Test 1: Wk2: 1 Antilipemics - Velentovic Flashcards
1
Q
Acceptable cholesterol level
A
<200
2
Q
Acceptable LDL-C level
A
<100
3
Q
Acceptable Triglyceride level
A
<150
4
Q
Hyperlipidemia primary causes (2)
A
diet and genetics
5
Q
Hyperlipidemia secondary causes (2)
A
drugs
certain diseases and conditions (diabetes and alcoholism)
6
Q
1st Line of therapy
A
diet
7
Q
decreasing total daily — intake will help cholesterol and triglyerides
A
fat
8
Q
high triglycerides are caused by — reduce them by decreasing intake of — and —
A
high carb intake
carbs and alc
9
Q
increasing exercise increases — levels
A
HDL
10
Q
5 Drugs that lower Cholesterol
A
resins Statins Nicotinic Acid Ezetimibe PCSK9 Inhibitors
11
Q
what are the 3 resins
A
Cholestyramine
Colesevelam
Colestipol
12
Q
the bioavailability of statins is — why?
A
0; not absorbed in GI
13
Q
Normally bile acids undergo —
recirculation 6x/day blocked by —
A
Normally bile acids undergo enterohepatic
recirculation 6x/day blocked by resins
14
Q
resins cause increased — excretion of —
A
fecal; bile acids
15
Q
resins increase conversion of hepatic — to —
A
cholesterol to bile acids
16
Q
bile acids have a negative feedback on — and — remove this negative feedback
A
7a hydroxylase
resins
17
Q
resins increase number of — receptors
A
hepatic LDL
18
Q
increased hepatic LDL receptors causes a compensation for — resulting in —
A
compensation for decreased intrahepatic
cholesterol
lower plasma LDL-C
19
Q
resins are used to treat
A
hypercholesterolemia
20
Q
how long for resins to have maximal effects
A
4 weeks
21
Q
resins decrease LDL-C by — %
A
20
22
Q
resins are often combine with (4 drugs)
A
HMG CoA reductase inhibitors
ezetimibe
fibrates
Nicotinic acid
23
Q
can resins be used in pregnant women and children
A
yes
children older than 6
24
Q
where do the major side effects of resins occur and what are they
A
GI
bloating and constipation
25
what is taken with resins to lessen side effects
Colesevelam
26
resins interfere with ---
fat sol vit and drugs
27
how much should resin dosing be staggered
1 hr before
| 4 hrs after
28
HMG CoA Reductase Inhibitors are also known as
Statins
29
what are the 7 statins
Atorvastatin , Simvastatin , Lovastatin, Rosuvastatin Pravastatin, Fluvastatin &
Pitavastatin
30
Statin are a --- inhibitor of --- enzyme in --- biosynthesis
competitive, HMG CoA reductase; cholesterol
31
Statin site of action is primarily in
the liver
32
Statins increase the number of --- and increase the clearance of ---
hepatic LDL receptors
plasma LDL
33
Statins are used to lower
cholesterol
34
what 2 statins are used to lower cholesterol and triglycerides
Atorvastatin and Rosuvastatin
35
Statins elevate --- and ---
plasma ALT/AST
CPK
36
Statins increase risk of --- and ---
hepatic and renal disease
37
the risks of statins --- with --- dose
increase with higher dose
38
increased CPK is associated with ---
myalgia
39
what to statins have the least side effects
fluvastatin and pravastatin
40
3 Statin contraindications
Pregnancy X
Nursing mothers
Acute Liver Dz
41
max effect of statins takes
2 weeks
42
statins increase --- levels
HDL
43
statins have --- absorption and --- bioavail
good, low
44
What statin can be used in pediatrics (8 yrs)
pravastatin
Age 10+ for other statins
45
peak cholesterol synthesis is from --- to ---
midnight to 2 am
46
what 3 statins are taken at night
Fluvastatin , Lovastatin, Simvastatin
47
what 3 statins can be taken any time of day
Atorvastatin, rosuvastatin and pravastatin taken
48
what 2 statins bioavail is lowered by food
Pravastatin & Pitavastatin
49
why do Atorvastatin and
Rosuvastin reduce
cholesterol and triglycerides
(3 reasons)
loner t1/2
higher increase in LDL receptors
increase clearance of IDL
50
--- and --- statins are prodrugs and are converted to active metabolites by --- and ---
Lovastatin and Simvastatin
intestinal carboxylesterase and CYP3A4
51
--- is the substrate for atorvastatin, lovastatin
| and simvastatin
CYP3A4
52
avoid grapefruit juice with
atorvastatin, lovastatin
| and simvastatin
53
--- rosuvastatin and fluvastatin
CYP2C9 rosuvastatin and fluvastatin
54
--- simvastatin
CYP2D6 simvastatin
55
simvastatin induced --- is higher with --- allele
muscle pain; CYP2D6*4
56
--- SNP lowers hepatic
| uptake, higher plasma levels
```
SCLO1B1 SNP (OATP1B1) lowers hepatic
uptake, higher plasma levels
```
57
Ezetimibe inhibits --- absorption at the ---
cholesterol; brush border of SI
58
Ezetimibe inhibits Inhibits cholesterol absorption at ---
enterocytes
59
