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4-Hyperlipidemia
Lipids
81
Chemistry
Graduate
10/15/2017

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Term
vLDL is made in____
Definition
Liver
Term
LDL is made____
Definition
from vLDL catabolism and cellular synthesis
Term
HDL is made in _____and ______ cells
Definition
Hepatic and Intestinal cells
Term
Exogenous Lipid metabolism
Definition
LPL converts Chylomicrons to Chylo remnants.
(from foods)
Term
Endogenous Lipid Metabolism
Definition
-vLDL converted to IDL then LDL. SOme LDL go to subendothelial space in arteries and are oxidized & taken up by macrophages to make foam cells.
(from liver cells)
Term
HDL reverse Transport
Definition
Excess cholesterol from peripheral tissues is removed and transportd bac to liver.
-Starts at liver/small intestine w/ APO1.
-MAcrophage takes excess cholesterol fromarteries
-too much Chol in mac signals receptors
-HDL/APO1 takes chol
Term
CAD(Coronary artery disease)
Definition
Stable chol plaq in coronary artery
-plaq can rupture
-If muscle dies__>>>Heart attack
Term
Cerebrovascular Disease
Definition
Chol plaq ruptures in cerebral artery casue stroke (permanant damage)
-Or TIA(temporary)
Term
PAD (Peripheral Artery Disease)
Definition
Blocked artery in leg
-dificulty wlkng
-slows wound healing bc bad circulatn
Term
HMG COA RED Inhibitors
Definition
-Statins
-Block convrsn of HMGCOA to mevalonic acid.
Term
STrongest statins....longest half lifes
Definition
Crestor
Lipitor
(can be taken anytime of day)
Term
Pt renal impaired avoid this statin
Definition
Pravastatin
Term
Very bad cyp3a4 intrxns
Definition
Simvastatin
(Take at night )
Term
HMG COA intrxn [STATINS]
Definition
-Azoles
-AMlodipine -Gemfibrozil
-Verapamil, Diltiazem
-MAcrolides -Grapefruit
Term
HMG COA Adv effx [STATINS]
Definition
-HA, GI, Fatigue,myalgia (can do myopathy,rhabdo)
Term
for HMG COA inhibs LFTs and CKs
Definition
AHA/ACC recommends agnst routine monitoring
-LFT (ALT) baseline test recommended
-CK evauated only for hi risk pt w/ muscle related side effx
Term
HMG Contra [STATINS]
Definition
prego
hep disease (LFTs >3xULN)
rhabdo
breast feed
Term
Cholesterol absorption INHIBITOR MOA
Definition
-ZETIA(Ezetimibe) [well tolerated/no sidefx]
-targets NPC1L1 protein. reduc absorp of cholesterol from the small intestines
Term
CHol absorp inhib RX intrxn
Definition
BAS(bile acid seq)->tk Zetia 2 hrs before or 4 hrs aftr
-cyclosporine
-Fibrates(myopathy)
Term
Chol abs Inhib WARNINGS
Definition
preg cat C
elderly
hep disease
myopathy
Term
Chol ABs Inhib are considered similar to _____
Definition
