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26 Cards in this Set
- Front
- Back
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what are the optimal LDL-C goals for primary prevention?
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no previous CHD
higher risk- lower target LDL-C goal dictates more aggressive therapy needed |
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what are the optimal LDL-C goals for secondary prevention?
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past CHD event, lower risk in general population, but it may be higher risk forthis population
the higher the risk the lower the target LDL-C goal |
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how does decrease in LDL-C decrease CHD risk?
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-change plaques w/ large lipid, thin fibrous layer to smaller lipid w/ more connective tissues and smooth muscle (harder lesion)- dec. risk of rupture
-may dec. plaque size -endothelial dysfunction may reverse (improve vasodilatory property, inc. blood flow to ischemic areas) -inflammatory processes may be reduced (measure CRP) |
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What are the ATP III risk factors?
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cigarette smoking
HTN (>140/90mmHg or on anti-HTN) low HDL-C family history of premature CHD (in male 1st degreee relative <55y, in femila <65y) age (men>45, women >55y) DM is equivalent to CHD risk HDL>60mg/dl counts as negative risk factor |
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What are the LDL-C goals according to risk factors?
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CHD or CHD risk equivalent- <100mg/dl
multiple (2+)risk factors- <130mg/dl zero to one risk factor- <160mg/dl |
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what are therapeutic lifestyle changes?
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diet low in saturated fat and XOL, incy. physical activity, weight reduction, smoking cessation
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what are soem of the TLC diet recommendations?
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low fat does not mean low calories, complex carbs good replacement for saturated fat, replace satruated fats w/ unsaturated fats (canola oil, fish oil, olive oil)
mediterranean diet |
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More diet recommendations?
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lean meat, grill or broil, smaller portions
skim milk margarine instead of butter low fat sof cheese instead of hard cheese non-fat frozen yogurt instead of ice cream avoid cream sauce or soup low fat or not fat products if possible |
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what are some other dietary interventions?
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viscous fiber (psyllium, oat gum)- can dec. LDL by 5%
fibers (whole grains, fruits, veggies)- can dec. LDL by 5% plant stanol and sterol (benecol, total control)- dec. absorption of XOL in intestine- can dec. LDL by 5-15% |
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what is the mechanism of action of Statins?
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inhibits HMG-CoA synthase, dec. hepatic XOL, Inc. LDL-R, dec. LDL circulating, dec. VLDL syn. and dec. TG
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what are the statin pearls?
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most potents XOL lowering agents
LDL-C dec log linear dose dependent efficacy higher if given in evening |
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why give statin at night?
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night time upturn of endogenous C biosynthesis, rosu and ator have long half-life so do not have to be taken at night.
giving does bid does not significantly improve efficacy |
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What is the most potent statsin? Least?
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rosu>ator>sim>lo>pra>flu
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what are some of the adverse effects of statins?
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HA, GI upset, myalgias, increase LFTs, myopahty (most serious), rhabdomyolysis, muyoglobinuria, acute tubular necrosis
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what are signs of myophaty?
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muslce pain or weakness with inc. CPK, r/o trauma or inc. physical activity, more in combined with gemfibrozil, DDI that inc. statin level (erythromycin)
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what cyps are involved in statin metabolism?
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cyp3A4- lova, sim, ator (a little)
cyp2c9- flu, rosu (only 10% metbolized) |
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What are some contraindications and precations for statin use?
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caution if add gemfibrozil (2-4 fold inc. in statin level)
elderly, small frame, dec. renal fxn, multiple meds (interacting)- use smaller does, monitor closely lovastatin and rosu incre INR, caution with warfarin avoid in patients with liver disease |
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What is the mechanism of action of bile acid resin?
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bind bile acids in intestine, decrease XOL absorption, inc. liver synthesis of XOL, inc. LDL-R, dec. LDL-C in circulation
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What are some adverse effects of BAR?
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bloating, constipation, flatulence, eipigastric, dec. absorption of fat soluble vitamins
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How can a patient possibly decrease risk of adverse effects?
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mix powder in juice, minimize air ingestion by using a straw, take tablet not powder, take vitamins either 1 hour before or 4 hours after BAR to inc. absorption of vitamins
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What drugs do BAR interact with?
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older BAR interact with Digitoxin, warfarin, beta blockers, HCTZ, thryoxine, iron, nicotinic acid, loperimide, other ionic drugs, colesevelam appears to be ok
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What is the mechanism of action of cholesterol absroption inhibitors?
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work locally in intestine, block absorption of XOL from gut, inc. liver synthesis of XOL, inc. LDL-R on liver, dec. LDL-C and VLDL in circulation
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What are some adverse effects of Ezetimibe?
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minimal, diarrhea, cough, fatigue, arthralgias, no evidence of DDIs yet
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waht are some adverse effects of fibric acid derivatives?
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ususally well tolerated, Gemfirbrozil can cause mild GI upset, muscle SE esp with statin (do not use with statin), XOL gallstones
fenofibrate- rash 2-4%, XOL gallstones |
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Are fibartes safe?
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Clofibrate- dec. non-fatal MI by 25% but inc. total mortality
Gemfribrozil- helsinki trial- dec fatal and nonfatal MI, no net dec in total mortality, inc. non-CHD mortality Fenofibrate- no major clinical trial |
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What is the mechanism of action of fibric acid derivatives?
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activates PPAR-alpha (peroxisome proliferator activated receptors) nuclear hormone receptor super family
inc. synthesis of HDL, dec. VLDL, dec. TG, does not dec. LDL that much only 10-25% |
