Cardiovascular 2 Anti-lipids Flashcards
MoA for HMG-CoA reductase inhibitors
inhibits cholesterol synthesis
Indications for HMG-CoA reductase inhibitors
hyperlipidemia
SE/ADRs for HMG-CoA reductase inhibitors
diarrhea, arthralgia, nausea, myopathy, rhabdomyolysis
Contra-indications for HMG-CoA reductase inhibitors
liver disease (CYP450 metabolism)
Dx-Dx interactions for HMG-CoA reductase inhibitors
decrease [Dabigatron]
St John’s Wort decrease [Atorvostatin]
Monitoring for HMG-CoA reductase inhibitors
creatinine kinase (CK), AST/ALT baseline & later if sxs; lipid panel
PG category for HMG-CoA reductase inhibitors
avoid
Atorvastatin
HMG-CoA reductase inhibitors
CYP3A4 metabolism
10mg
Lovastatin
HMG-CoA reductase inhibitors
cautious use in decreased renal function
40mg
Pravastatin
not CYP450 metabolized; caution in renal, hepatic dysfunction
40mg
Rosuvastatin
second most potent for combo LDL/Trig reduction; caution renal/hepatic dysfunction
5mg
Simvastatin
no longer use 80mg dose, caution in renal dysfunction
20mg
Fluvastatin
daily or twice daily dosing
80mg
Drug class for Cholestyramine
bile-acid sequestrant
MoA for Cholestyramine
binds bile acids inhibiting enterohepatic circulation of cholesterol
Indications for Cholestyramine
hypercholesteremia
SE/ADRs for Cholestyramine
constipation, heartburn, nausea, bloating, long term may decrease folate absorption
Contra-indications for Cholestyramine
hypersensitivity, bowel or biliary obstruction
Dx-Dx interactions for Cholestyramine
not absorbed from bowel
Monitoring for Cholestyramine
lipid panel
PG category for Cholestyramine
PG B
What should we be cautious about with Cholestyramine & Colesevelam?
constipation
Drug class for Colesevelam
bile-acid sequestrant
MoA for Colesevelam
binds bile acids inhibiting enterohepatic circulation of cholesterol
Indications for Colesevelam
LDL reduction, DM2, usually adjunct
SE/ADRs for Colesevelam
constipation, heartburn, nausea, bloating, long term may decrease folate absorption
Contra-indications for Colesevelam
hypersensitivity, bowel or biliary obstruction
Dx-Dx interactions for Colesevelam
not absorbed from bowel
Monitoring for Colesevelam
lipid panel
PG category for Colesevelam
PG C
Drug class for Gemfibrazil & Fenofibrate
fabric acid
MoA for Gemfibrazil & Fenofibrate
unknown; possible changes in various enzymes involved in VLDL & IDL metabolism
Indications for Gemfibrazil & Fenofibrate
hypertriglyceridemia, low HDL
SE/ADRs for Gemfibrazil & Fenofibrate
fatigue, N/V, dyspepsia, diarrhea, flatulence, potentiates Warfarin
Contra-indications for Gemfibrazil & Fenofibrate
hypersensitivity, hepatic or severe renal disease, GB disease
Dx-Dx interactions for Gemfibrazil & Fenofibrate
caution with HMG-CoA reductase inhibitors, avoid w/ Clopidogrel, Repaglinide, Warfarin
Monitoring for Gemfibrazil & Fenofibrate
hepatic function, LDH, Alk phos, eGFR, lipid panel, glucose, CK
PG category for Gemfibrazil & Fenofibrate
PG C
Drug class for Niacin
nicotinic acid
MoA for Niacin
inhibits fatty acid release from adipose tissue & hepatic trig production
Indications for Niacin
hypertriglyceridemia, low HDL, high LDL
SE/ADRs for Niacin
flushing, itching, arrhythmias, decrease glucose tolerance, gout, blurred vision
Contra-indications for Niacin
alcoholism, hypersensitivity, peptic ulcer
Dx-Dx interactions for Niacin
may increase [HMG-CoA RI]
Monitoring for Niacin
uric acid, blood glucose, lipids
PG category for Niacin
PG C
Drug class for Exetimibe
cholesterol absorption inhibitor
MoA for Exetimibe
decrease absorption of cholesterol from GI tract
Indications for Exetimibe
hypercholesteremia
SE/ADRs for Exetimibe
minimal
Contra-indications for Exetimibe
active hepatic disease, hypersensitivity
Dx-Dx interactions for Exetimibe
fibrates
Monitoring for Exetimibe
liver function
PG category for Exetimibe
PG C
Drug class for Omega 3 Fatty Acids
other
MoA for Omega 3 Fatty Acids
unknown
Indications for Omega 3 Fatty Acids
high Trig despite diet, alcohol restriction, fibrates
SE/ADRs for Omega 3 Fatty Acids
diarrhea, belching, dyspepsia, change in taste, angina, flue type syndrome, excess bleeding
Contra-indications for Omega 3 Fatty Acids
fish allergy
Dx-Dx interactions for Omega 3 Fatty Acids
anticoagulants
Monitoring for Omega 3 Fatty Acids
lipids
PG category for Omega 3 Fatty Acids
PG C
Drug class for Evolocumab
PCSK9 inhibitor
MoA for Evolocumab
human monoclonal antibody that binds to proportion converts subtilisin kexin type 9 inhibiting the degradation of LDLR; this increases the # of LDLRs available to clear LDL from the blood, thereby lowering LDL-C levels
Indications for Evolocumab
drug resistance hyperlipidemia, esp homozygous familial hypercholesterolemia
SE/ADRs for Evolocumab
nasopharyngitis, HTN, gastroenteritis, URIs
Contra-indications for Evolocumab
hypersensitivity
Dx-Dx interactions for Evolocumab
unknown
Monitoring for Evolocumab
lipid profile
PG category for Evolocumab
unknown
How is Evolocumab administered?
new drug class; admin SQ