Moderate dose statin
Term
Bile Acid Seqs
and MOA
Definition
-Cholestyramine(Questran)
-Colestipol HCl(Colestid)
-Colesevelam (Welchol)
-MOA: prevents bile from small intest from going bac to liver. Depletes chol strg by forcing chol to be converted to more bile salt
Term
Triglycerides are inc as a result of what meds?`
Definition
BAS(bile acid seq)
Term
BAS administer________
Definition
2 hrs before or 4 hrs after any other med
(not signifcntly absrbd..excreted in feces)
Term
Drug INTRXN BAS
Definition
-Fat solble vitamins
-B-blokcrs
-Warfrin
-Thiazide Diuretics
Term
BAS Adverse FX
Definition
-GI constipation!!!
-bloat, nasuea,flatuence
-Inc triglyc (caution if TG>300)
-inc bleeding in Vit K def pts
Term
Nicotinic Acids and MOA
Definition
Niacin(reg release),NIASPAN(ext release)
MOA:inhibits fat from making fatty acid to be turned into TG
Term
Nicotinic Acids RX intrxn
Definition
Alcohol(flushing)
BAS(Niacin dec)
Warfrn(inc INR)
Term
Nicotinic Acids SIDE FX
Definition
-Flushing/warm feeling
-GI-NVD
-Hyperglycemia (be careful w/DM pt)
-Hepatotoxic or Hyperuricemia
Term
Dec flushing from niacin by____
Definition
giving Aspirin 1/2 to 1 hr before administration of niacin
Term
Nicotinic Acids Contraindications
Definition
-Hep disease
-Arterial Bleeding
-Active peptic ulcer
__---DISCONTINUE(AFIB,AST/ALT>2-3ULN,Acute gout,AB pain unexplained,Perisitent Hyperglyc)
Term
Most efective in HDL level inc (15-35%)
Definition
Nicotinic Acids
Term
Fibric Acid Derivatives and MOA
Definition
-Fenofibrate,Gemfibrozil MOA: activates PPARs to enhace lipoprotein lipase act & inc TG rich protein breakdwn.(reduces Hepatic vLDL)
Term
Fenofibrate ______but Gemfibrozil doesnt
Definition
Decreases LDL
Term
Fibric Acid Derivatives require _____adj
Definition
renal adjustment (metab thru glucuronidation)
Term
Fibric Acid Derivatives INTRXN RXs
Definition
-Statins(especlly Gemfibrozil) -->RHABDO
-BAS(dec absrp of fibrates)
-WRFRN(inc INR)
Term
Fibric Acid Derivatives
Definition
-well tolrtd
-NVD
-Risk of Rhabdo&Myopathy
Term
Fibric Acid Derivatives CONTRaINdication
Definition
Active Liver Disease,gall bladder dis,biliary cirhosis
-renal failure/dialysis
Term
OMEGA 3 FATTY ACIDS and MOA
Definition
LOVAZA(EPA 465mg&DHA375mg)
VASCEPA(EPA 1000mg)
MOA: not completely defined,,,may reduce hepatic synth of TG
Term
OMEGA 3 FATTY ACIDS may inc________
Definition
LDL up to 45% with LOVAZA due to DHA
(has not been studied w/ renal.hep impairment)
Term
OMEGA 3 FATTY ACIDS INTRXN & Side fx
Definition
Warfarin--inc INR
SIDE FX-Nausea,burp,fish breath/taste,prolong bleeding
Term
PCSK9 Inhibitors & MOA:
Definition

