Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
96 Cards in this Set
- Front
- Back
|
Epidemiologic Data/Two major early studies showed:
|
Framingham
MRFIT *Continuous/Linear relationship between cholesterol levels and CHD *Risk of CHD increases as LDL increases *Risk of CHD increases at low levels of HDL |
|
|
Framingham Heart Study
|
1948; 5,127 men & women; 30-62 years; Total C>240 increases risk of CHD; elevated HDL-C protects against CHD; elevated LDL increases risk of CHD; total-C: HDL-C RATIO predictor of CHD risk
|
|
|
MRFIT
|
12,866 middle-aged men with CHD risk factors; 1% decrease in total-C=2% decrease in CHD risk
|
|
|
Key Classes of Lipid-Lowering Drugs
|
1. HMG-CoA reductase inhibitors (statins)
2. Fibric Acid Derivatives (fibrates) 3. Nicotinic Acid (niacin) 4. Bile acid sequestrants (resins) |
|
|
Which most effective?
|
Statins
|
|
|
HMG-CoA Reductase Inhibitors (STATINS) MOA
|
MOA: 1)Upregulate LDL receptors in liver/"pulls out the LDL"
2)Inhibit the biosynthesis of LDL |
|
|
Statins: contraindications and warnings
|
Contraindications: Active liver disease, hypersensitivity, pregnancy/lactation
Warnings: Muscle-related effects; abnorm liver function tests |
|
|
*Dosing
*Maximum response in __ wks |
*Administer in evening except for PLC
*Four |
|
|
PLC
|
Not taken in the evening/take anytime: Pravachol, Lipitor, Crestor
|
|
|
Fibric Acid Derivatives (fibrates)
|
MOA: breakdsdown the VLDL/IDL, which REDUCES TGs
Safety: GI adverse events |
|
|
Nicotinic Acid (Niacin)
|
-Increases HDL
-Limited use due to poor tolerability: 25% discontinue -Flushing of face |
|
|
Bile Acid Sequestrants (Resins)
|
Bind to intestinal bile acids and form insoluable; Safety: GI disturbances; hard to tolerate; POWDERS/MIXES/tablets; "Welcol"
|
|
|
Selective Cholesterol Inhibitors
|
Inhibits absorbption of cholesterol in SMALL INTESTINE; "zetia"
Dosing: once daily w or w/o statin Safety: back pain; diarrhea |
|
|
NCEP ATP III Guidelines
|
1) LDL primary target of therapy
2) Most stringent classification of LDL/HDL/TG Levels 3) Recom intensive treatment for patients w/ CHD but focus is prevention of CHD |
|
|
FOCUS of NCEP
|
1) LDL 2) TG
|
|
|
NCEP ATP III stands for...
|
National Cholesterol Education Program Adult Treatment Panel
|
|
|
HDL
|
Reverse Cholesterol Transport
Low HDL=high CHD risk >60 HDL=carioprotective |
|
|
Risk Equivalents
|
Diabetes
Atherosclerosis rel diseases Multiple risk factors: 10-yr CHD risk >20% |
|
|
What type of cholesterol do most diabetics have?
|
LDL: small, dense, bullet-like C that can penetrate the endothelial
|
|
|
Risk Factors (excluding LDL)
|
^Smoking
^Hypertension ^Low HDL ^Family history ^Age: men 45, women 55 |
|
|
Risk Categories
|
CHD/CHD risk equivalents: 10-yr CHD risk: >20%; <100
Multiple >=2 risk factors: 10-yr CHD risk <=20%; <130 0-1 risk factor: 10-yr CHD risk: <10%; LDL<160 |
|
|
Risk Determination: If pt has greater than ___ risk factors assess 10-year absolute risk
|
TWO
|
|
|
What is the goal of primary prevention?
|
Goal: reduce both long-term and short-term risk for CHD in people who have yet to have a cardiovascular event
|
|
|
What is the goal of secondary prevention?
