Cardiovascular System Anatomy and Blood Flow

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Questions and Answers

Which of the following describes a benefit of Icosapent ethyl?

  • It should only be given to patients under 50 years old.
  • It increases VLDL-TG synthesis in the liver.
  • It is primarily used for lowering LDL-C only.
  • It is effective in reducing MACE compared to fibrates. (correct)

In which group is Icosapent ethyl recommended after reaching the LDL-C goal?

  • Patients diagnosed with Clinical ASCVD. (correct)
  • People with normal triglyceride levels.
  • Those with TG levels between 400-800 mg/dL.
  • Individuals with diabetes and no risk factors.

What is the first-line approach for a patient with triglycerides greater than 500 mg/dL?

  • Start Icosapent ethyl immediately.
  • Intensify Icosapent ethyl dosage.
  • Ensure adherence to statin therapy before considering additional treatments. (correct)
  • Administer fenofibrate to lower LDL-C.

Which of the following is NOT a risk factor for ASCVD?

<p>Normal HDL cholesterol levels. (B)</p> Signup and view all the answers

The primary mechanism of omega-3 fatty acids in managing triglycerides involves:

<p>Inhibiting VLDL-TG synthesis in the liver. (D)</p> Signup and view all the answers

What is the primary mechanism of action for Inclisiran Leqvio?

<p>Gene silencing of PCSK9 mRNA (A)</p> Signup and view all the answers

Which of the following is a labeled indication for Bempedoic acid?

<p>Atherosclerotic CVD for primary or secondary prevention (A)</p> Signup and view all the answers

What is the recommended interval for repeat dosing of Inclisiran after the initial single injection?

<p>Every 3 months, then every 6 months (D)</p> Signup and view all the answers

Which patient group falls under the first line treatment with statins?

<p>Patients aged 40-75 with diabetes and LDL-C levels greater than 70 (A)</p> Signup and view all the answers

Which of the following statements about the lipid panel screening is true?

<p>Screening can be performed on adults over 20 years without fasting. (B)</p> Signup and view all the answers

What is the elimination half-life of Inclisiran from circulation?

<p>9 hours (C)</p> Signup and view all the answers

For patients with clinical ASCVD, what is the target LDL-C reduction goal following high-intensity statin therapy?

<p>50% reduction (C)</p> Signup and view all the answers

What is a potential advantage of Bempedoic acid in treatment?

<p>Reduces muscle-related side effects (D)</p> Signup and view all the answers

What condition is indicated for screening with lipid panels at an earlier age?

<p>Significant family history of hypercholesterolemia (D)</p> Signup and view all the answers

How does Inclisiran primarily enter hepatocytes?

<p>Endocytosis via a specific glycoprotein receptor (B)</p> Signup and view all the answers

What is the primary mechanism of action of bile acid sequestrants?

<p>Prevent reabsorption of bile acids in the intestine (C)</p> Signup and view all the answers

Which of the following drugs is effective in treating severe hypertriglyceridemia?

<p>Icosapent Ethyl (A)</p> Signup and view all the answers

What is the common adverse effect of fibrates?

<p>Hepatotoxicity (D)</p> Signup and view all the answers

Which condition is most critical when considering the use of bile acid sequestrants?

<p>High baseline fasting triglyceride levels (C)</p> Signup and view all the answers

Why is fasting recommended when measuring lipid panels in patients with elevated triglycerides?

<p>Fasting reduces variability in triglyceride levels (C)</p> Signup and view all the answers

Which drug should not be used in combination with statins due to the risk of myopathy?

<p>Gemfibrozil (A)</p> Signup and view all the answers

What is the goal of using fibrates in patients with hypertriglyceridemia?

<p>Stimulate fatty acid oxidation (C)</p> Signup and view all the answers

Which substance is released as a metabolic product of Icosapent Ethyl?

<p>EPA (A)</p> Signup and view all the answers

What approach should be prioritized when managing triglyceride levels in patients?

<p>Weight loss and lifestyle modifications (B)</p> Signup and view all the answers

Which statement about bile acid sequestrants is true?

<p>They can increase hepatic triglyceride synthesis (B)</p> Signup and view all the answers

Which is an indication for using fibrates?

<p>Hypertriglyceridemia unresponsive to diet (A)</p> Signup and view all the answers

When should direct LDL-C measurement be considered?

<p>When triglyceride levels are extremely high (B)</p> Signup and view all the answers

What potential complication may arise with the use of Icosapent Ethyl?

