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What is elevation of blood conc. of lipid such as cholesterol or triglycerides?
hyperlipidemia
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What are 4 major classification of lipids?
total cholesterol, low density lipoprotein(LDL), high density lipoprotein (HDL), and triglycerides
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What is friederwald equation to calculate LDL?
LDL= total cholesterol - (HDL +TG/5)
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What is artherosclerosis?
- fatty substance form deposit of plaque in arterial walls
- foam cells are the initial lesion
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What should the levels be for: total cholesterol, HDL, TG?
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What is familial hypercholesterolemia?
LDL 250-450mg/dL
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What is polygenic hypercholesterolemia?
LDL 160-250 mg/dL
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What is familial combined hyperlipidemia?
- LDL 160-250
- TG 200-800mg/dL
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What are secondary causes of lipid disorders?
- DM
- hypothyroidism
- renal failure
- obstructive liver disease
- drugs: BB, thiazide, oral contraceptive, oral estrogen, cyclosporine, glucocorticosteroids
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What are the major nonlipid risk factors for coronary artery disease (CAD)?
- cigarette smoking
- HTN
- family history of premature CHD
- low HLD <40
- age men greater or equal to 45;women age greater or equal to 55
- LDL <130 (2 or more risk factors)
- LDL<160 (0-1 risk factors)
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Goal LDL is <100 for who?
- pt. with CHD or sumptomatic carotid artery disease
- peripheral carotid disease
- abdominal aortic aneurysm
- DM
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What are the drug classes used to treat high cholesterol?
statins, bile acids (resins), nicotinic acid, fibric acids, cholesterol inhibitor, omega-3 fatty acids, combo drugs
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What are the common statins? (generic/brand)
- atrovastatin (Lipitor)
- fluvastatin (Lescol)
- lovastatin (Mevacor) lovastatin ER (Altoprev)
- pravastatin (Pravachol)
- simvastatin (Zocor)
- rosuvastatin (Crestor)
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What is the MOA of statins?
- inhibit HMG-CoA (3hydroxy-3methyl-glutaryl-CoA) reductase
- enzyme responsible for conversion of HMG-CoA to mevalonate
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Statins are usually administered when?
- at bedtime because that is when most hepatic cholesterol production happens
- atrovastatin can be taken anytime due to longer 1/2life
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What statin needs to be adjusted for renally impaired pt.?
rosuvastatin
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What are the most common SE with statins?
myopathy (muscle damage), myalgia, rhabdomyolysis
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Which statin is not metabolized by CYP450?
pravastatin (no drug interactions)
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What are the common bile acids?
- cholestyramine (Questran)-powder
- colestipol (Colestid)-powder/tabs
- colesevelam (Welchol)-tabs
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Bile acids are contraindicated when TG are?
TG >400 (caution when TG>200)
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What is the MOA of bile acids?
exchange chloride for bile acids, bile excretion to decrease cholesterol
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What are the SE of bile acids?
GI distress, constipation
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Seperate what drugs with bile acids by 1hr before use or 4hrs after?
digoxin, levothyroxine, tetracycline, warfarin, fat soluble vitamin, minerals
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What does nicotinic acid (niacin,niaspan) do?
decrease LDL and TG and increase HDL
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What can you take with niacin to decrease flush?
- aspirin 325mg
- or
- ibuprofen 200mg
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What are the SE of niacin?
flush, hyperglycemia, hyperuricemia
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What are examples of fibric acids?
- gemfibrozil (Lopid)
- fenofibrate (Tricor)
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What is the MOA of fibric acid?
- fibrates reduce TG by reduction of apolipoprotein B
- (main role is to decrease TG)
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What are the SE of fibric acids?
dyspepsia (impaired digestion), gallstones, myopathy
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Fibric acids increase what drug?
- warfarin (monitor prothrombin time)
- decrease anticoagulation drug
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What is the MOA cholesterol inhibitor ezetimibe(Zetia) and SE and drug interactions?
- inhibit intestinal absorption og cholesterol ay brush border of small intestine
- GI distress
- Cyclosporine (may increase zetia conc)
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When is omega-3 fatty acid used?
- brand name is Lovaza
- used when TG are greater or equal to 500
- (if drug in not effective in 2months then stop Lovaza)
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What are the SE of Lovaza?
burping, taste alteration, backache
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What are the combo. products used?
- aspirin +pravastatin (Pravigard pack)
- ezetimibe +simvastatin (Vytorin)
- lovastatin +niaspan (Advicor)
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What classes of drugs are used to decrease LDL, LDL and TG, TG?
- LDL: statins (alone or with niacin, zetia, resins)
- LDL +TG: statin with niacin or fibric acid
- TG: fibric acid or niacin
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What is the only class of agents to control hyperlipidemia that is NOT contraindicated in pt. with active or chronic liver disease?
bile acids (resins)
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T/F: Advicor should not be substituted for equivelent doses of immediate relase niacin?
True
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