Cardiopulmonary: Hyperlipidemia Flashcards by jennifer cortese

What does ASCVD risk calculator take into account? (9)

gender
race
age
hdl
total cholesterol
dm
treatment for bp
systolic bp
smoking status

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Depending on risk factors or PMH, treatment will be either

life style mod, moderate intensity statins, or high intensity statins

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The foundation of ASCVD prevention

heart healthy lifestyle habits

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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

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For adults who have LDL greater than or equal to 190 but do not have an ASCVD, what intensity statin?

high

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For adults age 40-75 who are diabetic but without ASCVD and have LDL < 190, what treatment?

moderate intensity statin

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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

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HMG-CoA Reductase Inhibitors

Statins

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The MoA of statins

Statins inhibit HMG-CoA reductase which is the enzyme involved in cholesterol formation.

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high intensity statins do what

daily dose lowers LDL cholesterol by approximately greater than or equal to 50%

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moderate intensity statin

daily dose lowers LDL cholesterol by approximately 30-<50%

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4 pharmacological treatments for hyperlipidemia

HMG CoA Reductase Inhibitors (statins)
fibrates
bile acid sequestrants
nicotinic acid (niacin)

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Suffix for statins

-statin

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low intensity statins lower LDL by

< 30%

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moderate intensity statins lower LDL by

30-50%

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high intensity statins lower LDL by

greater than or equal to 50%

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high intensity statin examples

atorvastatin

rosuvastatin

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low intensity statin examples

pravastatin

lovastatin

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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.

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which statins are water soluble, and thus less myopathic?

pravastatin

rosuvastatin

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what organ abnormalities can arrive from statins?

liver

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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

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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

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