Cardio-Dyslipidemia Flashcards
LDL preferred value
< 100 mg/dl
HDL preferred value
> 40 mg/dl in men
> 50 mg/dl in women
TG preferred value
< 150 mg/dl
>300 - 500 mg/dl really bad
LDL calculation
TC - HDL - TG/5
Natural products to treat dyslipidemia
fish oil
garlic
fibrous foods
niacin
Drugs that increase LDL/TG levels
- Protease Inhibitors
- Atypical antipsychotics
- STEROIDS
- DIURETICS
- cyclosporine/ tacrolimus
Drugs that increase TG levels only
- IV lipid emulsions
- propofol (propofol holidays)
- ETOH
- Beta-blockers
Drugs that increase LDL levels only
- Fibric acids
- SGLT2 inhibitors (DM)
- TZDs (DM)
What is considered Clinical ASCVD events (CA-STAMP)
- Coronary/arterial re-vascularization
- Angina
- Stroke
- TIA
- ACS
- MI
- PAD
Name the STATINS in order from most potent to least potent.
Pharmacist Rock At Saving Lives/ Preventing Flu P- pitavastatin 2 mg R- rouvastatin 5 mg A- atorvastatin 10 mg S- simvastatin 20 mg L- lovastatin 40 mg P- pravastatin 40 mg F- fluvastatin 80 mg
Name the appropriate STATIN therapy:
Clinical ASCVD less than or equal to age 75
HIGH intensity
Name the appropriate STATIN therapy:
Clinical ASCVD greater than age 75
MODERATE intensity
Name the appropriate STATIN therapy:
LDL > or equal to 190 mg/dl
HIGH intensity
Name the appropriate STATIN therapy:
DM + elevated LDL (<190 mg/dl) + < 75 years of age
10-yr ASCVD > or equal to 7.5%
HIGH intensity
Name the appropriate STATIN therapy:
DM + elevated LDL (<190 mg/dl) + < 75 years of age
10-yr ASCVD < 7.5%
MODERATE intensity
Name the appropriate STATIN therapy:
Elevated LDL (<190 mg/dl) + < 75 years of age
10-yr ASCVD > or equal to 7.5%
MODERATE- HIGH intensity
Name the appropriate STATIN therapy:
Elevated LDL (<190 mg/dl) + < 75 years of age
10-yr ASCVD < 7.5%
consider risk/benefit
STATIN MOA/ Toxicities
HMG CoA Reductase Inhibitor- inhibits rate-limiting step in cholesterol production by breaking down the enzyme that yields cholesterol conversion
H- hepatoxicity
M- myalgias/myopathy/ muscle break down (elevated CPK)
G- glucose
What statins must taken in the evening?
Simvastatin
Lovastatin
Fluvastatin
What statins have limited dosing when taking with CYP 3A4 inhibitors?
Simvastatin
Lovastatin
What is the max dose of SIMVASTATIN when taken with CCB and amiodarone?
Max 10 mg/day: verapamil and diltiazem (Non-DHP)
Max 20 mg/day: amiodarone and amlodipine
Can atorvastatin be taken with cyclosporine?
NO- AVOID this combination
Azoles, Macrolides, Protease Inhibitors and Cyclosporins should be avoided with what 2 statins?
Simvastatin and Lovastatin
Name the drug class:
Works by blocking cholesterol absorption in the small intestines.
Zetia (ezetimibe)
Vytorin: simavastatin + zetia
Name the drug class:
Works by binding bile acid and excreting it in the feces
BAS- bile acid sequestrants
Welchol (colesevalam)
Name the drug class:
Works by activating PPAR-alpha
Fibrates
- gemfibrozil
- fenofibrate
What CAN NOT be taken with fenofibrate due to increased risk of myopathy?
statins and zetia
What drug TX can increase TGs?
BAS
What drug TX can increase LDLs?
Fibrates~ if TGs levels are high. Fish Oils -Lovaza- omega-3-acid -Vescepa- lcosapent ethyl esters -Epanova- omega-3-COOH
What drug TX can increase bleeding risk?
Fish oils
What drug TX can cause flushing and hepatoxicity? What can you take to relieve the flushing?
Niacin IR (Niacor) Niacin ER (Niaspan) Niacin SR (Slo-Niacin)
-ASA or NSAID 30 minutes before
How long should medications be separated when taking BSAs?
- 1 to 4 hours before or 4 to 6 hours after
Can fibrates be taken with food?
Yes, 30 minutes before breakfast and dinner
Lopid (gemfibrozil)
ALSO…
Fenoglide, Lipofen (Tricor)
Other brand names: Antara, Tricor, Trilipix
What statin must be taken with food?
lovastatin IR
PCSK9 inhibitors (2)
ALIrocuMAB (Praluent)- sc q2wks
EVOlocuMAB (Repatha)- sc q2wks or qmonth
Which PCSK9 inhibitor is indicated for familial, primary dyslipidemia and decreased CV events?
EVOlocuMAB (Rapatha)
What are the most common SE associated with fish oils?
Dsypepsia, Erutation (burping), taste perversions Epanova only (flatulence- gas)
Which formulation of Niacin has the highest risk of hepatoxicity?
Niacin (immediate release niacin)
Vitamin B3 is also known as
Niacin
General Niacin SEs
flushing, increase in UA, increase in BG
Which STATIN can be considered in patient’s with renal impairment or CrCl <30 ml/min?
Lipitor (atorvastatin)
When can BSA’s NOT be used?
Welchol (colesevelam)
Questran (Cholestyramine)
-TG > 500 mg/dl
- bowel obstruction
Welchol- safe in pregnancy
When can fibrates NOT be used?
- gallbladder disease
- renal impairment CrCl < 30 ml/min
- severe liver disease
What do Niacins, Statins and Fibrates all have in common?
LFTs must be monitored due to risk of hepatoxicity