Alirocumab(q 2 weeks SQ) Evolocumab (q 2 weeks SQ) MOA:-monoclonal antibodies bind PCSK9

-inc Hepatic LDL receptors.

[PCSK9promotes degradation of LDL receptors]

Term
PCSK9 inhib indications
Definition
Familial hypercholesteremia in addition to diet and max tolerated statin therapy WARNING:sensitivity(expensive)
Term
MTP inhibitor
Definition
-Lomitapide(juxtapid)
-Inhibits MTP,prevents formation of apoB containinglipoproteins in enterocytes & hepatocytes
-reduces chylo&vLDL formation
Indicated for familial hypercholesteremia
Term
MTP inhibitor Adverse effx
Definition
Adverse Reactions:
NVD,ab pain
fatigue/dizzy
hepatic---steatoosis&liver transaminases inc >3xULN
Term
Dose limit w/ Clarithromycin and Atorvastatin
Definition
Atorvastatin dose limt to 20mg/D
Term
GRAPEFRUIT JUICE LIMIT WITH STATINS
Definition
1.2L/DAY GRAPEFRUIT WITH STATINS

CANNOT TAKE GRAPEFRUIT W/ lova or simvaSTATIN!!!!!
Term
CANNOT TAKE GRAPEFRUIT W/
Definition
LOVA or SIMVASTATIN
Term
CHD Prevention strategies
Definition
smoke cessat
BP reduc
Psycosocial
weight loss
nutrition
physical act(30-60mins 5-6 days/wk)
Term
Metabolic syndrome--->>>>CV RISK CONTRIBUTIONS (3/5 OF FOLLOWING)
Definition
-HDl <50(women) <40(men)
-Trigllycerides>/= 150mg/dL
-Glucose>/= 100mg/dL
-Waist circumf>/= 35 inches(men,,,30(women)
-BP >/= 130/85mmHg
Term
Metabolic syndrome more common in_______
Definition
Women---Afric-Amer,Hispanics
Term
Recheck Lipid profile q 5 yrs if normal in
Definition
men>40yrs
women>50yrs
Term
Friedewald equation for LDL-C
Definition
LDL=TC-(HDL+TG/5)
Term
Friedewald Equation for TC
Definition
TC=LDL+(HDL+TG/5)
Term
Friedewald for NON HDL
Definition
NON HDL=TG/5+LDL or
TC-HDL
Term
Secondary causes of Lipid Abnormalities
Definition
Diet,Drugs,Diseases.Disordersof altred metab(preg,obese,hypothyroid)
Term
Benefits Exceed risks for initiating STATIN in
Group 1
Definition
Pt w/ [w/o NYHA class II-IV HF or hemodialysis pt]
-ASCVD
-ACS or MI Hx
-Stable/unstable Angina
-Coronary/arterial revascularization
-Stroke,TIA, or PAD
Term
Benefits Exceed risks for initiating STATIN in
Group 2
Definition
pt w/ LDL-C>/= 190mg/dL
Term
Benefits Exceed risks for initiating STATIN in
Group 3
Definition
40-75yrs
w/ DIABETS and LDL-C 70-189mg/dL
w/o clinical ASCVD
Term
Benefits Exceed risks for initiating STATIN in
Group 4
Definition
40-75yrs w/o diabetes or ASCVD
-LDL-C 70-189mg/dL
& estimated 10 yr ASVD risk of 7.5% or higher
Term
High dose statins lower LDL by
Definition
>/= 50%
Term
Moderate dose statins lower LDL by
Definition
30-<50%
Term
Grp(1) STATIN initiation Tx
Definition
Hi intensity statin
(mod statin if not candidate)
Term
Grp(1) STATIN initiation Tx
>75 yrs w/ Clinical ASCVD
Definition
Mod intensity statin
Term
Grp(2) STATIN initiation Tx
LDL-C >/=190mg/dL
Definition
Hi intensity statin
(mod if not candidate)
Term
Grp(3) STATIN initiation Tx
Diabetes w/ LDL-C 70-189mg/dL
Age 40-75yrs
Definition
Mod intensity statin
Term
Grp(3) STATIN initiation Tx
Diabetes w/ LDL-C 70-189mg/dL
Age 40-75yrs
w/ estimated 10yr ASCVD risk >/=7.5%
Definition
Hi intensity statin
Term
High Intensity Statin Therapy
Definition
atorvastatin 40-80 mg
•rosuvastatin 20-40 mg
Term
Moderate Intensity Statin Therapy
Definition
•Atorvastatin 10 (20) mg
•Rosuvastatin(5) 10mg
•Simvastatin 20-40mg
•Pravastatin 40 (80) mg
•Lovastatin 40mg
•FluvastatinXL 80mg
•Fluvastatin40mg bid
•Pitavastatin2-4mg
Term
Low Intensity Statin Therapy
Definition
•Simvastatin 10 mg
•Pravastatin 10-20 mg
•Lovastatin 20 mg
•Fluvastatin20-40 mg
•Pitavastatin1 mg
Term
FibricAcids: Place in therapy
----Caution when initiating gemfibriozilin patient on statin,WHY???
Definition
–increased risk for muscle symptoms
Term
Consider fenofibratein combo with low or moderate intensity statin WHEN????
Definition
when TG ≥ 500 mg/dl
Term
Decreasing the statin dose maybe considered when.....
Definition
2 consecutive values of LDL are < 40 mg/dl
Term
If pt on STATIN develops DM is this a reason to stop STATIN Tx?
Definition
NO
not an indication to stop statin
Term
PREGO WARNING w/ STATINS
Definition
should be D/C if pregnant and D/C 2-3 mobefore getting pregnant. Resume post pregnancy.
Term
Fasting lipids panel within ______weeks after initiation or dose adjustment of statin
Definition
4-12 weeks
(Fasting lipid panel every 3-12 months after dose stable)
Term
SIMVASTATIN dose
Patients taking diltiazem or verapamil
Definition
5-10mg
Term
SIMVASTATIN dose
amlodipineor ranolazine–
Definition
5-20mg
Term
Statins significantly metab by CYP3A4
Definition
-Lova
-Atorv
-Simva
Term
Statins significantly metab by 2C9
Definition
Fluvastatin
Term
Statins NOT significantly metab by CYP450
Definition
Prava
Rosuva
Pitava
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