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Pharm 2 Exam > ch 44 COPY > Flashcards

ch 44 COPY Flashcards

1
Q

approved for treating dyslipidemia in children and addolescents

A

lovastatin
simvastatin
pravastatin
atorvastatin

avoid in children younger than 10

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2
Q

approved for treating dyslipidemia in pregnant

A

no

Ezetimibe and fibrates can be used but benefit outweigh risk

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3
Q

approved for treating dyslipidemia in breastfeeding

A

not studied in this group

same as pregnancy

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4
Q

approved for treating dyslipidemia in older adults

A

in pt 65 and old, statins significantly reduced risk for stroke . take cost into consideration

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5
Q

what tool is used to categorize risk for ASCVD

A

Framingham risk prediction score

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6
Q

what factors is considered in the Framingham risk prediction score

A 
age
total cholesterol
HDL
smoking status
systolic BP
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7
Q

The ACC/AHA cholesterol guidelines defines high ASCVD risk as

A

20% or more

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8
Q

The ACC/AHA cholesterol guidelines defines very high risk are pt with

A

existing clinical ASCVD

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9
Q

low intensity statin therapy options

A

daily dose lowers LDL-C on average <30%

Pravastatin: 10-20mg
Lovastatin: 20mg
Simvastatin: 10mg

(PLS let this work)

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10
Q

Moderate intensity therapy

A

daily dose lowers LDL-C on average <30% to <50%

Atorvastatin: 10mg
Rosuvastatin: 10mg
Simvastatin: 20-40mg
Pravastatin: 40mg
Lovastatin: 40mg

(PlS RA)

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11
Q

High intensity therapy

A

daily dose lowers LDL-C on average > equal to 50%

Atorvastatin 40-80mg
Rosuvastatin: 20mg

(RA)

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12
Q

Therapeutic lifestyle therapy for hyperlipidemia

A

diet
exercise
weight control
smoking cessation

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13
Q

how long is statin treatment

A

lifelong

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14
Q

what drug class is most effective agent for hyperlipidemia

A

HMG-CoA reductase inhibitors (statins)

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15
Q

how do you treat high TG

A

diet mods
statins

if still remain high fibrates may be needed

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16
Q

when fibrates are combined with statins, the adverse effects of cholesterol lowering agents may

A

be intensified

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17
Q

most effective drugs for lowering LDL and total cholesterol They can raise HDL and lower TGs in some pts

A

HMG coA reductase inhibitors (Statins)

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18
Q

How long does it take to statins to work

A

significant within 2 weeks
max within 4-6 weeks
serum cholesterol levels will return if you stop taking med. This is lifelong.

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19
Q

Low levels of HDL

A

below 40 mg/dL

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20
Q

goal is to raise levels of HDL to

A

50 mg/dL or more

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21
Q

Do we prescribe statins to lower TGs

A

No, but it is a good side effect that has been documented

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22
Q

Statins also help with

A

reducing the risk for CV events such as

risk for a-fib
risk for thrombosis
stabilizes plaque
reducing inflammation
suppresses production of thrombin (key factor in clot formation
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23
Q

what statin is approved for reducing the risk for CV events in people with normal levels of LDL and no clinically evident ASCVD but do have an increased risk based on advancing age, high levels of CRP and at least one other risk factor for CV disease such as HTN , Low HDL or LDL

A

rosuvastatin (crestor)

