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
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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
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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? |
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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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