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48 Cards in this Set
- Front
- Back
What are the types of lipoproteins?
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1) Chylomicrons
2) VLDLs 3) IDL 4) LDL 5) HDL |
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What are the types of hyperlipidemia? |
1) Type 1 2) Type 2a 3) Type 2b 4) Type 3 5) Type 4 6) Type 5 |
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What is Type 1 hyperlipidemia? |
Familial Hyperchylomicronemia 1) Excess Chylomicrons 2) Increased Triglycerides 3) HDL < 40 ** not someone that looks like high risk for CAD |
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What is Type 2a hyperlipidemia? |
Familial Hypercholesteremia 1) Excess LDL 2) Increased Cholesterol |
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What is Type 2b hyperlipidemia? |
Familial Mixed hyperlipidemia 1) Excess LDL and VLDL 2) Elevated Cholesterol & triglycerides |
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What is Type 3 hyperlipidemia? |
Familial dysbetalipoproteinemia 1) Excess lipoprotein remnants 2) Elevated Cholesterol & triglycerides |
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What is Type 4 hyperlipidemia? |
Familial Hypertriglyceridemia 1) Excess VLDL 2) Elevated triglycerides |
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What is Type 5 hyperlipidemia? |
Familial Mixed Hypertriglyceridemia 1) Excess VLDL & Chylomicrons 2) Elevated Cholesterol & triglycerides |
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What is hyperlipoproteinemina? |
1) Primary -- Inherited Trait -- Defects in lipoprotein metabolism 2) Secondary -- Due to other disease such as DM -- Drugs |
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What are the drugs that affects the lipid levels? |
1) Thiazides = hypertriglyceridemia 2) b-blockers 3) Antiretroviral = hyperlipidemia 4) Isotretinoin |
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What is the classification based on LDL? |
1) Desirable = < 100 2) Borderline high = 130-159 3) High = > 160 |
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What are the diet modifications? |
1) Reduce total caloric intake 2) Reduce fat (both saturated & polyunsaturated) 3) Reduce alcohol consumption |
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What are the classes of medications used for hyperlipidemia? |
1) Bile acid binding resins
2) Nicotinic acid 3) Dextrothyroxine -- Only historic (no therapeutic value) 4) HMG-CoA reductase inhibitors (Statins) 5) Fibric acid derivatives |
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What is the mechanism of action of Bile acid binding resins? |
1) Binds to bile acids and remove them from enterohepatic circulation 2) Lower total cholesterol and LDL |
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List the Bile acid binding resins drugs |
1) Cholestyramine (Questran) -- Powder form -- Not well tolerated due to taste 2) Colestipol 3) Cholesevelam (WelChol) |
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What are the adverse effects of Bile acid binding resins? |
1) Constipation 2) Bloating 3) Abdominal pain 4) Interfere with absorption of fat-soluble vitamins |
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What is the mechanism of action of Nicotinic acid (Niacin)? |
1) Decreases VLDL synthesis in liver 2) Reduce HDL catabolism 3) Decrease triglycerides |
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What are the adverse effects of Nicotinic acid (Niacin)? |
1) Vasomotor reaction (prostaglandin mediated) 2) Elevated Liver enzymes 3) Increase blood glucose level 4) Niacin flush |
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What can prevent or minimize the niacin flush? |
1) Use sustain release preparation 2) Take it with aspirin half hour prior to niacin 3) Start with lower dose and increase dose slowly |
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Which patient is niacin contraindicated for? |
1) DM patients |
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What is the mechanism of action of HMG-CoA reductase inhibitors (Statins)? |
1) Decrease cholesterol synthesis 2) Increase LDL breakdown |
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List the HMG-CoA reductase inhibitors (Statins) drugs |
1) Lovastatin (Mevacor) 2) Pravastatin (Pravachol) 3) Simvastatin (Zocor) 4) Fluvastatin (Lescol) 5) Atorvastatin (Lipitor) 6) Rosuvastatin (Crestor) 7) Pitavastatin (Livalo) |
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What are the adverse effects of statins? |
1) Diarrhea 2) Abdominal cramps 3) Elevation of liver enzymes (MC) 4) Cholestasis (monitor Bilirubin) 5) Myalgias, Myositis (rare) 6) Rhabdomyolysis 7) Lens opacities |
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How are statins metabolized? |
1) Some by liver 2) Some by Cytochrome P450 |