|
To prevent another event with Patients who have established CHD or CHD risk factors, for example diabetes
|
|
|
True or False: The Primary goal of lipid-lowering therapy: to lower LDL-C and the secondary goal is to increase HDL
|
Secondary Goal is to decrease TG (or non-HDL cholesterol)
|
|
|
True or False: Pravachol is indicated for both Primary prevention of coronary events & Secondary prevention of cardiovascular events
|
TRUE
|
|
|
What are some of the drug interactions associated with Zocor?
|
Drug interactions:
Other potent CYP3A4 inhibitors (eg, cyclosporine, ketoconazole, clarithromycin, grapefruit juice) Lipid-lowering drugs (fibrates, niacin), amiodarone, verapamil, propranolol, digoxin, anticoagulants |
|
|
What is Zetia's MOA?
|
Inhibits intestinal absorption of cholesterol
|
|
|
Vytorin should be taken in the evening with or without food. True or False.
|
True
|
|
|
What are Lipitor's indications?
|
In the prevention of CV disease: Reduce risk of MI
Reduce risk for revascularization + angina Reduce Stroke Reduce elevated total cholesterol, LDL-C, apo B, triglycerides; increase HDL-C in primary hypercholesterolemia and mixed dyslipidemia |
|
|
NCEP ATP III stands for...
|
National Cholesterol Education Program Adult Treatment Panel
|
|
|
HDL
|
Reverse Cholesterol Transport
Low HDL=high CHD risk >60 HDL=carioprotective |
|
|
Risk Equivalents
|
Diabetes
Atherosclerosis rel diseases Multiple risk factors: 10-yr CHD risk >20% |
|
|
What type of cholesterol do most diabetics have?
|
LDL: small, dense, bullet-like C that can penetrate the endothelial
|
|
|
Risk Factors (excluding LDL)
|
^Smoking
^Hypertension ^Low HDL ^Family history ^Age: men 45, women 55 |
|
|
Risk Categories
|
CHD/CHD risk equivalents: 10-yr CHD risk: >20%; <100
Multiple >=2 risk factors: 10-yr CHD risk <=20%; <130 0-1 risk factor: 10-yr CHD risk: <10%; LDL<160 |
|
|
Risk Determination: If pt has greater than ___ risk factors assess 10-year absolute risk
|
TWO
|
|
|
What is the goal of primary prevention?
|
Goal: reduce both long-term and short-term risk for CHD in people who have yet to have a cardiovascular event
|
|
|
What is the goal of secondary prevention?
|
To prevent another event with Patients who have established CHD or CHD risk factors, for example diabetes
|
|
|
True or False: The Primary goal of lipid-lowering therapy: to lower LDL-C and the secondary goal is to increase HDL
|
Secondary Goal is to decrease TG (or non-HDL cholesterol)
|
|
|
True or False: Pravachol is indicated for both Primary prevention of coronary events & Secondary prevention of cardiovascular events
|
TRUE
|
|
|
What are some of the drug interactions associated with Zocor?
|
Drug interactions:
Other potent CYP3A4 inhibitors (eg, cyclosporine, ketoconazole, clarithromycin, grapefruit juice) Lipid-lowering drugs (fibrates, niacin), amiodarone, verapamil, propranolol, digoxin, anticoagulants |
|
|
What is Zetia's MOA?
|
Inhibits intestinal absorption of cholesterol
|
|
|
Vytorin should be taken in the evening with or without food. True or False.
|
True
|
|
|
What are Lipitor's indications?
|
In the prevention of CV disease: Reduce risk of MI
Reduce risk for revascularization + angina Reduce Stroke Reduce elevated total cholesterol, LDL-C, apo B, triglycerides; increase HDL-C in primary hypercholesterolemia and mixed dyslipidemia |
|
|
Lipitor Dosing
|
10 mg, 20 mg, 40 mg, 80 mg tablets
Flexible Start™ Starting dose: 10 mg/day or 20 mg daily Dose range: 10 mg to 80 mg Patients requiring larger LDL-C reduction (>45%) may start on 40 mg/day 80 mg dose is a titration dose Taken any time of day, with/without food |
|
|
What is the reduction of LDL-C for Lipitor across the 10-80 mg dose range?
