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Endocrinology > Lipids Pharm > Flashcards

Lipids Pharm Flashcards

1
Q

Mainstay of hyperlipidemia treatment

A

statins

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2
Q

All patients should have their ___ and ___ measured before starting and after starting a statin if symptoms of ___ are evident

A

All patients should have their AST and ALT measured before starting and after starting a statin if symptoms of hepatotoxicity are evident

About 1% of patients will develop elevations in LFTs that require D/C the drug

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3
Q

When to prescribe a High intensity statin (3)

A
  1. Anyone with atherosclerotic CV disease
  2. Anyone with a > 7.5% 10 year CV disease risk
  3. LDL > 190mg/dL
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4
Q

Effectiveness of high intensity statins

A

daily doses lowers LDL-C by about 50% on average

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5
Q

When to prescribe a Moderate intensity statin (4)

A
  1. Anyone with atherosclerotic CV disease > 75
  2. Cannot take a high dose statin
  3. ASCVD risk of 7.5% or higher
  4. You’ve got DB and LDL of 70 to 189 mg/dL
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6
Q

Effectiveness of moderate intensity statins

A

daily dose lowers LDL-C by ~ 30% to 50% on average

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7
Q

When to prescribe a low intensity statin (1)`

A

cannot take a high or moderate dose

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8
Q

Effectiveness of low intensity statins

A

Daily dose lowers LDL-C by less than 30% on average

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9
Q

MOA of statins

A

Inhibit cholesterol synthesis by inactivating HMG CoA reductase and increasing catabolism of LDL

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10
Q

pitavastatin
rosuvastatin
atorvastatin

potency?

A

Most potent LDL-C lowering agents

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11
Q

pravastatin
simvastatin

potency?

A

Intermediate potency

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12
Q

fluvastatin
lovastatin

potency?

A

lowest potency

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13
Q

Meds primary affect what organ

A

liver - that’s why you’re check AST and ALT and watching for transaminitis

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14
Q

Patients who are homozygous for familial hypercholesterolemia lack LDL receptors, and therefore, benefit much less from treatment with these drugs

A

statins

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15
Q

ADE of statins (4)

A
  • elevated LFTs
  • hepatic insufficiency can lead to problems
  • increased effects on warfarin
  • contraindicated in pregnancy
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16
Q

which statin has an increased risk of myopathy and rhabdomyolysis

A

simvastatin

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17
Q

increased incidences of myopathy and rhadomyolysis occurs in…

A

patients with renal insufficiency or concurrent use with nephrotoxic drugs

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18
Q

Muscle complaints should be evaluated with ___ levels

A

Muscle complaints should be evaluated with plasma creatine kinase (CK) levels

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19
Q

Most effective agent for increasing HDL-C

A

other than exercise… Nicotinic acid

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20
Q

Lowers triglycerides by 20% to 35% at typical doses of 1.5 to 3 grams/day

A

Nicotinic acid

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21
Q

At gram doses, strongly inhibits lipolysis in adipose tissues, thereby reducing the free fatty acid production

A

Nicotinic acid

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22
Q

Useful in treatment of familial hyperlipidemias:

  • Lowers plasma levels of cholesterol
  • Lowers plasma levels of triglycerides
A

Nicotinic acid

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23
Q

How do you prevent the intense cutaneous flushing and pruritis that is common with Nicotinic acid

A

Administration of aspirin 30 minutes prior to niacin decreases the flush (prostaglandin-mediated)

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24
Q

ADE of nicotinic acid (4)

A
  1. Nausea and abdominal pain
  2. Niacin inhibits tubular secretion of uric acid, may predispose to hyperuricemia and gout
  3. Impaired glucose tolerance
  4. Hepatotoxicity (avoid use of drug in setting of hepatic disease or impairment)
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25
Q

good drug for hypertriglyceridemia and subsequent pancreatitis that can develop from elevated Trig.