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What are some drug interactions of statins? |
1) Erythromycin -- Can cause statin toxicity 2) Grapefruit juice -- Increases absorption of statin and also inhibits the metabolism of statins |
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What is the mechanism of action of Ezetimibe (Zetia)? |
1) Inhibits absorption of dietary and bilary cholesterol in small intestine 2) Decrease delivery of intestinal cholesterol to the liver ** Lowers LDL cholesterol ** |
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Where is Ezetimibe metabolized? |
Metabolized in small intestine and liver Excreted by kidneys |
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What is the half life of Ezetimibe? |
22 hours ** does not affect Cytochrome P450 |
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What is the benefit of the combination of Ezetimibe with Statin? |
Simvastatin + Ezetimibe (Vytorin) -- Synergistic effect to decrease LDL (much greater decrease in LDL) |
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What is the mechanism of action & effects of Fibric acid derivatives? |
1) Lowers serum triglycerides 2) Increase HDL levels |
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List the Fibric acid derivatives drugs |
1) Clofibrate
2) Gemfibrozil 3) Fenofibrate |
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What is the mechanism of action of Clofibrate? |
1) Increase VLDL breakdown 2) Decreases VLDL and triglycerides |
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What are the adverse effects of Clofibrate? |
1) Nausea 2) Diarrhea 3) Elevation of liver enzymes |
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What is the mechanism of action & adverse effects of Gemfibrozil? |
1) Increase VLDL breakdown 2) Decreases VLDL and triglycerides Adverse effects are similar to Clofibrate but in reduced frequency |
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What is the mechanism of action of Fenofibrate? |
1) Inhibits triglycerides synthesis 2) Long half life = 20 hours |
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What are the adverse effects of fenofibrate? |
1) Muscle pain 2) Rash 3) Elevated liver enzyme |
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What are the drug interactions with fenofibrate? |
Enzyme inhibition ** Only Fibric acid derivative that is safe to take with statins ** |
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What are C-Reactive Proteins? |
Inflammation markers ** Statins have shown to lower C-reactive protein levels ** |
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What is the drug of choice for treatment of Hypercholesterolemia? |
1) Bile acid sequestrants 2) Statins 3) Niacin |
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What is the first line treatment for Hypercholesterolemia? |
1) Start with Statin 2) Use bile sequestrants for patients who can't tolerate statin 3) Niacin can be started with statin --- However monitor labs every two weeks |
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What is the drug of choice for treatment of Hypertriglyceridemia? |
1) Fibric acid derivatives (fenofibrate) --- First choice 2) Niacin 3) Atorvastatin --- If concomitant Hypercholesterolemia |
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What is the drug of choice for treatment of mixed hyperlipidemia? |
1) Niacin 2) Alternate therapies --- Fibric acid &/or Statin 3) Eliminate causative factors |
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Which drugs are exception to the rule for not using statins and fibric acid derivatives? |
Exception to the rule 1) Pravastatin + Gemfibrozil or 2) Any Statins + fenofibrate |
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What is the mechanism of action of PCSK9 inhibitors? |
Newest class of drugs (injectable use) 1) Binds to LDL receptors in the liver - rendering inactive 2) Prevents the receptors function of clearing LDL from blood 3) Inhibitors are preserving the function of LDL receptors |
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List the PCSK9 inhibitors drugs |
1) Alirocumab 2) Evolocumab ** Monoclonal antibodies ** |
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What is the indication for PCSK9 inhibitors? |
1) Approved for their ability to lower LDL when statins are not effective or enough 2) Not proven to reduce cardiovascular disease * Administered Injected SubQ (hospitals only) * |
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What are the adverse effects of PCSK9 inhibitors? |
1) Injection site reaction 2) Pharyngitis 3) Influenza 4) Elevated liver enzymes 5) Confusion |
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What are important components of patient education? |
1) Compliance 2) Dietary changes 3) Recognize side effects 4) Explain drug interactions ** Always monitor patients and levels ** |