Term
| how much choelsterol is synth by the body daily? |
|
Definition
|
|
Term
| what is cholesterol important for-5 |
|
Definition
steroid sytnh
bile acid synth
cell membranes
absorption of fats and fat vitamins
trnasport of fats |
|
|
Term
| are statins non competitive or cmoeptitive inhibitors |
|
Definition
|
|
Term
| what statins have a lactone ring-3 |
|
Definition
simvastatin
mevastatin
lovastatin |
|
|
Term
statins block conversion of acyl coA into-
by decreasing cholesterol synth, you increase? |
|
Definition
|
|
Term
| what strength and statin are not used as much bc of high risk of myopathy |
|
Definition
|
|
Term
| what are the 2 wyas statins also lower TGs |
|
Definition
1) lower cholesterol means less VLDL synth
2) increasing LDL recpotrs increases uptake of VLDL and IDL |
|
|
Term
TG > _ have the highest reduction due to statin
-with what dose? |
|
Definition
|
|
Term
| overall how do statins affect liprotein conc? -3 |
|
Definition
lowers LDL
Lower TG
Raises HDL- a little |
|
|
Term
| statins pleiotropic effects, do they matter about LDL lowering? |
|
Definition
|
|
Term
| statins pleiotropic effects -4 |
|
Definition
endothelium stability
increase NO
down regulate AT1 rectpors
plaque stability |
|
|
Term
| how do statins have plaque stability-2 |
|
Definition
decrease migraiton and porliferaiton of smooth muscle cells
-decrease migration of monocytes |
|
|
Term
| what are the 3 statin pleiotropic effects that begin with "anti" |
|
Definition
antiinflammatory
antioxidant
anti-platelet |
|
|
Term
| how are statins anti inflammator? |
|
Definition
|
|
Term
| how are statins antioxidants |
|
Definition
| reduce oxidaiotn of lipoproteins |
|
|
Term
statins have a large-
and so they have a poor- |
|
Definition
1st pass metab
bioavilblity |
|
|
Term
| what statins are prodrugs? -2 |
|
Definition
|
|
Term
| most statins are excreted by the? |
|
Definition
|
|
Term
| which statins are metab by CYP3A4 |
|
Definition
| atorvastatin, lovastatin, simvastatin |
|
|
Term
| what statin is metb by CYP2C9 |
|
Definition
|
|
Term
| what statin isnt metab by CYP? |
|
Definition
|
|
Term
what statin has the hgihest half life?
which is 2nd? |
|
Definition
|
|
Term
| which statin's bioavail is increased with food? |
|
Definition
|
|
Term
| what are the inducers of CYP3A4 |
|
Definition
|
|
Term
| what are the CYP3A4 inhibitors-6 |
|
Definition
| clarithromycin, erythromycin, ketoconazole, itraconazole, greapefruit juice, HIV protease inh. |
|
|
Term
| what substance inhibits CYP2C9 |
|
Definition
|
|
Term
for hepatotoxicity in statins- what do you do about LFT?
why? |
|
Definition
dont need to monitor aas much,
levels resolve spontaneoulsy |
|
|
Term
|
Definition
|
|
Term
Mypoathy can devlop into-
it is casued by break down of? and is show by CK > _ |
|
Definition
rhabdomyolysis
muscle fiber
10 of upper limit |
|
|
Term
| CK can be increasedd by 2 daily activites? |
|
Definition
|
|
Term
| what ADE of statins isnt dose depenednt and is more in >50 yo |
|
Definition
|
|
Term
| how do statins affect glucose? |
|
Definition
|
|
Term
how do statins affect TSH?
