Term
| Lipid Lowering Therapy is aimed at reducing _____ and _____. |
|
Definition
reducing LDL and total cholesterol
specific targets levels are chosen based on the existance (or not) of coexisting conditions |
|
|
Term
| VLDL is produced by ___________ and have a ________ core composed primarily of __________. |
|
Definition
|
|
Term
| > 500 trigs assc. with increased risk of ______________ and should be treated with which drugs? |
|
Definition
pancreatitis
VLDL lowering drugs (ie nicotinic acid) |
|
|
Term
| If the total cholesterol in someone >45 years old is >200, it increases the risk of ______ significantly. |
|
Definition
|
|
Term
| Lowering LDL by 25% may reduce CAD risk by ______. |
|
Definition
|
|
Term
| What are the desirable cholesterol levels? |
|
Definition
TC <200
LDL <130
HDL >60
Trigs <150 |
|
|
Term
| What are the moderate cholesterol levels? |
|
Definition
TC 200-239
LDL 130-159
HDL 35-60
Trigs 150-199 |
|
|
Term
|
Definition
TC >240
LDL >160
HDL <35
Trigs >200 |
|
|
Term
| List the HMG-CoA Reductase Inhibitors. |
|
Definition
Atorvastatin
Lovastatin
Pravastatin
Fluvastatin
Simvastatin
Rosuvastatin
Cerivastatin |
|
|
Term
|
Definition
| inhibit HMG-CoA reductase, the rate limiting enzyme in chol. biosynthesis |
|
|
Term
| How do statins effect cholesterol levels? |
|
Definition
decs TC, LDL-C, VLDL-C and total trigs
HDL-C remains the same or increases |
|
|
Term
| Which statins have the best oral absorption? |
|
Definition
| Pravastatin and Fluvastatin |
|
|
Term
| statins are metabolized by... |
|
Definition
|
|
Term
| Which statins have the most drug interactions? |
|
Definition
Atorvastatin
Lovastatin
Simvastatin |
|
|
Term
| Statins are excreted via ___________ and ___________. |
|
Definition
|
|
Term
| How are statins administered? |
|
Definition
PO once daily
usually at night |
|
|
Term
|
Definition
Liver problems
Mm problems: myalgia and rhabdo
renal problems |
|
|
Term
| What should you monitor while using statins? |
|
Definition
|
|
Term
| Renal problems are more likely to occur with statin use if the patient also... |
|
Definition
has renal dz
(or is taking erythromycin, niacin, gemifibrozil, itraconazole or cyclosporin) |
|
|
Term
| Who should not use statins? |
|
Definition
pregnant women
nursing moms
kids |
|
|
Term
| What should you make sure your patients report to you if they are on statins? |
|
Definition
unusual, diffuse or persistant mm pain, tenderness or weakness
esp if accompanied by fever or malaise |
|
|
Term
| What would make you D/C statins? |
|
Definition
myopathy is diagnosed or
CPK increases |
|
|
Term
| (DI) statins + fibrates = |
|
Definition
| increased risk of mm damage |
|
|
Term
| Itraconazole, erythromycin and cyclosporin can ________ ________ of statins. (DI) |
|
Definition
|
|
Term
| Statins may increase the levels of what drug? (DI) |
|
Definition
|
|
Term
| List the bile acid binding resins. |
|
Definition
cholestyramine
colestipol
colesevelam |
|
|
Term
| Which drugs are good to give to someone who can't tolerate a statin? |
|
Definition
|
|
Term
| Bile Acid Binding Resins form an_____________ complex with bile acids present in the intestines; This complex prevents the ____________ of bile acids and is then excreted. (MOA) |
|
Definition
insoluble
reabsorption
(the increased excretion of bile acids creates a demand for inc bile acid synthesis...
