1 - Cholesterol

Question 1

What are the guidelines for LDL cholesterol?

Answer 1

• *70 - ideal
• < 100 - optimal
• 100-129 - near optimal
• 130-159 - borderline high
• 160-189 - high
• >190 very high

Question 2

What are the guidelines for total cholesterol?

Answer 2

• <200 - desirable
• 200-239 - boderline high
• >240 high

Question 3

What are the guidelines for HDL cholesterol?

Answer 3

• < 40 - low
• > 60 - high

Question 4

What are the guidelines for triglycerides?

Answer 4

• <150 - normal
• 150-199 - boderline high
• 200-499 - high
• >500 - very high

Question 5

Why is Lipitor the #1 drug in terms of sales worldwide for the 6th year in a row?

Answer 5

New lower target of “70” for optimal LDL range is virtually impossible to reach without “statins”

Question 6

What is a class of medications used to reduce cholesterol by binding bile acids in the gut?

Answer 6

Bile Acid Sequesters

Question 7

What are some common preparations of Bile Acid Sequesters?

Answer 7

“cole-“ or “chole”

• cholestyramine resin
• colesevelan
• colestipol

Question 8

What drug decreases liver triacylglycerol synthesis necessary for VLDL production?

Answer 8

Nicotinic Acid (Niacin)

Question 9

What’s the common side effect of niacin?

Answer 9

Facial flushing

Question 10

What do fibric acids do?

Answer 10

• Lowers plasma triglycerides
• Increases HDLs
• Inhibits cholesterol synthesis in liver

Question 11

What are the common preparations of fibric acids?

Answer 11

Look for “fiber” sound in name!

• clofibrate (Atromid)
• fenofibrate (Tricor)
• gemfibrozil (Lopid)

Question 12

What is the rate-limiting step in the synthesis of cholesterol?

Answer 12

HMG-CoA reductase

Question 13

What type of drugs are the “statins”?

Answer 13

HMG CoA Reductase Inhibitors

Question 14

There’s new evidence that shows that HMG CoA reductase inhibitors may have _____________ activity?

Answer 14

Anti-inflammatory

Question 15

HMG CoA Reductase Inhibitors cannot be taken if patient has what?

Answer 15

Liver disease - drugs may alter liver function

Question 16

What are some side effects of HMG CoA reductase inhibitors?

Answer 16

• myalgias
• rhabdomyolysis - disintegration of the muscle tissue

Question 17

What are the important dental drug interactions with HMG CoA reductase inhibitors?

Answer 17

Avoid use of:

• Macrolide antibiotics (erythromycin)
• Systemic (azole) antifungals

They will promote rhabdomyolysis

Question 18

What is Vytorin?

Answer 18

Combination of a statin drug (Zocor) with ezetimibe (Zetia)

**Vytorin = Zetia + Zocor **

Long term studies shows no greater benefit of using this combo compared to statin alone

Question 19

What are the oral considerations with lipid lowering agents?

Answer 19

• Multiple drug interactions
• Assess risk for increased bleeding
• Avoid azole antifungals, macrolide antibiotics with HMG CoA reductase inhibitors
• Assess changes in cholesterol lowering meds at each visit