

decreases LDL but unproven yet to lower ischemic CV events

18
Q

What is effect of statins? [on LDL/HDL/TG/outcomes]

A
  • decrease LDL by a lot
  • increase HDL
  • decrease TG
  • decrease risk of poor outcome [death/MI]
19
Q

What is effect of ezetimibe? [on LDL/HDL/TG/outcomes]

A
  • decrease LDL
  • not really affect HDL and TG
  • not known whether it decreases risk of poor outcome
20
Q

What is effect of bile acid binders [on LDL/HDL/TG/outcomes]

A
  • 15-20% decrease LDL
  • slightly increase HDL and TG
  • decrease CHD events within 3 yrs
21
Q

Fibrates [on LDL/HDL/TG/outcomes]

A
  • decrease LDL a little
  • increase HDL
  • decrease TG a lot
  • prevent ischemic CV disease
22
Q

Niacin [on LDL/HDL/TG/outcomes]

A
  • decrease LDL
  • increase HDL a lot [#1 choice]
  • decrease TG
  • decrease CV risk
23
Q

What is difference cholestyramine vs colesevalam?

A

cholestyramine = first gen; anion binder = lots of drug interactions b/c binds other medications

colesevalam = docking site more specific for bile acid –> less drug interactions

24
Q

What are side effects of bile acid binders [colesevalam and cholestyramine]?

A

difficult to take = large pills
constipation
decrease absorption other drugs

25
Q

What normal TG level?

A

normal < 150

high >200

26
Q

When do chylomicrons appear?

A

at TG > 1000 –> can lead to pancreatitis

27
Q

What is risk with high TG?

A

independent risk factor for CHD especially with low HDL < 40

28
Q

Which meds can you use to lower TG?

A
  • statins
  • fibric acids
  • niacin
  • fish oils
29
Q

Which meds can you use to lower LDL?

A

d

30
Q

Which meds can you use to increase HDL?

A
  • niacin is best
  • fibrates

minor effect: statins, bile acid binders

31
Q

What is mech of action fish oil?

A

inhibits VLDL formation so less VLDL secreted

good for treating high TG

32
Q

What is action of fibrates on HDL/TG/LDL?

A

HDL: increases Apo A-I/II –> incraese HDL production

TG: decrease TG synthesis –> decreased VLDL synthesis; increase LPLipase –> increase VLDL clearance

LDL: decrease # of LDL particles

33
Q

Does fish oil decrease CV events?

A

no

34
Q

Does niacin added to statins bring extra benefit?

A

nope

Cardio Exam 1 (16 decks)

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