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24
Q

For many pt the goal is to drop LDL cholesterol to below

A

100mg/dL

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25
For pt with very high CV risk, a target LDL of ____ may be appropriate
70 mg/dL
26
Post MI and statins
Automatically start on Statin - better late than never
27
what antihypertensive may raise LDLs
B blockers
28
Diabetics and cholesterol
controlling HTN and high cholesterol is as important as controlling glucose. CV disease is the primary cause of death in people with DM American Diabetes Association recommends a statin for all patients 40 and older whose LDL cholesterol is greater than 100 mg/dL American college of physicians recommend a statin for 1) all pt with type 2 dm plus diagnosed ASCVD even if they don't have high cholesterol 2) all adults with Type 2DM plus one additional risk factor such as HTN, smoking, older than 55) even if they do not have high cholesterol
29
which statins undergo clinically significant excretion in urine
``` lovastatin pitavastatin pravastatin simvastatin fluvastatin ```
30
Statins metabolized by CYP3A4
atorvastatin lovastatin simvastatin levels of these drugs can be lowered by agents that induce CYP synthesis and speed up metabolism or statin levels can be increased by agents that inhibit CYP3A4
31
what statin reaches abnormally high levels in people of Asian heritage
Rosuvastatin if you have to use this - start with lowest available dosage and monitor diligently
32
side effects of Statins
headache rash GI disturbances - dyspepsia, cramps, flatulence, constipation, abd pain usually transient and mild
33
Serious adverse effects of statins
Hepatotoxicity, myopathy, rhabdomyolysis
34
symptoms of rhabdomyolysis
muscle aches tenderness weakness
35
what lab will show elevation in rhabdomyolysis
``` Creatine Kinase (CK) - released by injured muscle will be greater than 10 times the upper limit ``` elevation of free myoglobin
36
Muscle releases what when injured
CK and Potassium
37
high levels of CK can cause
renal impairment because excess CK can plug up the glomeruli thereby preventing normal filtration
38
while taking statins, if muscle pain develops what other labs should be checked
thyroid function
39
while taking statins, pt develops myopathy ck levels are greater than 10xs the normal limit what should you do
d/c statin if less than 10xs statin can be continued by with symptoms, ck levels are followed weekly however this is costly and inconvenient. Consider stopping and reevaluate therapy routine monitoring of CK in asymptomatic pt is unnecessary
40
what statin poses the highest risk for rhabdomyolysis
Rosuvastatin (Crestor)
41
Additional strategies for mgmt of myalgia with statins
Vit D and Coenzyme Q can help reduce myalgias in pt with low levels. Try another statin
42
adverse effect of statins with liver
LFT test recommended prior to starting treatment for baseline then repeat if clinically indicated after starting if transaminase levels rise to 3 times the Upper limit normal and remain there - d/c statins. levels should decline to pretreatment levels after drug withdrawal
43
What liver problem is a contraindication for taking a statin
viral or alcoholic hepatitis
44
can you use statins in pt with nonalcoholic fatty liver disease?d
yes - statins reduce cholesterol levels and may also decrease liver inflammation, improve LFTs and reduce steatosis (fatty infiltration in liver)
45
what endocrine problem does statins increase risk for developing
diabetes | however these pts were pre-diabetic
46
combining statins with other lipid lowering drugs
can increase risk of muscle injury, liver injury, kidney injury primarily for fibrates (gemfibrozil, fenofibrate)
47
inhibitors of CYP for lovastatin, simvastatin, atorvastatin include what meds risk for tox
``` macrolide abx (erythromycin) azole antifungal drugs (ketoconazole, itraconazole) HIV protease inhibitors (ritonavir) Amiodarone (antidysrhythmics) cyclosporine (immunosuppressant) ``` reduce dosage of stain if these drugs are used
48
What food should you avoid due to CYP inhibition for statins (lovastatin, simvastatin, atorvastatin)
Grapefruit juice
49
can you use statins in pregnancy
no
50
if a 30% - 40% reduction in LDL is sufficient what statin
any will do
51
