Quiz 3 Flashcards
Does a drug to decrease LDL
Simvastatin 20-40mg at night
Dose a drug that increases HDL significantly and helps decrease TG
Gemfibrizol 600mg 2x daily
30min before breakfast and dinner
Dose a drug that decreases TG and doesn’t interfere with a HMG-CoA reductase inhibitory
Slo-Niacin 500mg-1g at night
Define hyperlipidemia
Elevation in any lipoprotein species
Define hyperlipemia
Increased levels of triglycerides
Chylomicrons carry
They are very large, they carry dietary lipids
VLDL carry
triglycerides and to a lesser extent cholesterol
IDL carry
cholesterol esters and triglycerides
LDL carry
cholesterol esters to tissues/vessels
HDL carry
cholesterol esters from plaques and tissues to liver
What apoproteins convey lipids into the tissue and artery walls?
What lipoproteins have them?
B-100 & B-48
-VLDL, IDL, LDL, chylomicrons
What apoproteins is unique to HDL?
D
What lipoprotein reduces the risk of CHD?
HDL
Healthy adults over age____ should receive a lipid panel every_______
Obtained after a ________ hour fast
Over age 20, every 5 years
after 9-12hr fast
What is in the lipid panel?
Total Cholesterol (TC)
Triglycerides
HDL
LDL & VLDL are calcuated
VLDL=
Triglycerides/5
LDL=
TC- (HDL+VLDL)
Causes of secondary “acquired” hyperlipidemia
Diabetes Hypothyroidism Renal Failure Obstructive liver disease Drug induced
What guidelines do we use to establish dyslipidemia treatment goals?
ATP III Cholesterol Guidelines
What factors are considered when evaluating CHD risk
Clinical CHD Symptomatic carotid artery disease Peripheral artery disease abdominal aortic aneurysm diabetes
What are the major risk factors?
Smoking
HTN
HDL <60
Familial hx premature CHD
What factors are used to calculated Framingham risk score?
Age TC HDL Smoking status Systolic BP
ADRs of HMG-CoA reductase inhibitors
Myopathy
-re-challenge with another or smaller dose
What enzyme metabolizes Simvastatin?
CYP3A4
MOA for statins
Reduces hepatic cholesterol biosynthesis
Metabolic Syndrome looks at what risk factors?
Abdominal obesity Triglycerides HDL BP Fasting Glucose
IF triglycerides are >________ first lower triglycerides vs. LDL to prevent______
Use a ____
> 500
pancreatitis
Use fibrate or nicotinic acid
Initial treatment of choice for hyperlipidemia
Therapeutic Lifestyle Changes (TLC)
- weight management
- physical activity
- TLC diet
- Smoking cessation
- Manage comorbidities
Other benefits of statins include:
decrease oxidative stress
decrease vascular inflammation
stabilize atherosclerotic lesions
MOA of nicotinic acid
Decrease hepatic VLDL secretion and enhances VLDL clearance
ADRS of niacin include
Flushing, pruritus, warmth, tingling Hyperglycemia Hyperuricemia=gout Upper GI distress Hepatotoxicity
Drug interactions of Niacin include
Bile-acid binding resins decrease absorption
Enhances ADRs or statins
MOA of fibrates
Activate lipoprotein lipase
Promote delivery of TGs to adipose
Interfere with VLDL formation in the liver
Fibrate with Clcr <80-30mL/min=
Adjust dose
Fibrate with Clcr <=30
Contraindicated
ADRs of Fibrates
Rare but:
- GI symptoms
- Myopathy
- Arrhythmias
- Increased aminotransferases or alk phos
Drug interactions of fibrates include
Increase myopathies when with statins
Increased warfarin affect
OTC Fish Oil/Omega 3 fatty acids may
Decrease triglycerides
Pregnant women/lactating can not receive
Statins (Category X)
First drug choice for children
cholestyramine
