Lipid Update Flashcards

1
Q

What does the SPRINT study suggest?

A

The use of thiazides on top of everything else for secondary prevention in patients with Coronary Heart disease, prior MI and borderline BP of 140/100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the optimal medical therapy in people with coronary heart disease?

A
Intensive lifestyle modification 
Aspirin 
High dose statin 
Optimal BP control 
Thiazide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What kind of management of BP and lipids is best to improve survival

A

AGGRESSIVE management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a good drug option for people with statin intolerance?

A

Evolocumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Explain MOA of Evolucomab

A

it is a PCSK9 monoclonal antibody

PCSK9 is a protein that degrades LDL receptor (LDL R degrades LDL)

By blocking PCSK9, LDL R can keep degrading LDL

SO no heart disease occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What did the study on Evoloclumab establish?

A

It decreased CV events
Significantly reduced LDL
NO major effect on mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Who is Evoloclumab useful IN?

A

Patients with very high uncontrolled LDL e.g. familial hypercholesteraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a downside to Evoloclumab use?

A

It is a VERY EXPENSIVE drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What did the UKPDS study show?

A

That aggressive blood glucose control maintains low HbA1c over 14 years follow up
And improved outcomes for everything

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How long does it take for benefits to become apparent on the UKPDS?

A

15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What happened to UKPDS who after the study reverted to poor blood glucose control?

A

They quickly reached similar HbA1c to their counterparts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain the legacy effect in the UKPDS trial

A

Patients in the intensive treatment group had low mortality despite their blood glucose deteriorating the same as controls

This means that GOOD BLOOD GLUCOSe even for short time periods has beneficial effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What did the ACCORD study show

A

ACCORD: they tried to very aggressively control glucose (aimed for HbA1C of 6.0) in people who had decades of poor control
They found that this had massive increased mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What did the ADVANCE study show?

A

That less aggressive control (aim HbA1c of 6.5) reduced death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What did the DCCT study show?

A

In T1DM, good control improves outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does an SGLT2 inhibitor do in the kidney?

A

It blocks glucose resporption > makes you pee out glucoser

17
Q

What does SGLT2 inhibitor result in?

A
REDUCTION IN BLOOD GLUCOSE AND BP
also
- Weight loss 
- reduction in mortality after 4 years 
- prevents CV disease
18
Q

After how long were SGLT2 effects visible

A

6m

19
Q

What is the drug name of SGLT2 inhibitor

A

Empagliflozin

20
Q

What does GLP (endogenous) do?

A

It signals the pancreas to increase insulin secretion

Directly reduces appetite and increases gastric emptying

21
Q

What is the dug name for GLP1 analogue

A

Exenatide

22
Q

What does Exenatide do

A

Increases hypothalamic satiety

23
Q

What do GLIPTINS do?

A

They prevent the breakdown of GLP1 by inhibiting DPP4 (which normally breaks down GLP1)

24
Q

What drug is front line for T2DM=

A

Metformin