A

Fibric Acid Derivatives: fenofibrate and gemfibrizol

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26
Q

Derivatives of fibric acid, lowers serum ___ and increases ___

A

Derivatives of fibric acid, lowers serum triglycerides and increases HDL-C

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27
Q

Fenofibrate > ___ in lowering triglyceride levels

A

Fenofibrate > gemfibrizol in lowering triglyceride levels

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28
Q

Use of fibric acid derivatives

A

Treatment of hypertriglyceridemias

Particularly useful in treating familial dysbetalipoproteinemia

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29
Q

ADE of fibric acid derivatives (4)

A
  1. Mild GI disturbances are common; lessen as therapy progresses
  2. Gallstone formation due to increased biliary cholesterol excretion
  3. Myositis can occur; evaluate for muscle weakness or tenderness
  4. Use with caution in patients with renal insufficiency
  5. Myopathy and rhabdomyolysis reported if used with statins
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30
Q

Gemfibrizol + ____ is contraindicated

A

Gemfibrizol + simvastatin is contraindicated

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31
Q

Myopathy and rhabdomyolysis reported if ____ are used with statins

A

Myopathy and rhabdomyolysis reported if fibric acid derivatives are used with statins

32
Q

Avoid use of ___ in patients with severe hepatic or renal dysfunction, preexisting gallbladder disease

A

Fibric Acid Derivatives

33
Q

cholestyramine
colestipol
colesevelam

A

Bile Acid-Binding Resins

34
Q

MOA of ___:

  • Anion-exchange resins, bind negatively-charged bile acids and bile salts in the small intestine
  • The bound complex is excreted in feces (lowers bile acid concentration)
  • Causes hepatocytes to increase conversion of cholesterol to bile acids
  • Intracellular cholesterol concentrations decrease, activating an increased uptake of cholesterol-containing LDL particles and a fall in plasma LDL-C
A

MOA of Bile Acid-Binding Resins

35
Q

____ can relieve pruritus related to bile acid accumulation in patients with biliary stasis

A

Cholesytramine

36
Q

____ is also indicated for DMII due to glucose-lowering effects

A

Colesevelam

37
Q

Often used in combination with diet or nicotinic acid

A

Bile Acid-Binding Resins

38
Q

Bile Acid-Binding Resins most common ADE

A

GI related: constipation, nausea, flatulence

39
Q

Bile Acid-Binding Resin with fewer GI side effects than others in this drug class

A

Colesevelam

40
Q

This group may impair absorption of fat soluble vitamins

A

Bile Acid-Binding Resins

41
Q

Bile Acid-Binding Resins may increase…

A

triglyceride levels

42
Q

ezetimibe

A

Cholesterol Absorption Inhibitors

43
Q
  • Selective inhibition of dietary and biliary cholesterol in small intestine
  • Leads to decrease in hepatic cholesterol stores and increase in clearance of cholesterol from the blood
  • Lowers LDL-C by approximately 17%
A

ezetimibe

44
Q

adjunct to statin therapy or in statin-intolerant patients

A

ezetimibe

45
Q

Drug with little to no ADE

A

ezetimibe

46
Q

ezetimibe is primarily metabolized in the ____ and ____ via glucuronide conjugation

A

primarily metabolized in the small intestine and liver via glucuronide conjugation

47
Q

Essential fatty acids used mainly for lowering triglyceride levels

A

Omega-3 polyunsaturated fatty acids (PUFAs)

48
Q

Inhibit VLDL and triglyceride synthesis in the liver

A

Omega-3 polyunsaturated fatty acids (PUFAs)

49
Q

Although effective at lowering triglyceride levels, omega-3 PUFA supplementation has not been shown to reduce ___ morbidity or mortality

A

Although effective at lowering triglyceride levels, omega-3 PUFA supplementation has not been shown to reduce CV morbidity or mortality

50
Q

Drug class with greatest effect of lowering LDL?

Second greatest?

