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;
78 Cards in this Set
- Front
- Back
|
what is the leading cause of death
|
coronary heart dz
|
|
|
what type of cholesterol is called "atherogenic cholesterol"
|
non-HDL cholesterol
|
|
|
Apo B conc. represents total number of ____
|
lipoprotein particles
LDL + IDL+VLDL |
|
|
risk factors for CHD
|
abdominal obesity
triglycerides >150 HDL <40 men and <50 women BP >or= 130/85 fasting glucose >or= 110 smoking high homocysteine conc. age male>45 female >55 (or <55 if premature menopause w/o ERT) family hx of MI or SCD |
|
|
if your HDL is > ____ you can subtract ____ risk factors
|
60
1 |
|
|
how many risk factors do you need to be considered high risk
|
2 or more
|
|
|
tx goal for high risk pt
|
<100
|
|
|
tx goal for a moderately high risk
|
<130
|
|
|
tx goal for a moderate risk pt
|
<130
|
|
|
tx goal for lower risk pt
|
<160
|
|
|
what dz's classify you as a very high risk pt and what is your tx goal
|
CAD
DM PVD abdominal aorta aneurysm symptomatic carotid dz |
|
|
t/f therapeutic lifestyle change works for 80% of pts
|
F
doesnt' work on 80% b/c of lack of self discipline in pt |
|
|
what is the drug therapy of choice for high LDL
|
statins
|
|
|
what are the only 2 HMG Co-A reductace inhibitors used today
|
atorvastatin
rosuvastatin |
|
|
MOA of statins
|
dec. chol. synth in liver
dec. intracellular chol inc. LDL receptor synth which inc. uptake of LDL from systemic circ. |
|
|
ADRs of statins
|
myalgia* esp. elbows/knees
inc. in liver enzymes myopathy |
|
|
myopathy from statins is inc. when combo'd w/
|
fibrates
|
|
|
what do you do when pt experiences myopathy from statins
|
d/c the drug
|
|
|
t/f with statins you get the best "bang for your buck" w/ the higher doses
|
F
lower doses |
|
|
t/f statins are most effective at lowering TG levels that are already relatively low
|
F
work better on higher TG levels |
|
|
TG reduction w/ statins is dependent predominantly on...
|
treatment baseline level of TGs
|
|
|
t/f lowering TGs helps lower coronary morbidity/mortality
|
F
|
|
|
statins can lower LDL-C in days/years and can reduce cardiac events in days/years?
|
ldl - days
cardiac events - years |
|
|
what is the 2nd drug of choice for high LDL levels
|
bile acid resins
|
|
|
name the BARs available
|
cholestyramine
colestipol colesevelam |
|
|
MOA of BARs
|
inc. bile acid excretion in jejunum/ileum
inc. hepatic conversion of C to bile acids inc. LDL receptors and inc LDL and VLDL removal from circ. |
|
|
t/f BARs reduce coronary events
|
T
|
|
|
ADRs of BARs
|
GI: constipation, bloating, flatulence
no systemic toxicity |
|
|
CIs of BARs
|
**TQ** TGs >400 mg/dl
dysbetalipoproteinemia |
|
|
how do you dec. ADRs seen w/ BARs
|
slowly titrate dose
|
|
|
DDIs of BARs
|
-bind other neg. charged drugs
-impede absorption of fat and/or fat-soluble vitamins -must give 1 hr. before or 4-6 hrs. after other drugs |
|
|
MOA of niacin (nicotinic acid)
|
dec. hepatic production of VLDL and Apo B
|
|
|
ADRs of niacin
|
flushing
hyperglycemia (not good for DM pt) hyperuricemia (not good for gout pt) hepatotoxicity (monitor LFTs) GI |
|
|
what do you need monitor w/ niacin
|
uric acid
LFT blood glucose conc |
|
|
what can you do to prevent flushing w/ niacin
|
-start w/ a low dose and titrate up
-give ASA 30 mins. prior to dose to dec. vasodilatory effects |
|
|
do you want to use extended release or immediate release niacin.
why? |
sustained release preps may inc. risk of hepatotoxicity
|
|
|
t/f LDLs and TGs dec and HDL inc. w/ niacin
|
T
|
|
|
name the fibrates
|
gemfibrozil
fenofibrate clofibrate |
|
|
MOA of fibrates
|
inc. VLDL clearance and synth
|
|
|
fibrates have the most effect on... and the least effect on ....
|
most - TGs and VLDLs
least - LDL |
|
|
when should you give fibrates.
why? |
before morning and evening meals
gets TGs as they enter the blood |
|
|
ADRs of fibrates
|
myalgias
rash gallstone formation b/c of inc. chol. conc. in bile GI - flatulence |
|
|
DDIs of fibrates
|
avoid w/ lovastatin
caution w/ other statins -both b/c of risk of rhabdomyolysis |
|
|
t/f fibrates dec. mortality
|
F
|
|
|
t/f fibrates dec. progression of coronary lesions and reduce major coronary events
|
T
|
|
|
what is the only chol. absorption inhibitor available
|
ezetimibe
|
|
|
t/f ezetimibe may be used as primary therapy
|
F
adjunctive only |
|
|
MOA of ezetimibe
|
selectively inhibits intestinal absorption of chol.
