Mspa 2017 - Hyperlipidemia

Front 1

What are the types of lipoproteins?

Back 1

1) Chylomicrons

2) VLDLs

3) IDL

4) LDL

5) HDL

Front 2

What are the types of hyperlipidemia?

Back 2

1) Type 1

2) Type 2a

3) Type 2b

4) Type 3

5) Type 4

6) Type 5

Front 3

What is Type 1 hyperlipidemia?

Back 3

Familial Hyperchylomicronemia

1) Excess Chylomicrons

2) Increased Triglycerides

3) HDL < 40

** not someone that looks like high risk for CAD

Front 4

What is Type 2a hyperlipidemia?

Back 4

Familial Hypercholesteremia

1) Excess LDL

2) Increased Cholesterol

Front 5

What is Type 2b hyperlipidemia?

Back 5

Familial Mixed hyperlipidemia

1) Excess LDL and VLDL

2) Elevated Cholesterol & triglycerides

Front 6

What is Type 3 hyperlipidemia?

Back 6

Familial dysbetalipoproteinemia

1) Excess lipoprotein remnants

2) Elevated Cholesterol & triglycerides

Front 7

What is Type 4 hyperlipidemia?

Back 7

Familial Hypertriglyceridemia

1) Excess VLDL

2) Elevated triglycerides

Front 8

What is Type 5 hyperlipidemia?

Back 8

Familial Mixed Hypertriglyceridemia

1) Excess VLDL & Chylomicrons

2) Elevated Cholesterol & triglycerides

Front 9

What is hyperlipoproteinemina?

Back 9

1) Primary

-- Inherited Trait

-- Defects in lipoprotein metabolism

2) Secondary

-- Due to other disease such as DM

-- Drugs

Front 10

What are the drugs that affects the lipid levels?

Back 10

1) Thiazides = hypertriglyceridemia

2) b-blockers

3) Antiretroviral = hyperlipidemia

4) Isotretinoin

Front 11

What is the classification based on LDL?

Back 11

1) Desirable = < 100

2) Borderline high = 130-159

3) High = > 160

Front 12

What are the diet modifications?

Back 12

1) Reduce total caloric intake

2) Reduce fat (both saturated & polyunsaturated)

3) Reduce alcohol consumption

Front 13

What are the classes of medications used for hyperlipidemia?

Back 13

1) Bile acid binding resins

2) Nicotinic acid

3) Dextrothyroxine

-- Only historic (no therapeutic value)

4) HMG-CoA reductase inhibitors (Statins)

5) Fibric acid derivatives

Front 14

What is the mechanism of action of Bile acid binding resins?

Back 14

1) Binds to bile acids and remove them from enterohepatic circulation

2) Lower total cholesterol and LDL

Front 15

List the Bile acid binding resins drugs

Back 15

1) Cholestyramine (Questran)

-- Powder form

-- Not well tolerated due to taste

2) Colestipol

3) Cholesevelam (WelChol)

Front 16

What are the adverse effects of Bile acid binding resins?

Back 16

1) Constipation

2) Bloating

3) Abdominal pain

4) Interfere with absorption of fat-soluble vitamins

Front 17

What is the mechanism of action of Nicotinic acid (Niacin)?

Back 17

1) Decreases VLDL synthesis in liver

2) Reduce HDL catabolism

3) Decrease triglycerides

Front 18

What are the adverse effects of Nicotinic acid (Niacin)?

Back 18

1) Vasomotor reaction (prostaglandin mediated)

2) Elevated Liver enzymes

3) Increase blood glucose level

4) Niacin flush

Front 19

What can prevent or minimize the niacin flush?

Back 19

1) Use sustain release preparation

2) Take it with aspirin half hour prior to niacin

3) Start with lower dose and increase dose slowly

Front 20

Which patient is niacin contraindicated for?

Back 20

1) DM patients

Front 21

What is the mechanism of action of HMG-CoA reductase inhibitors (Statins)?

Back 21

1) Decrease cholesterol synthesis

2) Increase LDL breakdown

Front 22

List the HMG-CoA reductase inhibitors (Statins) drugs

Back 22

1) Lovastatin (Mevacor)

2) Pravastatin (Pravachol)

3) Simvastatin (Zocor)

4) Fluvastatin (Lescol)

5) Atorvastatin (Lipitor)

6) Rosuvastatin (Crestor)

7) Pitavastatin (Livalo)

Front 23

What are the adverse effects of statins?

Back 23

1) Diarrhea

2) Abdominal cramps

3) Elevation of liver enzymes (MC)

4) Cholestasis (monitor Bilirubin)

5) Myalgias, Myositis (rare)

6) Rhabdomyolysis

7) Lens opacities

Front 24

How are statins metabolized?

