Hyperlipidemia JC
Study Of Cardio Cardiopulmonary Therapeutics with Many at Rutgers University - New Brunswick/Piscataway
About this deck
By: Joshua Colorado
Created: 2011-10-22
Size: 81 flashcards
Views: 11
Created: 2011-10-22
Size: 81 flashcards
Views: 11
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lipids are a precursor for..
steroid hormones and bile acids
chylomicron (origin, main lipid component, function)
intestine, TG, transport dietary lipids to the liver
VLDL (origin, main lipid component, function)
liver, TG, transport lipids from liver to body
IDL ((origin, main lipid component, function)
VLDL in capillaries, TG and cholesterol, transport lipids to liver
LDL (origin, main lipid component, function)
IDL, cholesterol, transport cholesterol to the tissues
HDL (origin, main lipid component, function)
liver and intestine, cholesterol, removes cholesterol from the periphery
what do fibrous caps protect?
underlying lipids, collagen, calcium, etc.
what causes non drug-induced hypertriglyceridemia?
obesity, diabetes mellitus
what causes non drug induced decreased HDL?
obesity
what causes drug induced hypercholesterolemia?
protease inhibitors, cyclosporine, glucocorticoids, thiazide diuretics
what causes drug induced hypertriglyceridemia?
bile acid binding resins, anabolic steroids, alcohol
what causes drug induced decreased HDL?
anabolic steroids
can hyperlipidemia cause peripheral neuropathy?
yes
besides TC, LDL, and TG, what is elevated in the lab values?
apolipoprotein B and C-reactive protein
what can you use in a nonfasting lipid panel? critical values?
TC (>200) and HDL (<40)
identify CHD (6)
myocardial infarction, myocardial ischemia, stable angina, unstable angina, coronary angioplasty, coronary artery bypass
CHD risk equivalents (6)
peripheral arterial disease, abdominal aortic aneurysm, TIA's or strokes, diabetes, >50% occlusion of carotid artery, 2+ risk factors with 10-year CHD risk >20%
risk factors
smoking, HTN ( >140/90 or taking antihypertensives), age (men > 45 or women > 55), HDL <40, family history of premature CHD (male <55 or female <65)
negative risk factor???
HDL > 60
goals for lower risk
LDL <160, non-HDL <190
goals for moderate risk
LDL <130, non-HDL <160
goals for moderately high risk
LDL <130 (optional <100), non-HDL <160
goals for high risk
LDL <100 (optional <70), non-HDL <130 (optional <100)
metabolic syndrome
TG >200, non-HDL >130, HDL <40
what can you initiate therapy with?
statin, BABR, or niacin
order of potency of statins? (most to least)
rosuvastatin, pitavastatin, atorvastatin, simvastatin, lovastatin, fluvastatin, pravastatin
statins contraindicated in what?
acute or chronic liver disease and pregnancy (cat. x)
which statins are metab'd by 3A4?
atorvastatin, lovastatin, simvastatin
which statins are metab'd by 2C9?
fluvastatin, pitavastatin, rosuvastatin
which statins are metab'd by 2C19?
rosuvastatin
which statins are metab'd by no CYP?
pravastatin
which statin interacts with warfarin?
rosuvastatin
which statin should be taken with an evening meal?
lovastatin
which statins should be taken at bedtime?
fluvastatin IR, pravastatin, simvastatin
which statins can be taken any time of day?
atorvastatin, fluvastatin XL, pitavastatin, rosuvastatin
BAR's effects on lipid panel?
decreased LDL, increased HDL, no change or SLIGHT INCREASE in TG
adverse effects of BARs
constipation, bloating, flatulence, GI discomfort
drug interactions of BARs?
decreased absorption of fat-soluble vitamins, acetaminophen, thiazides, furosemide, propanolol, levothyroxine, digoxin, and warfarin
BARs contraindicated when?
TG > 400
name 3 BARs
cholestyramine, colestipol, colesevelam
when are BARs drug of choice?
Frederickson type IIa
MOA of niacin?
reduces TG synthesis in liver, decreasing VLDL and LDL, reduces HDL clearance
adverse effects of niacin
flushing, hyperglycemia, hyperuciemia (gout), upper GI distress, hepatotoxicity, dry eyes
absolute contra's of niacin?
chronic liver disease, severe gout
relative contra's of niacin
diabetes, hyperuricemia, PUD
which has less hepatotoxicity...sustained release or extended release niacin?
extended release
which is Rx, extended release or sustained release niacin?
extended release (Niaspan)
how should you dose niacin?
start with 50 or 100 mg and titrate up (always try IR first)
MOA of fibric acids?
activates PPAR alpha to stimulate lipolysis and elimination of TG
fibric acids' effect on lipid panel
VARIABLE EFFECT on LDL, increase HDL, decrease TG
adverse effects of fibric acids?
dyspepsia, gallstones, myopathy, hepatotoxicity, potentially improved glycemic control
contras of fibric acids?
severe renal (partially elim'd by kidney) and hepatic disease
name 3 fibric acids
gemfibrozil, fenofibrate, fenofibric acid
fibric acids primarily do what?
lower TG
what is the initial therapy when TG > 500?
fibric acids
what's a possible drug interaction with gemfibrozil?
avoid with simvastatin >10 mg or rosuvastatin
MOA of ezetimibe?
blocks sterol transporter in the small intestine
contra's of ezetimibe?
actue liver disease, pregnancy, nursing
drug interactions of ezetimibe?
separate from BARs by 2 hours, increased cyclosporine levels
adverse events of ezetimibe?
minimal, arthralgia and dizziness
MOA of omega-3 fatty acids?
decreases TG production in the liver
ceiling effect is seen with which combination?
statin + BAR
which combo has less side effects than statin/bar?
statin/ezetimibe
when shouldn't you use statin/ezetimibe?
when patient is already at LDL goal
what should you monitor with statin/fibric acids?
CK, patients must have normal renal function
when do you stop statin/fibric acids?
if CK > 10x ULN
how do side effects of statin/niacin compare to statin/fibric acid?
less risk of myopathy, however...limited by niacin side effects
does statin/niacin decrease atherosclerotic plaques?
yes
does statin/niacin decrease mortality in patients who have reached their LDL goal?
no
which combo is especially useful for diabetic patients with high TG?
statin + omega 3
is olestra absorbable and digestable?
no
is olestra heat stable?
yes
adverse effects of olestra?
increases flatulence, anal leakage
drug interactions of olestra
fat soluble vitamins
dose and reduction by plant sterols and stanols?
2-3 g/day reduces LDL by 6-15%
what does red yeast rice contain?
lovastatin
when do you use drug therapy in children?
> 8 years if LDL
>190
>160 with 2 or more risk factors, or premature CHD history
>130 with diabetes
what could you use in treating children?
statins, BARs, ezetimibe
drug of choice in pregnancy?
BABR's
what can you do to help with the GI discomfort associated with BAR's?
drink water
About this deck
By: Joshua Colorado
Created: 2011-10-22
Size: 81 flashcards
Views: 11
Created: 2011-10-22
Size: 81 flashcards
Views: 11
About StudyBlue
STUDYBLUE makes things that make you better at school.
Things like online flashcards with photos and audio.
Things like personalized quizzes and friendly reminders about when (and what) to study next.
Think of it as a digital backpack™: access to all of your study materials online and on your phone.
STUDYBLUE exists to make studying efficient and effective for every student, for free. Join us.
“I have been getting MUCH better grades on all my tests for school. Flash cards, notes, and quizzes are great on here. Thanks!”
Kathy
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