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Terms in this set (116)
An overproduction or defective clearance of TG and LDL?
Primary cause (genetic)
What are secondary causes?
Any reason causing dyslipidemia that is not genetic
What makes up hypercholesterolemia?
Increased LDL and total cholesterol
What are some drugs that can cause hypercholesterolemia?
What are some conditions that can cause hypercholesteroemia?
-Obstructive liver disease
What are the some medications that can cause hypertriglyceridemia?
-BB (carvedilol is preferred in DM pts and those with high trigs)
-Bile Acid Sequestrants
What are some conditions that can cause hyptriglyceridemia?
What are some risk factors for CHD?
-HTN or medication
-Low HDL (<40 mg/dL)
-Family history of CHD
-Age (M >45,W>55)
At what HDL does it count for negative risk factor?
What do we want TC to be?
Optimal LDL level
HDL Low and HIgh
Normal Trig lvl
TC - HDL - (TG/5)
only works if TG <400
What are very large particles that carry dietary lipids?
What are Chylomicrons main fuction?
deliver dietary TGs to skeletal muscle and adipose tissue
What transports cholesterol and new TGs to the tissues where TGs are removed and leave LDL? It serves as the primary transport system of cholesterol
What retrieves cholesterol from the artery wall and inhibts the oxidation of athergenic cholesterol in arteries?
What do Trigs do?
Store energy for later use
How are foam cells made?
Some LDLs enter the subendothelial space of arteries, which are then oxidized, and then are taken up by macrophages
How does the exogenous system make cholesterol?
Chylomicrons (rich in TGs) of dietary origin are converted to chylomicron remnants rich in cholesteryl esters by the action of lipoprotein lipase
How does the endogenous system work?
VLDL (rich in TGs) are secreted by the liver and converted to IDL and LDL (rich in cholesterol esters)
How much can exercise reduce LDL?
Can alcohol increase HDL?
Yes; but drinking more than what is considered moderate has an opposite effect and can raise cholesterol
inhibits HMG-CoA reductase
What do Statins do to a lipid panel?
Decrease LDL and TG
What is myopathy?
weakness and/or cramps AND elevation in serum CK <10X the ULN
What are the Low Intensity statins?
What are the high intensity statins?
When taking simvastatin and amlodipine together, what is the dose recommendation?
Do no exceed 20mg/day of simvastatin
What statins interact with grapefruit juice?
Lovastatin/Simvastatin and Verapamil/diltiazem dosing recommendations?
Lovastatin should not exceed >20mg/day
Simvastatin should not exceed >10mg/day
Why should you limit the dose on simvastatin (20mg) and rosuvastatin (40mg) while taking amiodarone?
Higher risk of myopathy/rhabdo
FDA recommendations on Zocor
Limit the use of simvastatin 80mg because of an increase risk of muscle damage
What are new C/I that the FDA established with Zocor?
What are the hydrophilic statins?
What are the lipophilic statins?
Lipophilic/Hydrophilic is more associated with more adverse evens such as myopathy and memory loss
Which statins require renal dose adjustments?
ALL except atorvastatin
Which statin requires dose adjustments in Asians?
What is the recommended dose to start in Asian when taking Crestor?
What is the Rule of 7's?
LDL is reduced 7% with each doubling of the dose
Effect that statins have on glucose and A1C?
Definition of statin intolerance
inability to tolerate at least 2 statins (1 at lowest starting daily dose and 1 at ANY dose)
Which statin should be taken with food?
What statins (3) can really be taken during any time of the day?
MOA of Zetia
Acts at the brush border of the small intestine to inhibit the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver
MOA of Bile Acid Sequestrants
binds with bile acids to prevent its reabsorption in the intestines
When are Bile Acid Sequestrants not recommended?
Which Bile Acid Sequestrant has less potential for DDIs compared to oters?
Colesevelam has a CI when TGs are ____
Can Bile Acids Sequestrants be given with statins?
