Tx of dyslipidemias

Question 1

diet

Answer 1

vegetables, fruits, whole grains, low fat dairy, poultry fish, legumes, non tropical veg oils anuts, limits sweets, sugar sweetened beverages and red meat

Question 2

exercise

Answer 2

40 minutes of mod intesity a week

Question 3

statin guidelines

Answer 3

clinical CVD- high intensity
LDL>190- high intensity
DM 40-75 yrs old LDL70-189 moderate to high intensity
LDL 70-189 + 7.5 risk of CVD mod intensity

high- Atorvastatin, Rosuvastatin

Question 4

Statins MOA

Answer 4

HMG COA reductase inhibitors

decrese hepatic pool of free cholesterol

increase the expression of the LDL receptor

INcrease catabolism of VLDL and LDL
Decresae LDL

Question 5

6% rule

Answer 5

if u double the dose of a statin u only get 6% lowering

Question 6

Statins s/e

Answer 6

rhabdo, myositis, liver issues, cognitive impairement

Question 7

Bile acid sequestrants/resins

Answer 7

cholestyramine, colestipol, colesevelem

combine bile acids, and intterfere with reabsorbtion
reduce cholesterol pool size
LDL receptor upregulates

s/e all gi

ddi- digoxin warfarin thiazide beta blockers thyroid hromones… inhibits their absorbtion

contraindication- broad beta disease or elevated TG’s since these resins raise TAGS

Question 8

ezetimibe

Answer 8

works in the gut, interferes with cholesterol receptor, stops resorption. very specific.
no adverse effects

Question 9

plant sterols and stanol esters

Answer 9

modest LDL lowering, might interfere with absorption of fat soluble vitamins
over the counter

no clinical evidence

Question 10

PCSK9 protein inhibitors

Answer 10

approved recently
alirocumab, evolocumab
for people who are statin intolerant
heterozygous FH

more efficacious than statins

Question 11

Triglyceride lowering drugs

Answer 11

fibrates, omega 3 fatty acids, nicotinic acid, “statins”

only work when patient get TG’s lower

Question 12

Fibrates

Answer 12

PPAR alpha agonists.

make muscle oxidize more FA’s

contraindicated in svere renal or hepatic disease

not relevant in statin era

Question 13

Feno fibrate S/E-

Answer 13

skin rash, myopathy, increase in liver enzymes, increase in creatinine

Question 14

Gemfibrozil S/E

Answer 14

cholelithiasis, myopathy GI distress

Question 15

omega 3 FA

Answer 15

only work at high doses
FDA indication- use only when TG above 500
hard to make a good decisions

Question 16

combined hyperlipidemia

Answer 16

Nicotinic acid (niacin)
binds Gi in liver increases fatty acid oxidation, decreses TG synthesis, decreases VLDL syntheis--> lower LDL

Question 17

Niacin s/e

Answer 17

many
severe skin rash
liver disease, gout
PUD, IBD
impaired glucose tolerance.

Bad drug

Question 18

HDL increse

Answer 18

oral estrogens, Niacin, CETP inhibitors
Lifestyle, etoh!

no clinical efficacy