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Cardiology Pharmacology > Anti-Lipid Pharmacology > Flashcards

Anti-Lipid Pharmacology Flashcards

1
Q

What LDL levels would indicate high intensity treatment?

A

LDL >190, those with proven ASCVD,
diabetics with >7.5% risk,
those 40-75 with >7.5% risk

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2
Q

What LDL levels would indicate moderate intensity treatment?

A

70-189

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3
Q

If we needed to reduce the LDL levels by greater than 50%, what medications would allow us to do that?

A

Atorvastatin & Rousuvastatin (at their highest doses)

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4
Q

What is the drug class of atorvastatin?

A

HMG-CoA reductase inhibitor

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5
Q

What is the MOA of the drug class HMG-CoA reductase inhibitor?

A

Inhibits cholesterol synthesis

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6
Q

Are there any side effects associated with the HMG-CoA reductase inhibitor medications?

A

Yes, diarrhea, arthralgia, nausea, myopathy, and rhabdomyolysis

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7
Q

Of the side effects associated with the HMG-CoA reductase inhibitor medications, which ones are of the most concern?

A

Myopathy & Rhabdomyolysis

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8
Q

If a patient has myopathy, what do you do?

A

Hold the medication, get a CK if elevated – wait for it to return to normal, then start the patient on a lower dose

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9
Q

Are there any patients that we need to be cautious about using HMG-CoA reductase inhibitors?

A

Yes, those with liver or renal impairments

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10
Q

What are the other drugs that make up the class of HMG-CoA reductase inhibitors?

A

Atorvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, and fluvastatin

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11
Q

What medication do you have to be cautious if the patient has an eGFR less than 30?

A

Lovastatin

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12
Q

What is the best medication, of the statins, at reducing both the LDL & triglycerides?

A

Atorvastatin

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13
Q

What medication is 2nd best at reducing both LDL & triglycerides?

A

Rosuvastatin

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14
Q

What medication, of the statins, must be taken twice daily?

A

Fluvastatin

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15
Q

What medications are bile-acid sequestrants?

A

Cholestyramine & Colesevelam

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16
Q

How do bile-acid medications work?

A

Work by binding bile acids, inhibiting enterohepatic circulation of cholesterol

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17
Q

What is the main goal for bile-acid medications? Who are they for?

A

To decrease LDL.

For- hypercholesterolemia & diabetes

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18
Q

What is the major concern with bile-acids? Why?

A

They are usually not well tolerated

They cause side effects of constipation, nausea, bloating, and belching.

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19
Q

When would you usually use a bile-acid medication?

A

as an adjunct medication

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20
Q

How good are bile-acids at lower cholesterol? Do they lower triglycerides too?

A

Moderately effective ~15%

They don’t lower triglycerides (may increase)

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21
Q

What is the goal of the fibric acid medications?

A

Lower triglycerides AKA treating hypertriglyceridema

22
Q

How do fibric acids lower triglycerides?

A

Unknown, but theorized to decrease VLDL metabolism

23
Q

What are our two fibric acid medications?

A

Gemfibrazil & Fenofibrate

24
Q

What medication is most effective at lower triglycerides?

A

Fenofibrate – works in about 2 weeks as compared to 3-4 weeks.

25
Q

When can you not use fibric acid medications?

A

Hepatic or renal disease OR gallbladder disease

26
Q

What medications are contraindicated with fibric acids?

A

Clopidogrel & Warfarin

27
Q

What is the purpose of nicotinic acid medications? How do they work?

A

Hypertriglyceridemia

- Works by inhibiting fatty acid release from adipose tissue and decreasing VLDL production

28
Q

What medication is our nicotininc acid?

A

Niacin AKA Vitamin B3

29
Q

What is critical to first use of Niacin?

A

Must use aspirin 30mins prior in order to prevent flushing & itching

30
Q

What patients can you not use niacin in?

A

alcoholics and those with history of peptic ulcers

31
Q

What is important about dosing niacin?

A

To titrate dose slowly

32
Q

What medication is our cholesterol absorption inhibitor?

A

Exetimibe

33
Q

What is exetimibe used for?

A

Hypercholesterolemia

34
Q

How does exetimibe work?

A

By decreasing absorption of cholesterol from the GI tract

35
Q

What patients can you not use exetimibe in?

A

Those with hepatic disease

36
Q

When would you want to use ezetimibe?

A

add it to statin therapy for MODEST benefit

37
Q

When would you use an Omega 3 Fatty Acid medication?

A

High VLDL despite diet, alcohol restriction, and fibrates

38
Q

What medication do you not want to use with omega 3 fatty acids?

A

Anticoagulants

39
Q

What medication is our PCSK9 inhibitor?

A

Evolocumab

40
Q

When would you utilize evolocumab?

A

drug resistant hyperlipidemia (especially with familial)

41
Q

How is evolocumab given?

A

Administered subQ

42
Q

To review, what medications are good for reducing triglycerides?

A

Fibric acids, nicotinic acid, and omega 3 fatty acids

43
Q

What herbal supplement might reduce the effect of atorvastatin?

A

St.John’s Wort

44
Q

If your patient is an alcoholic with LDL >190, what medication can you use?

A

Pravastatin, because it is metabolized by CYP450

45
Q

What other medication could you use for a patient with liver damage and high LDL?

A

Niacin

46
Q

What is the biggest side effect of niacin?

A

Flushing

47
Q

What medications together could give you slightly increased cholesterol reduction?

A

Statin + Fibric acid

48
Q

If you combine a Statin + Fibric acid, what must you be aware of?

A

There is now an INCREASED risk of myopathy

49
Q

If someone develops myopathy while taking a statin + fibric acid what do you do?

A

Stop the fibric acid and lower the statin dose

50
Q

What are fibric acids contraindicated with? Why?

A

Biliary disease. Because it can increase the risk of obstruction

51
Q

If we prescribe a fibric acid, what must we tell our patients about?

A

Take one hour BEFORE or 4 hours AFTER other prescriptions

Cardiology Pharmacology (4 decks)

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