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Dynamics Test 4 > Lipid lowering part 4 > Flashcards

Lipid lowering part 4 Flashcards

1
Q

What are statins contraindicated in

A

pregnacy

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2
Q

What type of risk factor is pregnancy and for what drug

A

statins; risk factor X

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3
Q

What can ethanol and statins do to the body

A

increases risk of liver damage w/ HMG-CoA reductase inhibitor

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4
Q

What happens when you take statins with grape fruit juice

A

statin serum concentrations go up if you take more than 1 quart per day

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5
Q

What does st.johns work do to statins

A

decrease statins levels

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6
Q

What is the argument behind why healthy people should take cholesterol drugs to prevent heart disease

A

need to give to patients who have high levels of bad cholesterol as well as other risk factor, but who are health because it prevents heart disease and is preventative

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7
Q

What are fibrates and what do they do

A

amphipathic carboxylic acid; used to treat triacylglycerol levels by activating PPAR (perioxisome proliferator activated receptors) esp. PPAR alpha

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8
Q

What are peroxisome proliferation activated receptors (PPAR-alpha)

A

intracellular receptors that control carbohydrate, fat metabolism and adipose tissue differentiation.

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9
Q

What statins are safer to use with fibrates

A

less lipoophilic statins

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10
Q

What are some side effects of fibrates

A

stomach upset
myopathy- muscle pain w/ creatine kinase elevating
rhabdomyolysis- if combined with statins
lithiasis- predispolistion to form gallstones

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11
Q

How do fibrates help the body with lipids

A

gene expression of fibrates-decrease triacylglycerol concentration by increasing lipoprotein lipase

increase HDL by increasing production of ApoI and II

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12
Q

What is fenofibrate

A

its a type of fibrate, it starts as a prodrug producing an active metabolite, fenofibric acid which is responisble for the primary effects of the drug

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13
Q

What are fibrates used for

A

in combination with statins to treat hypercholesterolemia

fibrate improve HDL and triglyceride levels and improve insulin resistance when abnormal amounts of lipids are associated with metabolic syndrome

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14
Q

What are some drug interactions of fibrates

A

fibrate + warfarin= compete for binding sites; too much anticoagulation activity,. watch with INR

elevate levels of sulfonylureas- used for diabetes
this will lower glucose levels=sulfonylureas=hypoglycemia

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15
Q

What is niacin and what is its function with lipids

A

niacin is nicotinic acid or vitamin B3 (water soluble)
its derivatives play a role in energy metabolism of the cell

Niacin inhibits triacylglycerols from coming out of adipose tissue—and from the liver fatty acids broken down in triacylclycerol–> VLDL—> LDL

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16
Q

What does lack of niacin cause

A

a deficiency disease of pellagra—mild deficiency slow metabolism(lower cold tolerance and increases obesity)

17
Q

What can niacin be synthesis from but what is the problem with this

A

body can synthesize niacin from amino acid trytophan, but its slow–need to consume niacin

serotonin synthesis relies on tryptophan availability—> inadequate vitamin B3 can lead to depression

18
Q

What does niacin inhibit

A

VLDL secretion in liver

and free fatty acid release from adipose tissue

19
Q

What does niacin increase

A

increase the activity of lpl

20
Q

What does niacin decrease

A

triglycerol systhesis and lipolysis

21
Q

What is a bad side effect of niacin and will tolerance develop

A

flushing, esp with the immediate release form; up to 20% can take it and discontinue therapy was a result- vasodilation
tolerance does not develop

22
Q

What are the benefits and down sides of sustained release niacin

A

with sustained release you don’t get as much flushing but its associated with high rate of adverse hepatic effects, leading to hepatic failure and because of this the patient can experience fatigue, anorexia, and nausea.

23
Q

Why is niacin a bad choice for diabetics

A

because studies have suggested that niacin at high doses lead to higher glucose levels; and can increase cardiovascular risk

24
Q

In large doses what are niacin other effects

A

vasodilator- in large doses (note found in meet to enhance color) can cause unpleasant short term symptoms such as skin flush, itching, gastric disturbances, and lowering of blood pressure

25
Q

What is ezetimibe (zetia)

A

its a cholesterol absorption inhibitor; blocks the intesinal absorption of cholesterol; its has enterohepatic circulation and a half life of 22 hours

26
Q

How often should ezetimibe be dose and what is its effect on LDL

A

give it once a day; the max effective dose is 10mg

it reduces LDL-c by 19%

27
Q

What is vytorin

A

its a combination with simvastatin 10/ 20, 40, or 80 mg provides an LDL-c reduction of 52%

28
Q

What is advicor and how should it be taken

A

its a combination of niacin and lovastatin–for an additive effect(absorption lower with food); only take with a low fat snack (can still cause flushing)

29
Q

What is simcor and how should it be taken

A

its niacin extended release with simvastatin @
ratios:
1,000/20 and 500/20 and 750/20

30
Q

What is caduet

A

its a combination atorvastin with amlopidine which a blood pressure medication

31
Q

Understand lipid panel

A

see back of notes

32
Q

What adverse effects can patients have while on statis

A

hepatotoxicity in 1% incidence elevations of hepatic transaminase- values are three times higher but with how rare it is FDA doesn’t make doctors check it as ofter

33
Q

What adverse drug reaction can occur with statins

A

fibrates and niacin can inhibit sterol synthesis in skeletal muscle leading to a build up of creatininine-
myopathy—its the major adverse effect only in 0.1% statins

34
Q

drugs that are metabolized by cytochrome P450 (CYP34a)

A 
macrolides
antifungals 
cyclosporine
phenylpeperazine antidepressants 
nefazodone
protease inhibitors 
amidoarone 
verapamil 
ditizem 
amidoipine 
warfarin

Dynamics Test 4 (29 decks)

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