18.12.2013 Flashcards
When should statins be stopped with regards to liver enzyme elevation
If enzyme elevation is 3 times the baseline
simvastatin increases the levels of
warfarin
digoxin
rosuvastatin increases the levels of
warfarin
greatest risk of myopathy is when statins are co administered with which fibrate
gemfibrosil
Risk of myopathy is increased when statins are given along with which drugs
fibrates ketoconazole itraconazole erythromycin clarithromycin protease inhibitors cyclosporine nefzadone
bile acid binding resins should not be used as a monotherapy in patients with triglycerides more than
250mg/dl
bile acid sequestrants reduce the absorption of
warfarin digoxin thyroid hormone thiazides statins glypizide amiodarone
bile acid sequestrant with least drug interaction
colesevalam
lipid lowering effect of statins begins by
1 week
stabilises by 4 weeks
Amount of LDL reduction by bile acid sequestrants
15-30%
Amount of LDL reduction by niacin
> 15%
Effect of niacin on lipid profile
LDL reduction of more than 15%
TG reduction of 20-50%
Increases HDL by 35%
Side effects of niacin
flushing headache pruritis elevation of liver enzymes bloating hyperuricemia hyperglycemia
Niacin should be avoided in pts with
Uncontrolled hyperglycemia
peptic ulcer
gout
liver disease
amount of LDL reduction produced by ezetimibe
18% when used as monotherapy
additional 25% when used with statins
Effect of triglycerides on lipid profile
reduce TGs by 30-50%
Increase HDL by 10-35%
effect on LDL depends on TG levels
omega 3 fatty acids
eicosapentanoic acid
docosahexaenoic acid
CHD risk equivalents
DM Non coronary atherosclerosis CVD AAA PVD CHD risk more than 20%
effect of statins on Lp(a)
NIL
Least potent statins
fluvastatin
lovastatin
statin that decreases fibrinogen level
pravastatin
food increases the absorption of all statins except
pravastatin
statin with least chance of drug interaction
pravastatin
statin with least risk of myopathy
pravastatin
transporter inhibited by ezetimibe
NPC1L1
Major adverse effects of bile acid binding resins
constipation
effect of bile acids on triglycerides
inhibit synthesis of TGs
ASO against apoB100 mRNA used in familial hypercholesterolemia
Mipomersen
CETP inhibitors
torcitrapib
anacetrapib
ACAT-1 inhibitor
avasimibe
Microsomal triglyceride transfer protein inhibitor
lomitapide
target INR in valve replacement
bioprosthetic: aortic-2 mitral-2.5 mechanical: aortic-2.5 mitral-3