|
39-60% over the 10-80 mg
|
|
|
What is the reduction of TG for Lipitor across the 10-80 mg dose range?
|
19-37%
|
|
|
How many patients were tested in ASCOT-LLA?
|
10,305 hypertensive subjects aged 40 to 79 years with at least 3 other
|
|
|
Results of ASCOT-LLA
|
36% reduction in nonfatal MI/CHD
45% reduction in nonfatal MI 27% in fatal/nonfatal stroke 29% reduction in total coronary events 21% reduction in total CV events, (incl revasc procedures) |
|
|
CARDS results...
|
37% in major coronary events
48% in stroke 27% in total mortality |
|
|
Which of the following statins can be taken once-daily, with or without meals, at any time during the day?
|
Pravachol, Lipitor, Crestor
|
|
|
Lipid hypothesis
|
Elevated total – C and LDL – C are central to the pathogenesis of Coronary heart disease and that lipid lowering reduces CHD risk.
|
|
|
Secondary prevention
|
A Secondary prevention study seeks to determine whether intervention (usually drug therapy) can prevent established disease from progressing (MI, angina, PVD, CAD)
|
|
|
First US study to show that CHD events are related to elevated lipids and lipoproteins
|
Framingham
|
|
|
Was MRFIT an epidemiologic or a secondary prevention study?
|
Epidemiologic study that followed 12,866 middle-aged men with CHD risk factors.
Continuous, linear relation between Total C and CHD mortatlity was noted 1% drop in TC = 2% drop in CHD risk |
|
|
Match the trial with its drug:
4S WOSCOPS CARE AFCAPS/TexCAPS LIPID ASCOT |
4S - Zocor
WOSCOPS – Pravachol CARE – Pravachol AFCAPS/TexCAPS – Mevacor LIPID - Pravachol AVERT – Lipitor |
|
|
Describe 4S
|
Secondary
4,444 patients Simvastatin/Zocor |
|
|
Drug to treat high TG
|
Fibric Acid Derivatives
Examples: Gemfibrozil Fenofibrate |
|
|
True or false: The combination of statins with fibrates or niacin should generally be avoided.
|
TRUE
|
|
|
Lipitor does which of the following in patients with hypercholesterolemia?:
A. lowers total cholesterol B. lowers LDL cholesterol C. lowers apo B D. all of the above |
D. All of the above
|
|
|
What is Lipitor’s effect on HDL?
|
Raises it by 5-9%
|
|
|
Where is Lipitor metabolized?
|
In the Liver: CYP 450
|
|
|
When a patient is initiated on Lipitor, what is the protocol for liver function testing?
|
Baseline
12 weeks Semi-annually (upon titration, need to run again after 12 weeks) |
|
|
Which drugs increase the risk of myopathy/ rhabdomyolysis with concomitant statin use:
|
Fibrates
Niacin Erythromycin/macrolides (not Zithromax) Azole antifungals cyclosporine |
|
|
The following describes which drug class?
Inconvenient dosing High incidence of GI effects LDL reductions of 15 – 30% HDL increases of 3 – 5% |
Bile Acid Sequestrants
|
|
|
How often do you need to complete a fasting lipoprotein trial?
|
From the age of 20 – every 5 years (unless health status dictates more frequently)
|
|
|
At what triglyceride level is treatment considered necessary, secondary to LDL?
|
>200
|
|
|
In clinical trials, what % of patients on Lipitor discontinued therapy because of adverse events?
|
<2%
|
|
|
Flexible Start
|
10mg, 20mg, or for patients requiring >45% drop in LDL to reach goal…40mg may be used as a starting dosage.
|
|
|
What is the clinically significant ALT elevation (where you would discontinue a statin or any other med)?
|
Clinically significant level is >3xULN
10 mg rate is 0.2 20 mg rate is 0.2 40 mg rate is 0.6 80 mg rate is 2.3 |
|
|
Which type of lipoprotein contains the highest concentration of cholesterol?
