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38 Cards in this Set

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8 Risk factors for CAD
1. Age
2. Fam hx
3. Smoking
4. HTN
5. Low HDL <40
6. High triglycerides >150
7. obesity
8. diabetes
Def of metabolic syndrome
combination of HTN, dyslipidemia, obesity and diabetes that puts patients at increased risk of CAD
structure of lipoproteins
lipid membrane
hydrophobic core
cholesteryl esters and triglycerides
Optimal plasma lipid levels:
Total Cholesterol
HDL
LDL
Triglycerides
1. Total < 200
2. HDL>60
3. LDL <100
4. Tri <150
How are triglycerides and cholesterol transported
Chylomicrons from the GI - dietary tris
VLDL, LDL from liver - endogenous tris
HDL - phospholipids and cholesterol esters
Calculation of LDL levels
Total Cholesterol - HDL - 1/5 Triglyceride
Fate of dietary cholesterol and triglycerides
converted to chylomicrons/remnants (bundles of fat w/ various lipoproteins) in GI --> substrate for lipase --> hydrolyzed and returned to liver
clinical use of apoA-1
removes cholesterol from already-formed plaque (reverse transport)
Statins: Mechanism of Action
Inhibit de novo synthesis of cholesterol by inhibiting the conversion of HMG-CoA reductase
F(x) of HMG-CoA reductase
catalyzes the conversion of HMG-CoA to mevalonate, a precursosr of sterols.
Statins: indications
high LDL
Statins: mechanism
dec. cholesterol --> inc. SREBP -->incr LDLR transcription --> inc LDL clearance
Statins: SE
GI, liver toxicity, muscle problems (myositis, myalsia, myolysis)
Which statins are not metabolized by CYP3A4
Pravastatin, rosuvastatin
CYP3A4 inhibitors
grapefruit juice
erythromycin
ketoconazole
cyclosporine
CYP3A4 inducers
rifampicin
barbs
carbamazepine
grisoefulvin
phenytoin
phenobarb
smoking
Randy's Black Car Goes Putt Putt and Smokes
Drug interactions of rosuvastatin
antacids interfere with absorption, increase warfarin levels
Name 4 Fibrates
Gemfibrozil
Clofibrate
Fenofibrate
Benzafibrate
Which fibrate is contraindicated in pregnancy
Gemfibrozil crosses placenta
Fibrates: indications
inc TG (at risk for pancreatitis)
Fibrates: mechanism
inc peroxisome proliferator-activated receptor a --> inc FA oxidation --> inc LPL clearance of TG rich VLDL, dec TG
Fibrates: SE
GI
liver toxicity
muscle toxicity
Fibrates: Drug interactions
Increase warfarin
increase myolysis when used for statins (gemfibrozil > fenrofibrate)
Why do both fibrates and statins cause gallstones
increase biliary ratio of cholesterol: bile salts
Bile Acid-sequestrants (resins): 3 drugs
Cholestryamine
Cholestipol
Colesevelam
Resin DOC
Colesevelam has less SE and less increase in TG
Resins: Mechanism
Bind bile acids in intestine --> excretion --> upregulation of LDLR --> increased LDL clearance
resins: SE
GI: bloating, constipation, steatorrhea, heartburn
resins: contraindications
Pt with high TG
resins: indications
second line treatment for high LDL (after statins)
digitalis toxicity
cholestasis
resins: drug interactions
FLUVASTATIN and PRAVASTATIN
digitalis
aspirin
warfarin
tetracycline
thyroid hormone thiazides
folic acids
phenylbutazone
Ezetimibe: Mechanism
inhibits cholesterol absorption in the brush border
Ezetimibe: Indications
high LDL and total cholesterol
Should be used with statins (not alone)
Ezetimibe: SE
Chest pain
sinusitis
diarrhea
ezetimibe: drug interactions
increased by Gemfibrozil and Fenofibrate
decr by cholestryamine
Niacin: mechanism
dec FA mobilization
dec synthesis and esterification of FA in liver
inc lipoprotein lipase to incr VLDL clearance
inc HDL reverse transport (inc plasma apoA1)
Niacin: SE
flusing, pruritus
hypotension
hepatotoxicity
exacerbates peptic ulcer
hyperuricemia

1/2 of pt stop using b/c of SE
Torcetrapib: mechanism
inhibits cholesteryl ester transfer protein (CETP) -> inc HDL, apoA-1 and decr LDL, apoB