Term
|
Definition
|
|
Term
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
Simvastatin
(Take at night ) |
|
|
Term
|
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
|
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
|
Definition
preg cat C
elderly
hep disease
myopathy |
|
|
Term
| Chol ABs Inhib are considered similar to _____ |
|
Definition
|
|
Term
|
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
|
|
Term
|
Definition
2 hrs before or 4 hrs after any other med
(not signifcntly absrbd..excreted in feces) |
|
|
Term
|
Definition
-Fat solble vitamins
-B-blokcrs
-Warfrin
-Thiazide Diuretics |
|
|
Term
|
Definition
-GI constipation!!!
-bloat, nasuea,flatuence
-Inc triglyc (caution if TG>300)
-inc bleeding in Vit K def pts |
|
|
Term
|
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
|
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
|
|
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
|
|
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
|
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
|
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
|
Definition
| Familial hypercholesteremia in addition to diet and max tolerated statin therapy WARNING:sensitivity(expensive) |
|
|
Term
|
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
|
|
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
|
|
Term
| Friedewald equation for LDL-C |
|
Definition
|
|
Term
| Friedewald Equation for TC |
|
Definition
|
|
Term
|
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
|
|
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
|
|
Term
| Moderate dose statins lower LDL by |
|
Definition
|
|
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
|
|
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
|
|
Term
Grp(3) STATIN initiation Tx
Diabetes w/ LDL-C 70-189mg/dL
Age 40-75yrs
w/ estimated 10yr ASCVD risk >/=7.5% |
|
Definition
|
|
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
|
|
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
|
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
|
|
Term
SIMVASTATIN dose
amlodipineor ranolazine– |
|
Definition
|
|
Term
| Statins significantly metab by CYP3A4 |
|
Definition
|
|
Term
| Statins significantly metab by 2C9 |
|
Definition
|
|
Term
| Statins NOT significantly metab by CYP450 |
|
Definition
|
|
