Lipids Flashcards
If a 60 year old patient with T2DM presents with an LDL of >70 what should you do?
- start statin immediately
What is the main adverse effect of ezetimibe?
- can increase LFTs
If a patient has an LDL > 190 what should you do immediately?
start on statin immediately
What are the main adverse effects you are concerned about with statins? (2)
- liver dysfunction (check LFTs)
- Rhabdomyolysis
What is the most common adverse effect of niacin?
flushing d/t cutaneous vasodilation
What is the main limiting factor in synthesis of lipids?
HMG-CoA reductase
Daily dose lowers LDL by approximately >50% in these 2 statins.
- Atorvastatin 40-80 mg
- Rosuvastatin 20 mg
If a patient has a pre-existing ASCVD what is the LDL target goal?
< 70 mg/dl (decrease by 50%)
What are the 3 main side effects of bile acid binding agents (cholestyramine)?
- bloating
- increased TG levels
- reduced fat soluble vitamins
What is the recommended follow up after initiating statins?
4-12 weeks
What is the MOA of ezetimibe?
inhibits cholesterol absorption in the intestines thus reduces LDL receptors and reduces plasma LDL
If a patient has a moderate risk of atherosclerotic disease but does not want to go on a statin what imaging modality can be done for further evaluation?
coronary calcium scan
What is the second line agent for treatment of hyperlipidemia?
ezetimibe
What is the Friedewald formula?
LDL = total chol - (TG/5) - HDL
Athereosclerosis is the cause of what % of all deaths?
50%
what lab test allows for direct measurements of LDL?
electrophoresis
People that are missing this enzyme have a low level of circulating LDL.
- PCSK9
new drugs to inhibit PCSK9 enzyme
What are the 3 factors that influence lipid levels?
- nutrition
- genetics
- derangements on metabolism
This drug is known to markedly increase the HDL.
niacin
Which of the drugs used to treat hyperlipidemia can induce insulin resistance?
- niacin
What drug significantly decreases triglyceride levels?
fibric acid derivatives (fibrates)
Fenofibrate**
What vitamin is Niacin?
vitamin B3
Negative feedback loop for synthesis is based on what enzyme?
mevalonate enzyme
What diet is recommended for patients at high risk of atherosclerosis?
- DASH
What are the 3 main side effects of fibrates?
- dyspepsia
- gallstones
- myalgias
What is the LDL target goal in a patient with a starting LDL of > 190.
<100
What medication is a good alternative for statins in patients who can’t deal with the muscle side effects?
- cholestyramine
What are the 2 cholesterol lowering medications that also have a cardiovascular risk reduction?
- statins
- cholesterol absorption inhibitors (Ezetimibe)
Which of the statins has an FDA warning for rhabdo at it’s highest dose?
Simvastatin (Zocor)
If AST/ALT increases greater than ___ times the baseline you should stop statins.
> 3 times normal
This drug should not be used in patients with gout.
Niacin
Ezetimibe inhibits absorption of dietary cholesterol by binding to what protein?
Niemann-Pick C1-like 1 (NPC1L1)
What drug undergoes CYP450 metabolism?
Ezetimibe