bile acids are made from cholesterol provided by LDL) |
|
|
Term
| How do Bile Acid Binding Resins effect Cholesterol levels? |
|
Definition
lowers LDL
sometimes raises HDL levels, but response is not uniform |
|
|
Term
PK of bile acid binding resins
|
|
Definition
PO
insoluble
not absorbed
not metabolized
total fecal excretion |
|
|
Term
| Which drugs are DOC for phenotypes of IIa and IIIb hyperlipidemia? |
|
Definition
cholestyramine
colestipol
colesevelam |
|
|
Term
| __________________ is used to relieve pruritis caused by accumulation of bile in patients with biliary obstruction. |
|
Definition
|
|
Term
| List the AEs of Bile Acid Binding Resins. |
|
Definition
- nothing systemic bc its not absorbed
- safest of all lipoprotein lowering drugs
GI: constipation, bloating, indigestion, N, flatulence
decreases if taken with full glass of water
rarely: dec fat absorption, def of fat soluble vits, folic acid and ascorbic acid |
|
|
Term
| Which group of drugs is the safest of all lipoprotein lowering drugs? |
|
Definition
bile acid binding resins
cholestyramine
colestipol
colesevelam |
|
|
Term
| What are the doses for bile acid binding resins? |
|
Definition
cholestyramine 4-12 grams bid (powdered or wafer)
colestipol 10-20 grams/day (granular)
colesevelam 625 mg tablets, 3 bid |
|
|
Term
| Bile acid binding resins may form complexes with: |
|
Definition
thiazides
digoxin
warfarin
some Abx
tetracyclines
aspirin
phenobarbital
statins |
|
|
Term
| Nicotinic acid's effect on cholesterol is ... |
|
Definition
lowers LDL and VLDL
modest increase in HDL |
|
|
Term
| Nicotinic Acid reduces hepatic LDL an VLDL _____________ and _______________. (MOA) |
|
Definition
synthesis and secretion
(inhibition of tissue lipolysis reduces the supply of circulating free fatty acids that the liver uses to synthesize trigs for incorporation into VLDL) |
|
|
Term
| Nicotinic acid is converted into ________ in the body. |
|
Definition
|
|
Term
| How is nicotinic acid administered? |
|
Definition
|
|
Term
| What are the indications for nicotinic acid? |
|
Definition
patients who have elevations in LDL and VLDL,
type IIa and IV hyperlipidemia
other severe hypercholesterolemias |
|
|
Term
| What drug increases plasma HDL levels the best? |
|
Definition
|
|
Term
| Which drug is the least expensive but also least well tolerated of all the lipid lowering drugs? |
|
Definition
|
|
Term
| What is the main AE for nicotinic acid? |
|
Definition
|
|
Term
| List the AEs for nicotinic acid. |
|
Definition
intense cutaneous flush
GI upset, NVD
Liver injury
Glucose Intolerance
Hyperuricemia
Metabolic syndrome |
|
|
Term
| Nicotinic acid is contraindicated in people with: |
|
Definition
hepatic dysfunction
PUD
Hyperuricemia
DM |
|
|
Term
| How can you diminish the effects of the intense cutaneous flush caused by nicotinic acid? |
|
Definition
begin with low doses
take with a meal
take ASA before dose
time released prep |
|
|
Term
| List the Fibric acid derivatives. |
|
Definition
gemifibrozil
fenofibrate
clofibrate |
|
|
Term
| Fibric acid derivative active _______________, thus promoting delivery of triglycerides to adipose tissue and interfere with the formation of ________ in the liver. (MOA) |
|
Definition
lipoprotein lipase
VLDL
(HDL is likely increased) |
|
|
Term
| List the AEs of Gemfibrozil, Fenofibrate, Clofiberate. |
|
Definition
GI disturbances
Cholelithiasis
myositis (more common if pt is also taking a statin)
ED
malignancy |
|
|
Term
| Which drugs can interact with Fibric acid derivatives |
|
Definition
|
|
Term
| How is gemfibrozil administered? |
|
Definition
|
|
Term
| How is Fenofibrate metabolized and excreted? |
|
Definition
metabolized by liver
excreted in urine |
|
|
Term
| What should you monitor when using fibric acid derivatives? |
|
Definition
LFTs
lipids
investigate mm complaints
CK
CBCs during first year |
|
|
Term
| Fibric acid derivative contraindications: |
|
Definition
patients w/ gallbladder disease,
severe hepatic/renal disease, and
preg. or lactating women |
|
|
Term
| Fibric acid derivative are indicated for: |
|
Definition
| hypertriglyceridemia assc. with low levels of HDL |
|
|
Term
| DOC for hypertriglyceridemia assc with low levels of HDL: |
|
Definition
|
|
Term
|
Definition
| a cholesterol absorption inhibitor |
|
|
Term
| List the SEs of ezetimibe. |
|
Definition
|
|
Term
| Ezetimibe inhibits ___________ absorption in the intestines from the ________. |
|
Definition
|
|
Term
| Ezetimibe works better if it is combined with what? |
|
Definition
|
|
Term
How is Ezetimibe administered, metabolized and excreted?
|
|
Definition
PO
metabolized by glucuronide conjugation
renally excreted |
|
|
Term
| Ezetimibe is indicated for... |
|
Definition
| primary hypercholesterolemia |
|
|
Term
|
Definition
a combination of niacin ER + lovastatin
500/20; 750/20; 1000/20 |
|
|
Term
|
Definition
a combination of Aspirin + Pravastatin
81/20; 81/40; 81/80
325/20; 325/40; 325/80 |
|
|
Term
|
Definition
a combination of ezetimibe + simvastatin
10/10; 10/20; 10/40; 10/80 |
|
|
Term
|
Definition
a combination of Amlodipine + Atorvastatin
5/10 to 10/80 |
|
|
Term
| HMG-CoA Reductase Inhibitors end in... |
|
Definition
|
|
