Lipid Lowering Drugs

Front 1

hyperlipoproteinemias are due to what?

Back 1

defects in the lipid transport system

Front 2

If you have an abnormally high level of lipoproteins you have what?

Back 2

A higher risk for: Atherosclerosis, pancreatitis, Xanthomas;

Front 3

Upper limit of normal chol is what?

Back 3

200 mg/DL total, less than 100 LDL

Front 4

LDL levels are especially important for predicting CAD in the presence of what?

Back 4

Other risk factors: Diabetes, Smoking, HTN, Fam history

Front 5

Chylomicrons are broken down to what by what?

Back 5

FFA's, chylomicron remnants; LPL;

Front 6

Chylomicron remnants end up where?

Back 6

The liver

Front 7

Following absorption, what molecule of interest is mostly contained in the chylomicron remnants?

Back 7

Cholesterol

Front 8

What is the fate of the chylomicron remnants once they go to the liver?

Back 8

chol extracted, packaged into VLDL, IDL, LDL etc; Also makes bile salts

Front 9

A VLDL mostly contains what?

Back 9

Lipid, very little cholesterol

Front 10

What then happens to LDL,VLDL etc?

Back 10

floats around, binds eventually to cells, taken up by cells, chol extracted

Front 11

What happens if you have excess LDL?

Back 11

taken up by macros, become foamy, form plaques;

Front 12

How does the cell make its own cholesterol?

Back 12

through the HMG CoA reductase pathway

Front 13

What is the main negative regulator of HMG CoA reductase endogenously?

Back 13

high levels of chol in the cell

Front 14

How does the liver scavenge extra cholesterol that’s just floating around?

Back 14

Via HDL, takes it up and brings it back to the cell

Front 15

Causes of secondary hyperlipoproteinemias?

Back 15

liver, renal, endocrine (diabetes, hypothyroid) dysfunction, stress, drugs (glucocorts)

Front 16

So if you're trying to treat a secondary hyperlipoproteinemia, what do you do?

Back 16

treat the underlying cause

Front 17

Primary hyperlipoproteinemias caused by what?

Back 17

genetics

Front 18

Non pharm tx of hyperlipidemias?

Back 18

Cut out the main risk factors Diet, exercise, stop smoking, etc;

Front 19

Main mech's of pharm tx of hyperlidemia?

Back 19

down production, up removal, down absorption of cholesterol

Front 20

Statins are what?

Back 20

HMG CoA reductase inhibitor

Front 21

Statins were derived from what?

Back 21

aspergillus

Front 22

Mech of statins?

Back 22

analog of HMG CoA which inhibits HMG CoA reductase

Front 23

What happens when you take away the cells ability to make its own cholesterol?

Back 23

has to make more LDL receptors, increases uptake of LDL, decreases circulating LDL;

Front 24

Overall good effects of statins?

Back 24

Down LDL, Down triglycerides, Up HDL

Front 25

SE's of statins?

Back 25

usual suspects (headache, rash, GI); Myositis (myalgia); Liver tox, NOT FOR PREGGERs, Memory loss;

Front 26

What do you do if you're patient is having myositis on statins and why?

Back 26

take them off immediately, can cause rhabdomyolysis;

Front 27

Dosage of Niacin for treating hyperlipidemia?

Back 27

100X RDA

Front 28

Mech of niacin?

Back 28

Inhibits enzyme for FFA release, which decreases FFA's, which are needed for VLDL synth; Increases half life of HDL

Front 29

Which drug is currently the best for increasing HDL?

Back 29

Niacin

Front 30

Se's of niacin?

Back 30

cutaneous flushing, itching, Increased Uric acid, insulin resistance;

Front 31

How can you block the cutaneous itching and flushing associated with niacin and why?

Back 31

aspirin - because it blocks the prostaglandins

Front 32

Niaspan?

Back 32

time release niacin

Front 33

Cholestyramine?

Back 33

Bile acid binding resin

Front 34

Colestipol?

Back 34

Bile acid binding resin

Front 35

Coleselevam?

Back 35

Bile acid binding resin

Front 36

Mech of bile acid binding resins?

Back 36

bind up the bile acids (contain tons of cholesterol); Those are normally recycled, but if they're bound and excreted, liver uses excess cholesterol to make more bile acids, decreases free cholesterol

Front 37

SE's bile acid binding resins?

Back 37

gritty texture, prevent absorption of fat soluble nutrients, constipation, belching

Front 38

Gemfibrozil?

Back 38

The fibrates

Front 39

Fenofibrate?

Back 39

The fibrates

Front 40

Mech of the fibrates?

Back 40

binds to PPAR receptor causes increase synth of LPL, Increases HDL, decreases LDL

Front 41

SE's of the fibrates?

Back 41

Gi upset, gallstones, displacement of warfarin from plasma proteins

Front 42

Mech of Ezetimibe?

Back 42

blocks chol transport from gut

Front 43

Mech of Sitostanol?

Back 43

decreases chol absorption (dietary aid)

Front 44

Mech of Orlistat?

Back 44

decreases GI and pancreatic lipase and thus fat absorption

Front 45

Mech of Olestra?

Back 45

Unabsorbable oil, causes leakae

Front 46

Lovaza?

Back 46

omega 3 fatty acid

Front 47

Mech of omega 3 fatty acids?

Back 47

Down TG synth, Up HDL

Front 48

SE's of omega 3's?

Back 48

GI upset, belching;

Front 49

Which type of drug here is category X for pregnancy?

Back 49

the statins