What proteins transport lipds (chol/trig) in bllod?

Lipoproteins

What are the 3 major types of lipoproteins?

1.  VLDL

2. LDL

3.HDL

What is one thing VLDL's transport?

TG's to peripheral tissues

Do VLDL's contribute to CHD? 

It's unclear.

What do LDL's transport?

cholesterol to peripheral tissues.

Elevation of LDL cholesterol greatly increases the risk of CHD.

True / False

True

Does decreasing LDL cholesterol levels impact atherosclerosis?

Yes, can arrest or reverse it, thereby reducing morbidity and mottality.

What do HDL's transport?

Cholesterol back to the liver.

HDL's protect against CHD?

True or False

True

What is atherogenesis?

Chronic inflammaotry process that begins with accumulation of LDL's beneath the arterial endothelium, followed by oxidation of LDL's.

Under the Adult Treatment Panel III (ATP III), all adults over the age of 20 should have a lipid panel how often?

Every 5 hears

What is the primary methods for reducing LDL cholesterol?

Diet & exercise.  Drug are indicated ONLY if diet and exercise fail to reach goal.

Is treatment with cholesterol lowering drugs a lifetime thing?

Yes, otherwise, the levels will rise again.

What is the most effective drug for lowering LDL Cholesterol?

Statins and ahve few adverse effects.

What are the top 3 things that statins can do?

1.  Slow progression of CHD.

2.  Decrease # of adverse cardiac events

3.  Reduce mortality

How do statins reduce LHL Cholesterol?

Increasing # of LDL receptors on hepatocytes, thereby enabling heaptocytes to remove more LDL's from the blood.

What are the 4 common statin drugs?

1.  Atorvastatin

2.  Fluvastatin

3.  Lovastatin

4.  Simvastatin

How are the statins metabolized?

By CYP3A4; therefore levels can be increased by CYP3A4 inhibitors (i.e. cyclosporine, EES, ketoconazole, ritonavir)

What is the most serious risk in taking statins?

Cause liver damage; should test liver enzymes at baseline and every 6-12 months thereafter.

What is a common adverse reaction to the statin drugs?

Myopathy - unusual muscle pain, soreness, tenderness, and/or weakness should inform provider.

Creatinine Kinase (CK) which measures muscle injury should be done at baseline and periodically thereafter; and whenever these type of S&S's develop.

Can statins be used during pregnancy?

Absolutely NOT

What is another natural way to impact elevated lipids?

Niacin - but does cause adverse effects.

Why would you add Niacin to a statin regimen?

Because it can reduce CV risk factors - BUT can not reduce risk of CV events.

What are the common side effects of Niacin?

Immediate release Niacin can cause:  intense flushing of face/neck/ears in most patients.  This can be reduced by taking ASA or Ibuprofen 30" prior, by dividing daily doses, or by using an ER product.

Does Niacin cause liver injury?

Yes.  Risk is highest with older SR formulations and lowest with newer ER formulas like Niaspan

When should children be screened for hyperlipidemia?

Starting at age 9-11 unless strong family hx, then age 2-8yo.

What are the two types of dyslipedemia?

Primary - Genetic

Secondary - Envioronmental

What are the cholesterol components?

1.  VLDL

2. HDL

3. LDL

4.  TG - chylomicrons

What is the target therapy for adults?

LDL <100

HDL

Total <200

TG<150

**Main Goal is to lower LDL

What are the 4 actions of drugs?

1.  Inhibit hepatic synthesis of VLDL

2.  Increase TG clearance

3.  Inhibit hepatic cholesterol synthesis

4.  Inhibit absorption of cholesterol in small intestine

What are the 3 major drug groups?

1.  HMG CoA reductace inhibitors - statins - LDL

2.  Niacin - HDL & TG

3.  Bile Acid Resins - LDL

What is the MOA of the statin drugs?

Inhibit the enzyme HMG-CoA reductase

Reduce hepatic cholesterol synthesis

Stimulates up regulation of LDL receptors

What statin is first choice and why?

Crestor - also dec stroke, MI and causes arterial revasculizastion

What are statins used for?

Hyperlipidemia

lower LDL

Lower Total Chol

reduce TG

may raise HDL

What are the contraindications for statins?

1.  Pregnancy

2.  LIver disease

3.  Abn LFT's

What are the SE's of Statins?

1. Common - mild gi, ha, rash, muscle pain

2.  Serious:  rhabdomyolysis and myoglobinemia

Crestor has greatest risk!

3.  Hepatic adverse effects - interactions with other lipid lowering & other drugs increase risk.  3A4 Inhibitors!

When can you use a statin in children?

ONLY if inherited condition

What does nicotinic acid impact?

inc HDL

dec Chol

dec TG

What is Niacin recommended for primarily?

Dec TG's