A
  1. statins (HMG CoA reductase inhibitors)

2. bile acid sequestrants

51
Q

Drug class with greatest effect of increasing HDL?

Second greatest?
Third?

A
  1. Niacin
  2. Fibrates
  3. statins
52
Q

Drug class with greatest effect of decreasing triglycerides?

Second greatest?
Third?

what increases the triglycerides?

A
  1. fibrates
  2. niacin
  3. statins

Bile acid sequestrants increase

53
Q

Elevated ___ are independently associated with increased risk of ASCVD

A

triglycerides

54
Q

Hypertriglyceridemia primary therapy (2)

A

diet

exercise

55
Q

Hypertriglyceridemia secondary therapy (2)

A
  1. Nicotinic acid and fibric acid derivatives are most effective
  2. Omega-3 fatty acids in adequate doses may be beneficial
56
Q 
Myocardial infarction
Stroke
Retinopathies
Nephropathies
Impotence

Rhabdomyolysis and renal failure related to statins

A

Atherosclerosis and associated sequelae of hyperlipidemias

57
Q

The primary organ at risk in hypoglycemia is the ___

Unlike other tissues, the ___ cannot use free fatty acids as an energy source

A

brain

58
Q

Usually results from an imbalance between insulin and glucagon

A

Hypoglycemia

59
Q

When glucose levels approach the low 80’s, insulin levels ____ to prevent hypoglycemia

A

decrease

60
Q

As glucose levels continue to decrease, ____levels increase

___ is the first line defense against again more severe hypoglycemia

A

glucagon

61
Q

____ is the next hormone to combat hypoglycemia; cortisol and other catecholamines also play a role

A

Epinephrine

62
Q
  • If patient took insulin surreptitiously, there will be a high blood insulin levels and a low blood C-peptide level (exogenous insulin does not contain C-peptide)
  • Patients taking exogenous insulin will also develop anti-insulin antibodies
  • If the patient took sulfonylurea, check urine or serum for drug levels
A

Factitious hypoglycemia

63
Q

Ethanol ingestion
Insulinoma
Reactive (idopathic) hypoglycemia

can all cause…

A

hypoglcyemia

64
Q

Insulin-producing tumor arising from beta-cells of the pancreas
Associated with MEN I syndrome
Usually benign (in up to 90% of cases)

A

Insulinoma

65
Q

headache, visual disturbances, confusion, seizures, coma

A

Neuroglycopenic symptoms of an insulinoma

66
Q

diaphoresis, palpitations, tremors, high blood pressure, anxiety

A

Sympathetic activation common in an insulinoma

67
Q

How to dx insulinoma

A

72 hour fast: insulin levels that are even more elevated than in normal individuals –> even in the hypoglycemic conditions

68
Q

How to diagnose an insulinoma

A

whipple triad

69
Q
  1. Hypoglycemic symptoms brought on by fasting
  2. Blood glucose < 50 mg/dl during symptomatic attack
  3. Glucose administration brings relief of symptoms
A

whipple triad

70
Q

whipple triad

A
  1. Hypoglycemic symptoms brought on by fasting
  2. Blood glucose < 50 mg/dl during symptomatic attack
  3. Glucose administration brings relief of symptoms
71
Q

Whipple triad is used to diagnose true ___ (i.e., ____ due to underlying disease (like in insulinoma)

A

hypoglycemia

72
Q

C-peptide levels are increased in ____ and in an ____

A

sulfonylurea abuse

insulinoma

73
Q

Proinsulin levels are increased in ____, decreased in _____, and normal in _____.

A

Increased in insulinoma
Decreased in Sureptitious insulin
Normal in sulfonylurea abuse

74
Q

If reactive hypoglycemia is suspected, ____ interventions are appropriate

A

If reactive hypoglycemia is suspected, dietary interventions are appropriate

75
Q

If the patient is an alcoholic (or suspected alcohol), give ___ before administration of glucose to avoid Wernicke encephalopathy

A

thiamine

Endocrinology (11 decks)

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