What does Red Yeast Rice contain that is similar to lovastatin?
Fish Oil tx and lipids
Decrease TG and VLDL
How much EPA and DHA are required for a clinical effect?
465mg of EPA and 375mg of DHA 4x daily
What can be used to decrease myopathy when taking a statin?
What clinical presentation can occur in pts with herditary hypertrig
What causes acute pancreatitis associated with hypertrig?
Just alot of chylomicron TG that arent able to clear out of the blood fast due
When should you start tx in patients with hypertrig?
TG levels persistently >886
What is the tx goal in someone with really high TGs?
<886 to a target of <500
Does targeting TG levels during treatment improve CVD outcomes?
MOA of fibrates
PPAR-alpha activator, which leads to enhance the elimination and decrease synthesis of VLDL
If TGs are high, reducing TGs may _______ LDL
What are some AEs that can happen when taking Lopid?
Cholelithiasis or Cholecytitis
Which fibrate drug is it safer to take with statins? Do to a decrease in statin concentration
Which fibrate drug inhibits glucuronidation more?
T/F) Fibrates should be taken without food
High-dose Niacin shouldn't be used in what pts? Why?
DM; worsening of diabetic control
What is a non-serious AE assocaited with Niacin? What can tx that AE?
Flushing; pretreat with ASA or IBU 30 minutes before dose
The flushing effect is mediated by _______
What formulation of Niacin might be better for DM pts?
Fish Oil indication
Adjunct to diet in pts with TGs >500
Omega-3-acid ethyl esters
EPA only formulation: icosapent ethyl
When would you typically see a response when taking fish oil?
What to formulations of fish oil may increase LDL?
Lovaza and Epanova
What statins have a higher potency at lowering TGs than other statins?
Homozygous Familial Hypercholesterolemia (HFH) is autosomal _______ disorder
What gene is effected by HFH? What does this cause?
Apo B/E (LDL) receptor
Reduced clearance of LDL particles from the circulation and elevated LDL-C
How would pts present with HFH?
-High LDL lvl from birth
-Early onset CHD
Where is the most common location for tendon xanthomas?
What causes tendon xanthomas?
When lipids are extremely elevated, extravasation of lipoproteins through dermal capillary blood vessels get engulfed by macrophages
Class 1 LDL receptor mutation
Null: synthesis is defective
Class 2 LDL receptor mutation
Transport defective: transport from the ER to Golgi is impaired
Class 3 LDL receptor mutation
Binding defective: binding to LDL surface is defective
Class 4 LDL receptor mutation
Internalization defective: Receptors do not cluster in coated pits ---> minimizes LDL internalization
A patient would be classified as receptor-_________ if they had virtually no detectable LDL receptor activity
A patient would be classified as receptor-__________ if the had markedly reduced but detectable LDL receptor activity
In general, plasma levels of LDL-C are directly/inversely related to the level of LDLR activity
FH women who are on statin therapy and anticipate becoming pregnant should stop statin ___ months prior to attempting to conceive
Are you more likely to bleed or clot during pregnacy?
What happens to TC, TG, and HDL during pregnancy? Esp. 3rd trimester
Increase TC and TG
What can statin therapy do to the fetus during the first trimester?
Increases congenital CNS and limb abnormalities
MTP inhibitor; which prevents the assembly of Apo-B containing lipoproteins in the ER of hepatocytes and Entercytes -----> reduces production of VLDL and chylomicrons
Overall Juxtapid MOA
Preg Cat of Juxtapid
When should Juxtapid be taken
2 hours after evening meal
What supplements must be given with Juxtapid?
Oligonucleotide inhibitor of ApoB-100 synthesis; binds to mRNA and prevents translacation of ApoB-100 protein
Overall Kynamro MOA
decrease LDL and VLDL lvls
injection site pain/rxn
MOA of PCSK9 inhibitors
Allow LDL-Rs to remain on the surface and continue removing LDL; PCSK9 usually degrades the receptor allowing it remain in cirulation
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