USMLE Step 2 Review 20 05 Drugs of Choice CHD and LDL, HDL

USMLE Step 2 Review 20 05 Drugs of Choice CHD and LDL, HDL

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Begin 20 05 Drugs of Choice CHD and LDL, HDL Transcription

In terms of coronary heart disease, associated with hyperlipoproteinemia, what are the 2 primary risk factors?

  • Elevated LDL or decreased HDL.

Trials have shown that lowering total cholesterol reduces risk for coronary heart disease; specifically what part of total cholesterol when it is lowered, causes the greatest reduction in risk?

  • LDL-C.

Generally, for every 1% reduction in total cholesterol or LDL-C, what reduction in risk occurs?

  • There is a 2% reduction in risk for every 1% reduction in total cholesterol or LDL-C.

What level of HDL-C is also a risk factor for coronary heart disease?

  • Levels below 35 mg/dL.

What level of HDL-C reduces the risk of coronary heart disease?

  • HDL-C higher than 60 mg/dL.

In terms of drug therapy to lower the level of triglycerides or LDL or cholesterol, what class of drugs are most widely used?

  • The HMG-CoA Reductase Inhibitors.

From highest relative potency to lower relative potency, what are the 4 HMG-CoA Reductase Inhibitors currently in use?

  • Simvastatin, Lovastatin, Pravastatin, Fluvastatin.

What is the trade name for Simvastatin?

  • Zocor.

And what is the trade name for Lovastatin?

  • Mevacor.

And what is the trade name for Pravastatin?

  • Pravachol.

And finally, the trade name for Fluvastatin?

  • Lescol.

What is the most important side effect of the HMG-CoA Reductase Inhibitors?

  • Transaminase elevations, which appear to be clinically significant.

How common are these?

  • These are quite rare.

And how long do they last?

  • They are usually transient.

Very rarely, what are 2 serious side effects of the HMG-CoA Reductase Inhibitors in addition to the transaminase elevations?

  • Myositis, rhabdomyolysis.

What is the class of drugs used to help lower cholesterol which work by helping with the elimination of cholesterol through the feces?

  • Bile acid sequesterants.

And what are the 2 currently used?

  • Cholestyramine, Colestipol.

And the trade name for Cholestyramine?

  • Questran.

And the trade name for Colestipol?

  • Colestid.

Why are the bile acid sequesterants considered to be very safe?

  • Because they are not absorbed systemically from the bowel.

About how much reduction in LDL-C expected from the use of HMG-CoA Reductase Inhibitors?

  • 20-40% reduction.

What level of reduction can usually be achieved with the bile acid sequesterants?

  • Only about 10-30% at best reduction.

What process or loop is interfered with by the bile acid sequesterants?

  • The entero-hepatic circulation of bile acids is decreased.

What effect does this have on the liver?

  • The liver puts out more LDL-C receptors in order for the liver to absorb more LDL-C from the blood because its internal content of cholesterol has been lowered.

What is the most common side effect of the bile acid sequesterants?

  • Constipation.

Can the bile acid sequesterants be used with other lipid-lowering drugs?

  • Yes, they can be used in combination with all of the other classes of lipid lowering drugs.

While the bile acid sequesterants may be used by themselves for a modest reduction in LDL-C, they’re most frequently used in combination with what other class of drug?

  • With the HMG-CoA Reductase Inhibitors.

What adverse effect can the bile acid sequesterants have on serum lipids?

  • They can increase triglyceride levels.

So, in what patients do you not use bile acid sequesterants?

  • Patients who have a triglyceride level of 250mg/dL or greater



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