Dyslipidemia 4 Flashcards

1
Q

Which drug?

MOA

  • Inhibits synthesis and secretion of VLDL, and therefore LDL
  • Proposed MOA: inhibition of FFA release from adipose tissue / increased LPL activity / Decreased TG synthesis
A

Nicotinic Acid

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2
Q

Which drug?

  • LDL lowering (10-25%)
  • Increases HDL (15-35%)
  • TGs decreased (25-30%)
A

Nicotinic Acid

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3
Q

The AHA/ACC 13 states the use of Nicotinic Acid therapy to additionally lower non-HDL once LDL target is achieved DID or DID NOT further reduce ASCVD outcomes?

A

DID NOT

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4
Q
  • Which form of Nicotinic Acid is available OTC?
  • Which form is Rx only?
A
  • OTC: Niacin
  • Rx: Niaspan
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5
Q
  • Which Nicotinic Acid is immediate or sustained release?
  • Which is extended release and has a better SE profile?
A
  • Immediate or Sustained: Niacin
  • Exended: Niaspan
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6
Q

Which drug?

Side Effects:

  • Flushing, warmth, tingling which is offset by taking what before dosing?
  • Hyperglycemia (insulin resistance)
  • Hyperuricemia (gout)
  • Hepatotoxicity (related to sustained release form)
A
  • Nicotinic Acid
  • sxs offset by taking NSAID (ASA 325)
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7
Q

2 contraindications of Nicotinic Acid

A
  • Active peptic ulcer
  • Arterial hemorrhage
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8
Q

What is the drug interaction of Nicotinic Acid?

A

Interacts w/ Anticoagulants (may increase bleeding time)

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9
Q

Which drug?

MOA:

  • Cholesterol is a precursor
  • Binds in the intestine which are then eliminated in feces
  • Increased excretion increases cholesterol catabolism to form more
A

BAS (bile acid sequestrants)

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10
Q

Which drugs?

  • Decreases LDL 15-30%
  • Can increase VLDL in combined HLD
A

BAS

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11
Q
  • What is the name of 2 BASs?
  • How is it administered?
A
  • Cholestyramine (Questran, Prevalite)
  • Powder (tastes bad), 1-2 times/day, then gradually increase to greater than 1 month intervals
  • Colesevelam (Welchol)
  • Tablets (most tolerable , tastes better)
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12
Q
A
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13
Q

What are the side effects of BASs?

(ABCNF) + one more

A
  • Abdominal pain
  • Bloating
  • Constipation
  • Flatulance
  • Nausea
  • Severe: bleeding w/ chronic use (affects Vit K absorption)
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14
Q

What is recommended to patients who take BAS and have other medications?

A

BAS will bind to other medications (decreases absorption), so administer 1 hour BEFORE, or 4 hours AFTER taking BAS.

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15
Q

Which drug?

MOA:

  • Uncertain, is thought to inhibit VLDL and TG synthesis in the liver
  • Target effect is 20-50% reduction of TGs
A

O3FAs (Omega 3 Fatty Acids)

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16
Q

Which drug?

  • Minimal affect on HDL
  • Can increase LDL at high doses
A

O3FAs

17
Q

Which drug?

  • Withdraw after 2 months of inadequate tx results
  • Only one w/ evidence that lowers cholesterol levels
A

Omega 3 Acid Ethyl Esters (Lovaza)

18
Q

2 side effects of O3FA

A
  • Eructation - “fish burp”
  • Dyspepsia
19
Q

Contraindication of O3FA

A
  • Fish hypersensitivity
20
Q

What 2 drugs does O3FA interact with?

A
  • Anticoagulants
  • Antiplatelets

(may enhance bleeding time)

21
Q

What are the 3 agents under development (LANGE)?

A
  • CETP inhibition
  • AMP Kinase activation
  • Cyclodextrins
22
Q
  • Leads to accumulation of mature HDL particles and diminution of the transport of cholesteryl esters to liver
A

CETP inhibition

(Torcetrapib, anacetrapib)

23
Q
A
24
Q
  • Increases fatty acid oxidation and insulin sensitivity
  • Inhibits cholesterol and triglyceride biosynthesis
  • May have merit for management of metabolic syndrome and diabetes
A

AMP Kinase Activation

25
Q
  • Circular sugar polymers
  • Can solubilize cholesterol from tissue sites such as arteriosclerotic plaque
A

Cyclodextrins