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51 Cards in this Set

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What are test used in diagnosing hyperlipidemia?
• complete lipoprotein profile • fasting total cholesterol • LDL • HDL • Triglycerides (TG) * tests are done 9-12 hours after fasting
What is the definition of Lipoproteins?
mixtures of fatty cholesterol and proteins in the blood that transport cholesterol, triglycerides, & other lipids
What are the 3 types of lipoproteins?
• VLDL • LDL • HDL
What is the units for measuring cholesterol?
mg/dl
What are the various classifications of LDL according to ATP III?
• < 100 = optimal • 100 - 129 = near optimal/above optimal • 130 - 150 = borderline high • 160 - 189 = high • > 190 = very high
What are the classifications of HDL according to ATP III?
• < 40 = Low • > 60 = high
What are the classifications of total cholesterol?
• < 200 = desirable • 200 - 239 = borderline high • > 240 = high
What is the classification of serum triglycerides according to ATP III?
• < 150 = normal • 150 - 199 = borderline high • 200 - 499 = high • > 500 = very high
What are major positive risk factors for hyperlipidemia?
factors that increase risk for hyperlipidemia: • age (men > 45 & women > 55) • CHD in male 1st degree relative > 55 y/o • CHD in female 1st degree relative > 65 y/o • HTN or HTN meds (beta-blockers) • low HDL • smoking
What is a negative risk factor for hyperlipidemia?
factors that reduce risk for hyperlipidemia • high HDL ( > 60)
What are the 2 types of hyperlipidemia?
• Primary: no signs of CHD • Secondary: patient has had an event (angina, stroke, CAD, CHD)
What are the LDL goals for lipid management?
• No CHD & less than 2 CHD risk factors = LDL < 160 • No CHD & 2 or more CHD risk factors = LDL < 130 • Patient has CHD/PVD/CVA/Diabetes = LDL < 100
What are lifestyle modifications to reduce LDL?
• Diet (TLC diet, DASH diet) • Increase fiber • Increase physical activity • Weight reduction
At what LDL levels do you consider starting medications?
• NO CHD and less than 2 CHD risk factors: LDL > 190 • No CHD and 2 or more risk factors: LDL > 160 • Patients with CHD/PVD/CVA/Diabetes: LDL > 130
What is the formula to calculate LDL?
LDL = TC - HDL + (TG/5) * TC = total cholesterol, TG = triglycerides
What is the MOA of HMG-CoA Reductase Inhibitors (aka statins)?
inhibits enzyme that is responsible for converting HMG-CoA to Mevalonate (rate limiting step in production of cholesterol)
What is the efficacy/actions of the statins?
• reduce LDL 18-55% • reduce TG 7-30% • reduces major coronary events, stroke, & total mortality
What are side effects of the statins?
• myalgias/arthralgias • increased liver function tests (LFTs)
What labs should be monitored when on a statin?
• must get baseline LFTs, creatine phosphate kinase (CPK), lipid levels • also following LFTs after 3 months
Patients on statins and with high CPK levels are more susceptible to what?
rhabdomyolysis
What are contraindications for using statins?
• absolute: liver disease • relative: CYP 450 drugs (inhibitors)
List the statins and their dosages
• Fluvastatin (Lescol) 20 - 80 mg QD • Pravastatin (Pravachol) 20 - 40 mg QD • Lovastatin (Mevacor) 20 - 80 mg QD • Simvastatin (Zocor) 20 - 80 mg QD • Atorvastatin (Lipitor) 10 - 80 mg QD • Rosuvastatin (Crestor) 5 - 40 mg QD
Which are the strongest statins?
Atrovastatin (Lipitor) & Rosuvastatin (Crestor)
What is the MOA of Bile Acid Seqestrants?
• binds to bile acids to disrupt enterohepatic recirculation of bile acids • stimulates the liver to convert hepatocellular cholesterol into bile acids
What are the actions of the bile acid sequestrants?
• reduces LDL 15-30% • raise HDL 3-5% • may increase TG • reduce CHD mortality
What are drug interactions of bile acid sequestrants?
• decreases absorption of other drugs which decreases their efficacy • Warfarin, Beta blockers, thiazides
What are side effects of bile acid sequestrants?
GI distress/Constipation
What are contraindications of bile acid sequestrants?
elevated TG (> 400)
Name the bile acid sequestrants and their dosages
• Cholestryramine (Questran) 4 - 16 gm QD • Colestipol (Colestid) 5 - 20 gm QD • Colesevelam (Welchol) 2.6 - 3.8 gm QD
What is the MOA of Nicotin Acid?
• inhibits the mobilizatio of free fatty acids from peripheral adipose tissue to the liver • reduces VLDL synthesis (LDL and TG)
What are the actions of Nicotinic Acid?
• Lowers LDL 5-25% • Lowers TG 20-50% • Raises HDL 15-35% • reduces coronary events and reduces total mortality
What are side effects of Niacin?
• flushing (#1 side effect) • GI (diarrhea) • Hepatotoxicity • Hyperglycermia • Hyperuricemia
What are contraindications for Niacin?
• Liver disease • Gout diseae • peptic ulcer disease (PUD)
What are the different formulation of Niacin?
• Immediate release: Niacin 1.5 - 3 gm BID - QD • Sustained Release: Niacin 1 - 2 gm BID - QD • Extended Release: Niaspan 1 - 2 gm BID - QD
Which formulation of Niacin causes the most side effects?
Immediate release
What is the MOA of Fibric Acids?
reduction of rate of lipogenesis in the liver
What are the actions of the Fibric Acids?
• Lower LDL 5 - 20% (with normal TG) • Increases LDL (with high TG) • Lower TG 10 - 20% • Raise HDL 10 - 20% • Reduces major coronary events
List the Fibric Acids and their dosages
• Gemfibrozil (Lopid) 600 mg BID • Fenofibrate (Tricor) 48-145 mg QD
What are side effects of fibric acids?
• GI (nausea/vomiting/diarrhea) • Gallstones • Myopathy/arthralgias (not as bad as statins)
What are contraindications of fibric acid?
severe renal or hepatic disease
What is the MOA of Ezetimbe (Zetia)?
inhibition of cholesterol absorption from GI tract
What is the dose of Ezetimbe (Zetia)?
10 mg po QD
What is the efficacy/action of Ezetimbe (Zetia)?
• Lowers LDL by 15 - 20% • Increases HDL by 3%
What are side effects of Ezetimbe (Zetia)?
• rash (#1) • headache
True/False: Ezetimbe (Zetia) can be used alone in treating hyperlipidemia
Ezetimbe (Zetia) is not used as a monotherapy. Often used as an add-on drug. The correct answer is: False
What is the goal of therapy for high triglycerides?
prevent pancreatitis
What drugs are good for treatment of high triglycerides?
fibrates and nicotinic acid
True/False: When managing cholesterol, the primary target is HDL
LDL is the primary target in hyperlipidemia management The correct answer is: False
Which drug class has the greatest effect on reducing LDL?
statins
Which drug class can raise HDL the most?
Nicotinic Acid (Niacin)
Which drug class is available over the counter (OTC)?
Niacin