00 Dyslipidemia Flashcards
How do you calculate LDL?
LDL = CH - HDL - (TG/5). Can’t be done if TG > 400
What are the four major statin benefit groups?
1) Pts w/ clinical ASCVD. 2) Pts w/ LDL 190+. 3) Pts 40-70 w/ DM w/ LDL 70-189. 4) Pts 40-70 w/ LDL 70-189 and estimated 10-year ASCVD 7.5%+
When would you not use high-intensity statin therapy?
10-year ASCVD < 7.5% (even if diabetic)
How are statin intensities defined?
High-intensity is a daily dose that lowers LDL by > 50%. Moderate-intensity by 30-49%
What intensity therapy should someone with ASCVD receive?
All patients who are age < 75, as well as > 75 years, should receive high-intensity statin therapy
What should be done if TG > 200 after LDL goal is reached?
Set secondary goal for non-HDL cholesterol 30 mg/dL higher than LDL goal
What should be done if TG is 200-499 after LDL goal is reached?
Consider adding drug if needed to reach non-HDL goal: Intensify LDL-lowering drug, add nicotinic acid or fibrate to further lower VLDL
What should be done if TGs > 500?
First lower TGs to prevent pancreatitis: very low-fat diet, fibrate or nicotinic acid
What is the only class of medication that consistently shows reduction in overall mortality rates?
HMG-CoA Reductase Inhibitors
What is the “Rule of 6” for HMG-CoA Reductase Inhibitors?
Every doubling of dose gives additional 6% reduction in LDL from baseline
What are the only High Intensity statin options?
Atorvastatin 40-80mg. Rosuvastatin 20-40mg
What are some Low Intensity statin options?
Pravastatin 10-20mg. Lovastatin 20mg. Simvastatin 10mg. Fluvastatin 20-40mg. Pitavastatin 1mg
What is the generic name of Livalo?
Pitavastatin
What is the generic name of Crestor?
Rosuvastatin
What is the generic name of Lipitor?
Atorvastatin
What is the generic name of Zocor?
Simvastatin
What is the generic name of Pravachol?
Pravastatin
What is the generic name of Mevacor?
Lovastatin
What is the generic name of Altoprev?
Lovastatin
What is the generic name of Lexcol?
Fluvastatin
Which statin is not significantly metabolized by CYP450 and may be less likely to be involved in a DDI?
Rosuvastatin & Pravastatin. Atorvastatin is metabolized by CYP3A4, but less so than other 3A4 statins
What population should be dose adjusted with Rosuvastatin?
Start with lower doses in Asian population and > 65 years (reach higher plasma concentration)
What concurrent medication causes you not to exceed 10mg dose of Simvastatin?
Verapamil. Diltiazem
What concurrent medication causes you not to exceed 20mg dose of Simvastatin?
Amiodarone. Amlodipine. Ranolazine
What medications are contraindicated with Simvastatin use?
Azoles. Macrolides. HIV PIs. Gemfibrozil. Cyclosporine
What are the statin ADRs?
GI. HA. Myalgia. Rhabdomyolysis. Hepatotoxicity. Proteinuria (dose related w/ rosuvastatin). Increase in BG
What are the contraindications to statin use?
Active hepatic disease. Unexplained elevated LFTs. Pregnancy (Category X). Breastfeeding
Which statins are CYP 3A4 substrates?
“SAL”: Simvastatin, Atorvastatin, Lovastatin
Which statins MUST be dosed at bedtime?
“I LovA Sleeping with Fleece”: Lovastatin (Altoprev), Simvastatin, Fluvastatin
Which statin must be taken with meals?
I Lov Meal times”: Lovastatin (Mevacor)
What is the statin order for dose equivalencies?
PRASP=LF
What is the generic name of Vytorin?
Simvastatin + Ezetimibe
What is the generic name of Caduet?
Atorvastatin + Amlodipine
What is the generic name of Simcor?
Simvastatin + Niacin
What is the generic name of Zetia?
Ezetimibe (intestinal cholesterol absorption inhibitor)
What is the benefit of using Zetia (Ezetimibe)?
Lowers LDL
What is the generic name of Liptruzet?
New product: Ezetimibe + Atorvastatin
What are the benefits of using Bile Acid Sequestrants?
Lowers LDL. Increases HDL. Slightly increases TGs (~5%)
What do you need to be cautious about with Bile Acid Sequestrants?
Binds! Including other medications! DDIs! Give meds 2 hours before or 4 hours after to avoid the binding (Welchol - less, but still present)
What is the generic name of Welchol?
Colesevelam (Bile Acid Sequestrant)
What is the generic name of Colestid?
Colestipol (Bile Acid Sequestrant)
What are the ADRs associated with Bile Acid Sequestrants?
Constipation. Abdominal pain/cramping. Gas/bloating (less GI side effects with Welchol). Potential increase in TGs. Decreased absorption of other medications
What are the contraindications to Bile Acid Sequestrant use?
Complete biliary obstruction. Bowel obstruction. Cholelithiasis (gall stones). High TG (> 500). Hx of hypertriglyceridemia-induced pancreatitis
What are the benefits of Nicotinic Acid (Niacin)?
Increase HDL. Decrease LDL. Decrease TG
What is the generic name of Niaspan?
Extended release niacin
What is the hallmark ADR of Niacin and how can it be avoided?
Flushing/itching. Pretreat with ASA 325mg or Ibuprofen 200mg 30 min prior to dose
What are some other ADRs of Niacin?
Hepatotoxicity! HA, GI upset, Hyperuricemia/gout, Hyperglycemia
When is Niacin contraindicated?
Active liver disease. Active PUD. Arterial bleeding. Caution in gout
What are the benefits of Fibrates?
Increase HDL. Decrease LDL and TGs
What is the generic name of Lopid?
Gemfibrozil (Fibrate)
What is the generic name of Tricor?
Fenofibrate (Fibrate)
What is the generic name of Trilipix?
Fenofibric Acid (Fibrate - micronized capsule)
What are the ADRs with Fibrates?
GI upset. Cholelithiasis (gall stones). Myositis. Increased LFTs. Increased CPK. Myopathy (especially when given with statins). Abdominal pain
What are the contraindications to Fibrate use?
Severe liver disease. Severe renal disease. Gallbladder disease. Nursing mothers
What are the benefits of Omega 3 Fatty Acids?
Decrease TGs. Increase HDL & LDL
What is the generic name of Vascepa?
Icosapent (new agent). Indicated for high TG levels > 500
What is the generic name of Juxtapid?
Lomitapide (new agent). Indicated for homozygous familial hypercholesterolemia
What are the contraindications for Juxtapid use?
Pregnancy (Category X). Moderate to severe hepatic impairment. Active liver disease
Which statin can be given BID?
Fluvastatin