<p>Antiplatelet aggregation effects (D)</p> Signup and view all the answers

Which is NOT a common adverse effect associated with bile acid sequestrants?

<p>Myopathy (C)</p> Signup and view all the answers

Flashcards

ASCVD risk reduction

First line approach to reduce major adverse cardiovascular events.

LDL-C lowering

Primary goal in managing lipid levels, with additional TG reduction benefits.

Clinical ASCVD TG Group

Patients with established ASCVD who have mild-moderate hypertriglyceridemia and require Icosapent ethyl addition.

Severe triglycerides

TG level > 500 mg/dL; treat with statin first before adding Icosapent ethyl or fenofibrate.

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Omega-3 Fatty Acids

Used in formulations like Icosapent ethyl to reduce VLDL-TG synthesis in the liver.

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Inclisiran Leqvio

A novel PCSK9 mRNA inhibitor used for lowering LDL cholesterol.

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PCSK9

A protein that regulates LDL receptor degradation, affecting cholesterol levels.

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siRNA

Small interfering RNA that silences specific mRNA to prevent protein production.

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Bempedoic acid (Nexletol)

First-in-class ACL inhibitor for cholesterol management.

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Statins

First-line agents for primary and secondary prevention of ASCVD.

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ASCVD

Atherosclerotic cardiovascular disease; a heart disease related to cholesterol buildup.

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Lipid panel

A blood test measuring cholesterol and triglyceride levels.

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Clinical ASCVD

History of acute coronary syndrome or other related cardiovascular conditions.

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Primary Prevention Groups

Identifies patients needing statins based on LDL-C and age criteria.

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Half-life of Inclisiran

The time it takes for half of the drug to be eliminated from circulation (9 hours).

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Bile Acid Sequestrants

Drugs that bind bile acids, promoting their elimination in feces.

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Cholestyramine

A specific bile acid sequestrant used to lower cholesterol.

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Fibrates

Drugs that lower triglycerides by stimulating fatty acid oxidation.

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Gemfibrozil

A fibrate drug used to treat hypertriglyceridemia.

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Icosapent Ethyl

A drug for CV risk reduction in severe hypertriglyceridemia.

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Mechanism of Action (MOA) of Fibrates

They act as PPAR-alpha agonists to increase fatty acid oxidation.

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Triglyceride Classification

Mild (150-499 mg/dL), Severe (>500 mg/dL), Very Severe (>1000 mg/dL).

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Statin Therapy Support

May initiate or intensify statin usage for cholesterol management.

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BAS-ADRs

Side effects of bile acid sequestrants include GI issues and drug absorption interference.

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HDL Changes from Fibrates

Fibrates may modestly increase HDL levels.

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Assessment for Dyslipidemia

Involves fasting/non-fasting lipid panels to evaluate triglycerides.

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Persistent Hypertriglyceridemia Risk

Increased risk of ASCVD from prolonged high triglycerides.

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Management of Triglycerides

Includes dieting, lifestyle optimization, and adherence monitoring.

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Enterohepatic Circulation

Recycling of bile acids in the small intestine and liver.

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CI of Fibrates

Fibrates contraindicated in severe renal impairment.

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Study Notes

Cardiovascular System Anatomy

  • The cardiovascular system transports oxygen and nutrients to tissues, exchanging them for carbon dioxide and other waste.
  • The heart, enclosed in a fibrous sac with layers (epicardium, myocardium, endocardium), has four chambers (2 atria and 2 ventricles).
  • Blood flows through the heart and lungs in a specific pathway: venous return, right side of the heart, pulmonary circuit, left side of the heart, and systemic circulation.

Pathway of Blood Flow

  • Deoxygenated blood returns to the heart via venae cavae.
  • Blood enters the right atrium.
  • Blood is pumped into the right ventricle.
  • Pulmonary circuit: Blood is pumped to the lungs for gas exchange.
  • Oxygenated blood returns to the heart via pulmonary veins.
  • Blood enters the left atrium.
  • Blood is pumped into the left ventricle.
  • Systemic circulation: Blood is pumped to the rest of the body.

Heart Chambers

  • Atria are receiving chambers, thin walled.
  • Ventricles are discharging chambers, thick walled with papillary muscles and trabeculae carneae muscles.
  • The right ventricle pumps blood into the pulmonary trunk.
  • The left ventricle pumps blood into the aorta.

Coronary Circulation

  • Coronary circulation supplies blood to the heart muscle.
  • Collateral circulation ensures blood delivery even if major vessels are blocked.

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