Ezetimibe inhibits ---transporter protein
NPC1L1
60
Ezetimibe targets
dietary cholesterol
61
Ezetimibe lowers LDL-C by max --- %
20
62
Ezetimibe works better when combined with -- instead of doubling --- dose
statin; statin
63
Ezetimibe adverse effects and what is most common
minimal GI
| diarrhea most common
64
don't use Ezetimibe with
hepatic dysfunction
65
Ezetimibe increases risk of elevated --- when combine with
transaminase; statins
66
Ezetimibe not often combined with
resins
67
2 PCSK9 Inhibitors
Alirocumab and Evolocumab
68
PCSK9 inhibitors MOA
bind LDL receptor and degrades it
less LDL can be removed from blood
By inhibiting PCSK9, more LDL receptor can remove more LDL
69
Alirocumab and Evolocumab are used with
statin or ezetimibe
70
Alirocumab and Evolocumab dosig
every 2 wks sub Q
71
Alirocumab and Evolocumab decrease --- by ---% when combined with ---
LDL-C 50-70% Ezetimibe
72
Alirocumab and Evolocumab side effects
allergy
73
3 Drugs that lower triglycerides
Fibrates
Nicotinic Acid
Omega-3-Acid Ethyl Esters
74
2 FIbrates
Gemfibrozil and Fenofibrate
75
Fibrates bind --- to stimulate ---
PPARa; FA oxidation
76
fibrates reduce --- expression resulting in increased --- activity
apoCIII
lipoprotein lipase
77
Fibrates decrease hepatic production of --- by increasing ---
VLDL; clearance
78
fibrates increase --- by ---%
HDL; 15%
79
increased risk of gallstones is only associated with which fibrate
clofibrate
80
fibrates have an increased risk of --- when combined with ---
myopathy; HMG CoA reductase inhibitors
81
myopathy is worse with what fibrate
Gemfibrozil
82
Gemfibrozil inhibits ---
OATP2
83
risk of myopathy is least with what fibrate
fenofibrate
84
fibrate contraindications (3)
liver dysfunction
renal dz
gallbladder dz
85
Nicotinic Acid decreases production of ---
hepatic VLDL
86
Nicotinic acid inhibits --- decreasing delivery of --- to the ---
lipolysis
FFAs
liver
87
Nicotinic acid inhibits --- in -fat cells decreasing circulation of ---
hormone sensitive lipase
| FFAs
88
increased --- increases --- clearance
lipoprotein lipase; VLDL
89
Nicotinic acid does not interact with
PPARa
90
Nicotinic acid lowers
TG and Cholesterol
91
Nicotinic acid adverse effects (3)
itching, flushing
| increased ALT/AST
92
what needs to be monitored when Nicotinic acid is combined with satins
creatine kinase
93
Nicotinic acid should not be used in pts with
peptic ulcer
94
Nicotinic acid may cause --- and ---
hyperuricemia and glucose intolerance
95
Nicotinic acid contraindications
bleeding disorder
liver dz
peptic ulcer
96
Icosapent Ethyl lowers --- in individuals with ---
TGs, high >500 mg/dl TG
97
Icosapent Ethyl inhibits
DGAT
98
Icosapent Ethyl decreases --- synthesis
VLDL
99
Icosapent Ethyl increases ---
lipoprotein lipase eicosapentatonic acid
100
Icosapent Ethyl adverse effects
arthralgia
101
Icosapent Ethyl contraindications
hypersensativity
102
Familial hyperchylomicronemia Type 1 has elevated --- and ---
chylomicrons and TGs
103
Familial hyperchylomicronemia Type 1 has defect in
lipoprotein lipase or Apo CII
104
Familial hyperchylomicronemia Type 1 control
diet therapy
fibrates and nicotinic acid
105
Familial hypercholesterolemia IIa elevated --- and ---
cholesterol and LDL
106
Familial hypercholesterolemia IIa increased risk for
CVD
107
Familial hypercholesterolemia IIa decreased clearance of
LDL
108
Familial hypercholesterolemia IIa tx
resins
statins, ezetimibe combined with PCSK9
109
Familial hypercholesterolemia IIb elevated --- and ---
VLDL and LDL
110
Familial hypercholesterolemia IIb tx
Statins and Nicotinic acid
111
Familial dysbetalipoproteinemia III elevated --- and ---
TGs and Cholesterol
112
Familial dysbetalipoproteinemia III --- and --- remnants
IDL and chylomicron
113
Familial dysbetalipoproteinemia III presence of abnormal
Apo E - E2
114
Familial dysbetalipoproteinemia III increased --- production
VLDL
115
Familial dysbetalipoproteinemia III most sensitive to
fibrates
50% TG redcution
116
Familial hypertriglyceridemia IV elevated --- and ---
TG and VLDL
117
Familial hypertriglyceridemia IV associated with --- and or ---
hyperuricemia and glucose intolerance
118
Familial hypertriglyceridemia IV tx
fibrates
| nicotinic acid
119
Diseases cholesterol elevated in
biliary dz
renal dz
hypothyroidism
diabetes
120
Diseases Triglycerides elevated in
alcoholism
renal dz
diabetes
121
thiazide diuretics elevated --- and --- by ---%
cholesterol and TGs by 10-15%
122
Beta Blockers elevate --- and decrease ---
TG and HDL
123
oral contraceptives elevate
TGs