how does it affect the thyroid |
|
Definition
fasely lower
doesnt affect it |
|
|
Term
| most statin ADES are proportional to? |
|
Definition
|
|
Term
| the most common interaction ALL statins have is with what med? |
|
Definition
|
|
Term
| how does gemfibrozil affect all statins-2 |
|
Definition
inhibits hydroxy acid uptake into liver
inhbiits gluconridation |
|
|
Term
| what are the bile acid sequestrants |
|
Definition
colesevlam
colestipol
cholestyramine |
|
|
Term
| what age population are bile acid sequestrants used in? |
|
Definition
|
|
Term
| why are bile acid sequestrants safer? |
|
Definition
| non absored systemically from intestine |
|
|
Term
| what is the MOA of bile acid sequstrants-3 |
|
Definition
resins (+) bind to bile acid-> cant be absorbed or excreted
- body needs to make more, so uses cholesterol
-this increases LDL recptors and decreases LDL |
|
|
Term
| why is the combo of bile acid seq. and statin so good? |
|
Definition
| bc in bile acid seq the HMG coA reductase is increased |
|
|
Term
| overall effects of bile acid sequestrants: |
|
Definition
LDL lowered
HDL raised
TG- RAISE! |
|
|
Term
| bile acid sequestrants can affect absorption of what sterol? |
|
Definition
|
|
Term
|
Definition
|
|
Term
what is the best agent for rasiing HDL?
max effect in _ days |
|
Definition
|
|
Term
| niacin is the _ vitamin; and is precursor for?-2 |
|
Definition
|
|
Term
| Overall effect of niacin: |
|
Definition
lower LDL
Lower TG
increase HDL |
|
|
Term
|
Definition
bind to recptor in adipose
reduces cAMP
decrease TG lysis-> decrease ffa to liver
decr- VLDL LDL |
|
|
Term
| how does niacin increase HDL? |
|
Definition
| decrease hepatic clearence of ApoA-1 |
|
|
Term
low dose vs high:
which is excreted as nicotunuric acid?
which is excreted unchanged? |
|
Definition
|
|
Term
|
Definition
| flushing, dyspepsia, heptox |
|
|
Term
| what are the 2 populations to not use niacin in? why? |
|
Definition
diabetics, gout ppl
incr uric acid, increase insulin resistance |
|
|
Term
| how do you tell you have toxicity with niacin? |
|
Definition
|
|
Term
| fibric acid compounds work as- |
|
Definition
|
|
Term
| what are the fibric acid derivatives? |
|
Definition
| gemfibrozil, fenofibrate, clofibrate |
|
|
Term
| PPARa recpotrs are abundant where- 2 |
|
Definition
|
|
Term
| PPARa agonists reduce TGs by: 3 |
|
Definition
increase LPL synth (incr TG clearence)
incr FFA oxidation
increases Apo C-III- incr clearence of VLDL |
|
|
Term
| how do PPARa agonists raise HDL |
|
Definition
| incr synth of apo A I and II |
|
|
Term
| fibrates are the choice for-2 |
|
Definition
severe Hyper TG
chylomicronemia |
|
|
Term
| what class binds to albumin |
|
Definition
|
|
Term
| what class do you take with food? |
|
Definition
|
|
Term
| how are PPARa agonists excreted? |
|
Definition
|
|
Term
| ADEs of PPARa agonists- 4 |
|
Definition
| rash, sex impotent, GI, anemia |
|
|
Term
caution use of PPARa agonists with-
why? |
|
Definition
oral coags
increase oral coag conctration |
|
|
Term
| what med inhibits dietary cholesterol absorbtion |
|
Definition
|
|
Term
| Ezetimibe inhibits absorption where |
|
Definition
|
|
Term
what is ezetimibe effect on cholesterol synth?
what about TG absorption? |
|
Definition
|
|
Term
| ezetimibe inhibits plant what? |
|
Definition
|
|
Term
|
Definition
decrease dietary chol. absoption
decrease chlyomicrons
increase LDL recptors |
|
|
Term
ezetemibe shouldnt be used in combo with?
why? |
|
Definition
bile acid sequestrant
inhibits abroption |
|
|
Term
| ezetimbe is clearned thru? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| omega 3 esters are used for what lipportein disorder |
|
Definition
|
|
Term
|
Definition
|
|
Term
| risk of mercury from omega 3 increases risk of |
|
Definition
|
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