-inc. expression of hepatic LDL receptors -dec. chol. content of atherogenic particles |
|
|
t/f ezetimibe enjoys enterohepatic circulation
|
T
limits systemic exposure |
|
|
t/f an inc. in dose of ezetimibe does not correlate to a dec. in LDL
|
F
as dose inc, LDL dec. |
|
|
ezetimibe is more effective as solo or add-on therapy
|
definitely add-on
|
|
|
DDIs of ezetimibe
|
**TQ*** CSA may inc. ezetimibe conc.
cholestyramine - dec. ez. conc. by 55% (give >2 hr. before/>4 hour after fibrates - combo not recommended |
|
|
CIs of ezetimibe
|
unexplained mod. to severe liver enzyme elevation
Preggo category C as monotherapy -All statins are CI in preggos and nursing women |
|
|
t/f all statins are CI in preggos and nursing moms
|
T
|
|
|
ezetimibe reduces...
|
total chol.
LDL Apo-B |
|
|
t/f ezetimibe can treat homozygous familial hypercholesterolemia
|
T
|
|
|
ezetimibe w/ statins is CI in...
|
active liver dz
preggos |
|
|
what are the pros of adding niacin, fibrate or CAI to a statin
|
**TQ** dec. Lp(a) w/ niacin
**dec. fibrinogen w/ fibrates better dec. in TG and inc. in HDL may dec. LDL more (niacin or fibrate) inc. LDL particle size |
|
|
what are the cons of adding drugs to statin therapy
|
inc. cost/complexity
inc. myositis risk inc. hepatitis risk w/ niacin DDIs lack of data |
|
|
once you reach your LDL goal what's next
|
achieve non-HDL goal
-inc. LDL lowering or add fibrate, niacin or fish oil |
|
|
adding ____ to a statin causes a dose dependent drop in the LDLs
|
niacin
|
|
|
indications of fish oil
|
adjunt therapy to diet hyperTG
w/ statins or other LDL lowering drugs for treating mixed hyperlipidemia |
|
|
effect of fish oil on TGs, LDL, HDL
|
*TG dec. 30-40%
LDL same or inc. HDL same |
|
|
fibrates + statins can inc. risk of...
|
myopathy
rhabdomyolysis |
|
|
fish oils rich in omega 3 FAs lower ___ levels and may be effective when combo'd w/____ for combined hyperlipidemia
|
TG
statins |
|
|
other CV effects of fish oil
|
dec. malignant ventricular arrhythmia
inc HR variablilty antithrombotic improved endothelial reactivity/relax slight lowering of BP anit-inflam |
|
|
smoking inc. your risk of dying after an MI by....
|
40%
|
|
|
1/5 deaths from CVD are attributable to...
|
smoking
|
|
|
to dec. LDL you should get what % of your calories from saturated fats and eat how much cholesterol per day
|
<7% from sat. fats
<200 mg chol./day |
|
|
what 2 things can you add to your diet to lower LDL
|
plant sterols (lots of DDIs)
inc. viscous fiber |
|
|
primary emphasis for diet changes is to reduce ______ and have a total fat range of ....
|
sat. fats
25-30% |
|
|
pts w/ metabolic syndrome should
|
avoid very high fat intake
avoid very low fat intake total fat intake can be 30-35% |
|
|
besides sat. fats, what other kind of fats should be avoided
|
trans fatty acids
|
|
|
what is metabolic syndrome
|
constellation of major risk factors, life-habit risk factors and emerging risk factors
-have distinctive body type w/ inc. abdominal circumference |
|
|
t/f if you treat metabolic syndrome your risk for diabetes dec by 58%
|
T
|
|
|
what TLC do you do for the first visit
|
emphasize dec. in sat. fat and chol.
-also physical activity |
|
|
what TLC do you do for the 2nd visit
|
evaluate LDL response
intensify LDL lowering w/ dietary adjuncts -plant sterols -inc. fiber intake |
|
|
what TLC do you do on 3rd visit
|
evaluate LDL response
initiate tx for metabolic syndrome -intensify wt. management -physical activity consider drug tx if LDL goal not achieved |
