Term
| What is the rate limiting step in cholesterol synthesis? |
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Definition
| HMGCoA is converted to Mevalonate by HMG CoA Reductase |
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Term
| What guidelines are used for dyslipidemia? |
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Definition
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Term
| When are cholesterol levels considered high? |
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Definition
Total cholesterol over 200
LDL over 160 but patient specific goals can be less that 130 or 100
TGs over 200, very concerned at 500
HDL needs to be between 40-60 |
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Term
| What positive risk factors are used to determine framingham risk? |
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Definition
- Age: male ≥ 45; female ≥ 55.
- Family history: premature CHD in 1st degree relative (male <55, female <65)
- Currently smoking
- HTN: > 140/90 mmHg or on antihypertensive medications)
- Low HDL: <40mg/dL
Negative = Decreased risk
- Increased HDL: >60mg/dL |
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Term
| What disease states are considered CHD for which the LDL goal is <100 |
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Definition
Myocardial ischemia
MI
Coronary angioplasty and/or stent placement
CABG
Prior unstable angina |
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Term
| What disease states are considered CHD risk equivalents, and also have an LDL goal of <100 |
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Definition
Stroke/TIA
Peripheral Artery Disease
Abdominal Aortic Aneurysm
Diabetes Mellitus |
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Term
| How are LDL goals determined if there are no CHD or risk equivalents? |
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Definition
0-1 risk factors - LDL < 160
>/2 risk factors and risk between 10-20% - LDL goal < 130
>/2 risk factors and risk over 20% - LDL goal < 100 |
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Term
| When can the lipid goal be less than 70? |
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Definition
If there are multiple risk equivalents, such as diabetes and PAD
Metabolic syndrome |
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Term
|
Definition
Total cholesterol - HDL - TG/5
Use only if TGs less than 400
VLDL = Tg/5 |
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Term
| What is metabolic syndrome? |
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Definition
3 or more of the following:
- Abdominal obesity - waist > 35 in in women, 40 in men
- high triglycerides
- Low HDL
- BP over 130/85
- Fasting glucose over 110 |
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Term
|
Definition
Therapeutic Lifestyle changes
Reduce intake of fat and cholesterol, increase fiber and activity. Stop smoking. |
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Term
| How is % reduction calculated? |
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Definition
| (Current level - Goal) / Current level |
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Term
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Definition
In order of potency:
Rosuvastatin/Crestor, Atorvastatin/Lipitor, Pitavastatin/Livalo, Simvastatin/Zocor, Lovastatin/Mevacor = Pravastatin/Pravachol, Fluvastatin/Lescol |
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Term
How do statins work?
Which are low potency? |
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Definition
Inhibit HMG-Coa reductase to increase LDL catabolism
Low: Lovastatin (with evening meal), pravastatin, fluvastatin - given at bedtime |
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Term
| How are statins metabolized? |
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Definition
| All through CYP450 except Pravastatin. Inhibitors raise statin levels - Azoles, macrolides, Cyclosporine, GEMFIBROZIL, Verapamil/Diltiazem, Amiodarone |
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Term
| What are statin side effects? |
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Definition
Muscle aches
Rhabdo - breakdown of skeletal muscle
Increase in blood glucose, liver function panels |
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Term
What are absolute contraindications for statins?
How are they monitored? |
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Definition
Chronic liver disease
Pregnancy category X
Watch use with CYP inhibitors
Baseline LFTS and recheck. Stop if 5x baseline, check CK if dark urine. |
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Term
What drug are fibrates?
How do they work? |
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Definition
Gemfibrozil/Lopid, Fenofibrate
Increase VLDL clearance and decr apoB100
Avoid using in low CrCl |
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Term
| What are the side effects, interactions, and contraindications for fibrates? |
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Definition
- increased LFTs, myalgia
- Avoid Gemfibrozil and statins. Also interacts w/ BAS, Zetia, warfarin
- Do not use in severe hepatic/renal disease, do not use Lopid w/ zocor/mevacor
- Monitor SCr and LFTs, get baseline CBC. Take Lopid w/ meals |
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Term
| How does Niacin work? What are side effects and complications? |
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Definition
Decreases LDL and VLDL. Have to take a lot of OTC niacin. ASA relieves flushing. Monitor blood glucose, interacts w/ warfarin & statins. Do not use in liver disease and severe gout. Monitor LFTs, glucose, uric acid
Take with ASA and meals, avoid hot drinks and EtOH |
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Term
What BAS are available?
When do you not use them? |
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Definition
Cholestyramine/Questran, Colestipol/Colestid, Colesevelam/Welchol
Do not use in a pt that has high TGs!!
Colestipol has many DIs. Space other drugs by 2 hrs. Welchol + verapamil interact.
Very bad GI side effects |
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Term
| When is Zetia used? How does it work? |
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Definition
| Used when LFTs increase and cholesterol reduction still needed. Blocks absorption at the brush border with few DIs and side effects. |
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Term
| What is Lovaza indicated for? |
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Definition
| Hypertriglyceridemia > 500, causes belching, pain. Not highly used |
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Term
| What did the heart protection study tell us? |
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Definition
| Statins bettered the outcome in every patient group tested |
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Term
What is cod liver oil used for?
Policosanol?
Stanols/Sterols?
Red Yeast Rice? |
|
Definition
- Hypertriglyceridemia
- High cholesterol, interacts w/ NSAIDS
- Competes w/ cholesterol for absorption
- Red Yeast Rice - Same as statins, do not use with statins |
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Term
| What is the only drug that could be used during pregnancy? |
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Definition
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