if LDL needs to be lowered more than 40%
atorvastatin | simvastatin
52
for pat with significant renal impairment that needs a statin
atorvastatin fluvastatin are preferred (no renal dosing needed)
53
what category of med is used as adjunct to statins
bile acid sequesterants - Colesevelam (Welchol) - cholestyramine - colestipol
54
Benefits of using Colesevalam (Welchol)
1) better tolerated (less GI effects) 2) does not reduce absorption of fat soluble vitamins (A, D, E, K) 3) does not sig reduce absorption of statins, digoxin, warfarin 4) helps control hyperglycemia in pt with Type 2DM
55
Colesevelam vs statins
Colesevelam (Welchol) does not work as well but safer bc they do not have systemic effects main complaint is constipation. minimized by increasing dietary fiber and fluids also bloating, indigestion, nausea
56
cholestyramine and colestipol and absorption
decrease fat absorption so may decrease uptake of fat soluble vitamins
57
what meds have the risk of forming complexes with Colesevalam so need to space either 1 hr before or 4 hours after
Thiazide digoxin warfarin some ABX
58
how does Ezetimibe (Zetia) work
reduces plasma cholesterol by blocking cholesterol absorption can be used as monotherapy or as adjunct with statin
59
what cholesterol does Ezetimibe (Zetia) work on
``` reduce plasma levels of total cholesterol LDL TGs apolioprotein B small increase in HDL ```
60
adverse effects of Ezetimibe (Zetia)
``` myopathy rhabdomyolysis hepatitis pancreatitis thrombocytopenia ``` NO GI SIDE EFFECTS
61
in pt taking a statin, adding Ezetimibe (Zetia) slightly increases r/o
``` liver damage (watch for elevated transaminase levels) get baseline LFTs and repeat when clinically indicated ``` myopathy
62
Ezetimibe (Zetia) and fibrates (gemfibrozil and fenofibrate) can increase r/o
can increase the cholesterol content of bile which increases r/o gallstones myopathy
63
______ and possibly _____ can significanty decrease the absorption of Ezetimibe (Zetia)
Cholestyramine and colestipol administer Ezetimibe (Zetia) at least 2 hours prior or more than 4 hours after
64
_________ may greatly increase levels of Ezetimibe (Zetia)
Cyclosporine | careful monitoring is needed
65
Pt with moderate to severe renal impairment and Ezetimibe (Zetia)
do not use, not enough data
66
most effective drugs for lowering TG levels can raise HDL little or no effect on HDL
Fibric Acid derivatives (fibrates)
67
Fibrates can increase r/o bleeding in pt taking ____
Warfarin
68
Fibrates can increase r/o _______ in pt taking statins
rhabdomyolysis
69
Fibrates are considered _____-line for managing lipid disorders
third
70
gemfibrozil (lopid) fenofibrate (Tricor) fenofibric acid (TriLipix, Fibricor)
what fibrates are approved
71
most common adverse effects of Gemifibrozil
rash | GI disturbances such as nausea, abd pain, diarrhea
72
Gembribrozil increases r/o
gallstones
73
symptoms of gallbladder disease
upper abd discomfort intolerance of fried foods bloating
74
who should not take Gemribrozil
pt with pre-existing gallbladder disease
75
serious adverse effects Gemfibrozil
myopathy - warn pt of muscle injury such as tenderness, weakness or unusual muscle pain liver injury - hepatotoxic risk for liver cancer periodic LFTs recommended
76
drug interactions for gemfibrozil
displaces warfarin from plasma albumin increases anticoagulant effects monitor Prothrombin time should be measured frequently to asses coagulation status. warfarin dosage may need to be reduced combined with statin - increases r/o myopathy
77
Monoclonal antibodies (Proprotein convertase subtilisin/kexin type 9 (kPCSK9) inhibitors
used as adjunct to diet mod and max tolerated statin therapy for reducing total LDL
78
Alirocumab (Praluent) | Evolocumab (Repatha)
Monoclonal antibodies (Proprotein convertase subtilisin/kexin type 9 (kPCSK9) inhibitors
79
Monoclonal antibodies (Proprotein convertase subtilisin/kexin type 9 (kPCSK9) inhibitors are administered
subcutaneously
80
hypersensitivity reactions for Monoclonal antibodies (Proprotein convertase subtilisin/kexin type 9 (kPCSK9) inhibitors
vasculitis rash urticarial requiring hospitalization
81
what will raise HDL
Fibrates
82
What lipid lowering agent has increased risk for rhabdomylosis
Rovustatin

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