|
LDL: small, bullet-like, very dense, able to easily penetrate endothelial
|
|
|
In ASCOT, Lipitor 10 mg reduced the risk of nonfatal MI and Fatal CHD by _______.
|
36%
|
|
|
What impact would an HDL level of 68 have on a person’s CHD risk factor profile?
|
Decrease it by ONE factor (Cardioprotective)
|
|
|
TRUE or FALSE: Nonpharmacologic therapy is the essential first step in the management of CHD?
|
TRUE!
|
|
|
What is the LDL cholesterol target level for drug therapy in a patient with CHD or Diabetes?
|
<100
|
|
|
What is the LDL reduction of Zetia monotherapy?
|
18%
|
|
|
The target LDL Cholesterol Goal is < 160 mg/dl for a patient with ≥____ risk factors and no CHD.
|
2
|
|
|
What is the generic name for Crestor?
|
Rosuvastatin
|
|
|
Follow-up of MRFIT showed that a __% reduction in total cholesterol resulted in __% reduction in CHD risk
|
1%; 2%
|
|
|
What type of trial was WOSCOPS?
|
PRIMARY
|
|
|
Which trials are secondary prevention trials for Zocor and Pravachol?
|
4S, CARE
|
|
|
The 40mg dose of this statin is not available for rapid distribution to pharmacies and is reserved for those patients who are not effectively treated with the 20mg dose.
|
Crestor
|
|
|
As of today, which statin is indicated for both primary and secondary prevention?
|
Pravachol
|
|
|
True or False: Zocor is indicated to reduce both elevated LDL and triglycerides.
|
True
|
|
|
With regards to the NCEP III Guidelines and TGs, what is considered to be normal?
|
<150
|
|
|
What is the most common side effect reported with Lipitor?
|
GI
|
|
|
Explain an epidemiologic study
|
Is Observational; no intervention by investigators. Is used to determine whether intervention can prevent disease development (primary prevention)
Is used to determine whether intervention can prevent established disease from progressing. (secondary prevention) |
|
|
Hypertriglyceridemia Treatment
|
Decrease weight and increase physical activity in BORDERLINE HIGH, HIGH and VERY HIGH patients; add drug therapy (statin) for HIGH patients; add very low-fat diet/fibrate/nicotinic acid for VERY HIGH pateients
|
|
|
Zocor Facts
|
Starting dose: 20-40 mg/day
Comes in: 5, 10, 20, 40, 80 Merck "simvastatin"; GI; myopathy; rhabdomyolysis; grapefruit juice; lipid-lwring drugs; 3rd statin, best statin pre-Lipitor |
|
|
Mevacor
|
"lovastatin"; Merck; 1987, first statin; 1/2-life=2-4 hours; 10, 20, 40 mg; start dose: 20mg/day with evening meal
|
|
|
Pravachol
|
"pravastatin sodium"; Bristol-Meyers Squibb; 1/2-life=77 hours; 10, 20, 40, 80 mg; start dose: 40, max 80; can be admin anytime with/w/o food; treats PRIMARY/SECONDARY
|
|
|
Lescol
|
"fluvastatin sodium"; Novartis; 20, 40 mg or 80 mg XL; start dose of 20-80mg; food decreases rate of absorption; secondary; liver complications
|
|
|
Crestor
|
Treats primary, high TG; homozygous FH; liver issues; myopathy, rhabdomyolysis; proteinuria/blood in urine/Asian patients
|
|
|
Zetia
|
Liver issues; pregnancy catagory C; GI; 10mg dosing; Merck-Sharing Plough
|
|
|
Vytorin
|
"simvastatin/ezetimibe"; Merck Schering-Plough; zetia 10 + Zocor 10, 20, 40 or 80; once daily 10/20 or 10/40; taken at night, with/w/o food; works in liver; "takes care of food you eat"; myopathy; rhabdomyolysis, grapefruit juice
|
