Cardiopulmonary: Hyperlipidemia Flashcards
What does ASCVD risk calculator take into account? (9)
gender race age hdl total cholesterol dm treatment for bp systolic bp smoking status
Depending on risk factors or PMH, treatment will be either
life style mod, moderate intensity statins, or high intensity statins
The foundation of ASCVD prevention
heart healthy lifestyle habits
For adults who are candidates for statins and have ASCVD, who should be getting a high intensity vs a moderate intensity statin?
high intensity - those younger then 75
moderate intensity - those older than 75 OR those who are not candidates for high intensity statin
For adults who have LDL greater than or equal to 190 but do not have an ASCVD, what intensity statin?
high
For adults age 40-75 who are diabetic but without ASCVD and have LDL < 190, what treatment?
moderate intensity statin
For adults age 40-75 who are diabetic but without ASCVD, have LDL < 190, but have 10-y ASCVD risk at or above 7.5%, what treatment?
high intensity statin
HMG-CoA Reductase Inhibitors
Statins
The MoA of statins
Statins inhibit HMG-CoA reductase which is the enzyme involved in cholesterol formation.
high intensity statins do what
daily dose lowers LDL cholesterol by approximately greater than or equal to 50%
moderate intensity statin
daily dose lowers LDL cholesterol by approximately 30-<50%
4 pharmacological treatments for hyperlipidemia
HMG CoA Reductase Inhibitors (statins)
fibrates
bile acid sequestrants
nicotinic acid (niacin)
Suffix for statins
-statin
low intensity statins lower LDL by
< 30%
moderate intensity statins lower LDL by
30-50%
high intensity statins lower LDL by
greater than or equal to 50%
high intensity statin examples
atorvastatin
rosuvastatin
low intensity statin examples
pravastatin
lovastatin
why should you be aggressive with statins?
we know statins have a good effect on cardiac health and in the setting of DM. if someone has a risk of MI, start out with atorvastatin 80mg for a short time.
which statins are water soluble, and thus less myopathic?
pravastatin
rosuvastatin
what organ abnormalities can arrive from statins?
liver
if patient on statin starts to have AEs/the doses are getting too high, what should you do?
switch to a water soluble statin like rosuvastatin because the risk for myalgias will go down
Myalgias and myopathies from statins may lead to
rhabdomyolysis or renal failure
Myalgias and myopathies from statins are depending on
dose
characteristic of myalgia/myopathy from a statin
pain is not brought on by activity
Patient on statins comes to you and reports muscle pain/tenderness/weakness
Assess and ask about malaise/fever
why are there a lot of drug/food interactions with statin?
because it is metabolized via CYP 3A4
what food to avoid on statins?
grapefruit juice
which 2 statins have the most interactions?
simvastatin
atorvastatin
Statin is a prodrug or APC?
APC
people who take fibrates typically have what?
familial hypertriglyceridemia
Fibrate drugs, 2 examples
gemfibrozil
fenofibrate
Most concerning side effect of fibrates
myopathy
increased risk with concurrent use of statins
what labs should you get for someone on fibrates?
LFTs
INRs if they’re on warfarin
risk of using fibrate and statin together
myopathies, fatal at high doses
What drugs should be avoided when taking fibrates?
statins
warfarin
fibrates and warfarin
increases warfarin conc by 30%
Bile acid sequestrants AKA
resins
Examples of bile acid sequestrants (3)
cholestyramine
colestipol
colesevelam
any time you see a med that alters absorption (like a resin) you should consider
what else they’re taking because these alter the environment of the GI tract
What discourages use of bile acid sequestrants?
side effect profile
Nicotinic acid aka
niacin
Availability of nicotinic acid
OTC or Rx
side effects of nicotinic acid
flushing
tingling
itching
toxicity: nicotinic acid
When does it happen
hepatotoxicity possible when changing from ER to IR
HDL ideally
> 60
total cholesterol ideally
< 200
what meds have to be dose reduced with simvastatin?
amiodarone
diltiazem
rosuvastatin and atorvastatin are used for both
high and moderate intensity
pravastatin and can be used as
moderate and low intensity
rhabdomyolysis is a rare ADR of statins, T or F
T
fat soluble statins are more or less likely too cause rhabdomyolysis/myopathy?
more likely
if a person on a statin complains of muscle pain brought on nothing, what to do?
LFTs, CK, fluids, take a break from med
when should LFTs/bili be done in the patient with statins?
when started, with dose change, and then yearly. unless muscle pain occurs.
which population should be started on statins at a lower dose?
asian. higher risk for myopathies/myalgias.
pt education for bile acid resins
need to be taken separately from other medications because they affect how other meds are absorbed
