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