Back 24

1) Some by liver

2) Some by Cytochrome P450

Front 25

What are some drug interactions of statins?

Back 25

1) Erythromycin

-- Can cause statin toxicity

2) Grapefruit juice

-- Increases absorption of statin and also inhibits the metabolism of statins

Front 26

What is the mechanism of action of Ezetimibe (Zetia)?

Back 26

1) Inhibits absorption of dietary and bilary cholesterol in small intestine

2) Decrease delivery of intestinal cholesterol to the liver

** Lowers LDL cholesterol **

Front 27

Where is Ezetimibe metabolized?

Back 27

Metabolized in small intestine and liver

Excreted by kidneys

Front 28

What is the half life of Ezetimibe?

Back 28

22 hours

** does not affect Cytochrome P450

Front 29

What is the benefit of the combination of Ezetimibe with Statin?

Back 29

Simvastatin + Ezetimibe (Vytorin)

-- Synergistic effect to decrease LDL (much greater decrease in LDL)

Front 30

What is the mechanism of action & effects of Fibric acid derivatives?

Back 30

1) Lowers serum triglycerides

2) Increase HDL levels

Front 31

List the Fibric acid derivatives drugs

Back 31

1) Clofibrate

2) Gemfibrozil

3) Fenofibrate

Front 32

What is the mechanism of action of Clofibrate?

Back 32

1) Increase VLDL breakdown

2) Decreases VLDL and triglycerides

Front 33

What are the adverse effects of Clofibrate?

Back 33

1) Nausea

2) Diarrhea

3) Elevation of liver enzymes

Front 34

What is the mechanism of action & adverse effects of Gemfibrozil?

Back 34

1) Increase VLDL breakdown

2) Decreases VLDL and triglycerides

Adverse effects are similar to Clofibrate but in reduced frequency

Front 35

What is the mechanism of action of Fenofibrate?

Back 35

1) Inhibits triglycerides synthesis

2) Long half life = 20 hours

Front 36

What are the adverse effects of fenofibrate?

Back 36

1) Muscle pain

2) Rash

3) Elevated liver enzyme

Front 37

What are the drug interactions with fenofibrate?

Back 37

Enzyme inhibition

** Only Fibric acid derivative that is safe to take with statins **

Front 38

What are C-Reactive Proteins?

Back 38

Inflammation markers

** Statins have shown to lower C-reactive protein levels **

Front 39

What is the drug of choice for treatment of Hypercholesterolemia?

Back 39

1) Bile acid sequestrants

2) Statins

3) Niacin

Front 40

What is the first line treatment for Hypercholesterolemia?

Back 40

1) Start with Statin

2) Use bile sequestrants for patients who can't tolerate statin

3) Niacin can be started with statin

--- However monitor labs every two weeks

Front 41

What is the drug of choice for treatment of Hypertriglyceridemia?

Back 41

1) Fibric acid derivatives (fenofibrate)

--- First choice

2) Niacin

3) Atorvastatin

--- If concomitant Hypercholesterolemia

Front 42

What is the drug of choice for treatment of mixed hyperlipidemia?

Back 42

1) Niacin

2) Alternate therapies

--- Fibric acid &/or Statin

3) Eliminate causative factors

Front 43

Which drugs are exception to the rule for not using statins and fibric acid derivatives?

Back 43

Exception to the rule

1) Pravastatin + Gemfibrozil

or

2) Any Statins + fenofibrate

Front 44

What is the mechanism of action of PCSK9 inhibitors?

Back 44

Newest class of drugs (injectable use)

1) Binds to LDL receptors in the liver - rendering inactive

2) Prevents the receptors function of clearing LDL from blood

3) Inhibitors are preserving the function of LDL receptors

Front 45

List the PCSK9 inhibitors drugs

Back 45

1) Alirocumab

2) Evolocumab

** Monoclonal antibodies **

Front 46

What is the indication for PCSK9 inhibitors?

Back 46

1) Approved for their ability to lower LDL when statins are not effective or enough

2) Not proven to reduce cardiovascular disease

* Administered Injected SubQ (hospitals only) *

Front 47

What are the adverse effects of PCSK9 inhibitors?

Back 47

1) Injection site reaction

2) Pharyngitis

3) Influenza

4) Elevated liver enzymes

5) Confusion

Front 48

What are important components of patient education?

Back 48

1) Compliance

2) Dietary changes

3) Recognize side effects

4) Explain drug interactions

** Always monitor patients and levels **