lipid lowering drugs

Question 1

hyperlipidemia

Answer 1

1) related to atherosclerosis
- inflammatory response
- plaque formation
2) mild - usually no symptoms
3) lab - elevated TGs and cholesterol
4) hypertension, CAD, heart attack associated, kidney disease

Question 2

risk factors CAD

Answer 2

1) hyperlipidemia

Question 3

lipid metabolism

Answer 3

1) food => liver => systemic circulation

Question 4

cholesterol

Answer 4

1) cholesterol membrane constitute
2) liver is major place for synthesis and degradation
3) acetyl coa
- HMG coa reductase is the primary rate limiting step

Question 5

triglycerides

Answer 5

1) three fatty acids covalently bonded to glycerol
2) membrane component, precursor, intracellular messenger
3) lipids do not go well with water

Question 6

plasma lipoproteins

Answer 6

1) combined with lipoproteins
2) wrap them and make them water soluble
3) transport exogenous CHO and TG from Gi to liver an other tissues
3) VLDL transport endogenous TG and CHO from liver to tissues
4) IDL transport VLDL remnant
5) LDL transport CHO from liver to tissue
6) HDL transport CHO from tissue to liver

Question 7

HDL

Answer 7

1) cardioprotective effect
2) atherogenetic lipoprotenia

Question 8

contraindication with mevacor (lipid lowering) and itraconazole?

Answer 8

1) cause of candidiasis
- corticosteroids
- compromised immune system, opportunistic infection
2) is dentist correct in prescribing itraconazole
-anti-fungal, but contraindicated with statin

Question 9

statins

Answer 9

1) lowers LDL lipoproteins
2) increases LDL receptors on liver
3) inhibit HMG CoA
- reduce synthesis
4) short half lives
5) metabolized through cyp enzymes in the liver (important drug interactions, first pass metabolism)
6) antiplatelet, antioxidant, stabilizing plaque, anti inflammatory effects, inhibit cell migration to vascular endothelium
7) major side effects: myopathy, hepatitis

Question 10

fibrates

Answer 10

1) lowers TG proteins
2) increase HDL
3) fibric acid derivatives: gemfibrozil
4) PPARs, synthesis of lipoprotein lipase, increase synthesis of HDL, increase clearance of TG rich lipoproteins
5) increase the risk of myopathy when used together with statins

Question 11

bile acid sequestrants

Answer 11

1) contains many lipoproteins
2) breaks down into little droplets, more digestion
3) cholestyramine: ion exchange resins
4) prevent the reabsorption of bile acids
5) GI side effects

Question 12

niacin

Answer 12

1) elevated expression of HDL
2) increase HDL-C
3) very high doses needed, which has side effects

Question 13

table of drug interactions

Answer 13

1) know the table
2) pay attention to elderly women, multisystem disease, organ transplant, long prescription list, surgery

Question 14

PCSK9 inhibitors

Answer 14

1) reduce degradation of LDL-R (receptors)
2)

Question 15

other bempedoic acid

Answer 15

1) reduce LDL synthesis through inhib of adenosine triphosphate citrate lyase
2) much more expensive

Question 16

dentists and interactions

Answer 16

1) drug interactions with statins, inhibitors of hepatic CYP3A4
2) caution in patients taking nicotinic acid
- avoid NSAIDs