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NAPLEX > Chapter 27: Dyslipidemia > Flashcards

Chapter 27: Dyslipidemia Flashcards

1
Q

Atherosclerosis is the formation of ____ from a buildup of fats, cholesterol, and other substances on the inner walls of arteries

A

plaque

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2
Q

Atherosclerosis leads to ____, which includes MI, stroke/TIA, angina, and peripheral arterial disease

A

ASCVD

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3
Q

Total cholesterol (TC) includes which 3 major lipoproteins

A

LDL, HDL and VLDL

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4
Q

High HDL (increases/lowers) ASCVD risk

A

lowers

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5
Q

______ is associated with high ASCVD risk

A

hypertriglyceridemia

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6
Q

TGs > ___ mg/dL can cause acute pancreatitis

A

500

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7
Q

____ hypercholesterolemias are genetic defects that cause severe cholesterol elevations

A

Primary (familial)

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8
Q

Severe elevations, including LDL >/= ___ and TG > ___ mg/dL, are very high risk and must be treated

A

190

500

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9
Q

Key Drugs that ↑ LDL & TG

A 
o	Diuretics
o	Efavirenz
o	Steroids
o	Immunosuppressants
o	Atypical antipsychotics 
o	Protease inhibitors
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10
Q

Key Drugs that ↑ TG only

A

o IV lipid emulsions
o Propofol
o Bile acid sequestrants (~5%)

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11
Q

Conditions that can increase cholesterol

A 
Obesity
poor diet
hypothyroidism
alcoholism
smoking
diabetes
renal/liver disease
nephrotic syndrome
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12
Q

How to calculate LDL using the Friedewald equation

A

LDL = TC – HDL – (TG/5)

***this formula is not used when TGs are >/= 400 mg/dL

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13
Q

Desirable non-HDL level

A

< 130

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14
Q

Desirable LDL level

A

< 100

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15
Q

Very high LDL level

A

> / = 190

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16
Q

Desirable HDL in men

A

> / = 40

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17
Q

Desirable HDL in women

A

> / = 50

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18
Q

Desirable TG level

A

< 150

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19
Q

If not fasting before blood work, the TG level can be falsely ____

A

elevated

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20
Q

Which guideline provides recommendations for cholesterol management

A

American College of Cardiology and the American Heart Association (ACC/AHA)

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21
Q

ASCVD calculation provides an estimate of an individual’s risk of having first CV event during the next ____

A

10 years

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22
Q

The online ASCVD risk calculator inputs what info

A
  • Gender, age (20-79 yrs), race
  • TC & HDL
  • SBP and whether antihypertensive treatment is used
  • Presence of diabetes and smoking status
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23
Q

How often should ASCVD risk assessment be repeated for low-risk patients

A

Every 4-6 years

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24
Q

ASCVD score is not needed in patients who have which conditions, since these groups should be started on a statin

A

Clinical ASCVD, diabetes, or LDL >/= 190 mg/dL

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25
Q

What score can be helpful in deciding if statins should be initiated in those with 10-year ASCVD risk of 7.5-19.9%

A

Coronary artery calcium score (CAC)

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26
Q

Non-drug treatment for cholesterol management

A
  • Maintain BMI 18.5-24.9 kg/m2
  • Diet rich in vegetables, fruits, whole grains, and high-fiber
  • Fish with high fat content
  • Limit intake of saturated fat, trans fat, and cholesterol
  • Aerobic physical activity 3-4 times per week
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27
Q

Natural products for cholesterol

A
  • Red yeast rice contains naturally occurring HMG-CoA reductase inhibitors in low amounts
  • OTC fish oils can be used to lower TG
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28
Q

Drugs of choice for treating high non-HDL and LDL

A

Statins

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29
Q

Which cholesterol-lowering drugs can cause liver damage

A

Niacin, fibrates, potentially statins and ezetimibe

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30
Q

Drugs can that cause liver damage should not be used if the AST or ALT are > __ times ULN

A

3

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31
Q

MOA of statins

A

inhibit synthesis of HMG-CoA reductase, which prevents the conversion of HMG-CoA to mevalonate

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32
Q

What is the rate-limiting step in cholesterol synthesis

A

Conversion of HMG-CoA reductase to mevalonate

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33
Q

Statin-benefit group for secondary prevention of patients with coronary heart disease, stroke, TIA, or PAD

A

High-intensity statin

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34
Q

Statin-benefit group for primary prevention of a patient with LDL >/= 190 mg/dL

A

High-intensity statin

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35
Q

Statin-benefit group for primary prevention of a patient with diabetes and age 40-75 years with LDL between 70-189 mg/dL and has multiple ASCVD risk factors

A

High-intensity statin

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36
Q

Statin-benefit group for primary prevention of a patient with diabetes and age 40-75 years with LDL between 70-189 mg/dL regardless of 10-year ASCVD risk

A

Moderate-intensity statin

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37
Q

Statin-benefit group for primary prevention of a patient age 40-75 years with LDL between 70-189 mg/dL & 10-year ASCVD risk >/= 20%

A

High-intensity statin

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38
Q

Statin-benefit group for primary prevention of a patient age 40-75 years with LDL between 70-189 mg/dL & 10-year ASCVD risk 7.5-19.9% + risk-enhancing factors

A

Moderate-intensity statin

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39
Q

Which two statins are high-intensity

A

Atorvastatin (40-80 mg) and Rosuvastatin

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40
Q

What are the statin equivalent doses

A 
*remember: Pharmacists Rock At Saving Lives & Preventing Fatty-deposits*
o	Pitavastatin 2 mg
o	Rosuvastatin 5 mg
o	Atorvastatin 10 mg
o	Simvastatin 20 mg
o	Lovastatin 40 mg
o	Pravastatin 40 mg
o	Fluvastatin 80 mg
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41
Q

Most important ADE of statins

A

Muscle damage

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42
Q

Symptoms of muscle damage usually occur within ___ weeks of starting treatment

A

6 weeks

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43
Q

How does muscle damage from statins present

A

o Myalgias
o Myopathy
o Myositis
o Rhabdomyolysis

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44
Q

muscle soreness & tenderness

A

Myalgias

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45
Q

muscle weakness + CPK levels

A

Myopathy

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46
Q

muscle inflammation

A

Myositis

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47
Q

muscle sx with very high CPK (> 10,000) + muscle protein in the urine (myoglobinuria), which can lead to acute renal failure

A

Rhabdomyolysis

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48
Q

How can you reduce risk of myalgias

A
  • do not use simvastatin 80 mg/day

- Do not use gemfibrozil + statin

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49
Q

How to manage myalgias

A
  • hold statin, check CPK. Investigate other possible causes
  • After 2-4 weeks, re-challenge with same stain at same or ↓dose.
  • If myalgias return, d/c statin. Once muscle symptoms resolve, use a low dose of a different statin & gradually ↑ dose
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50
Q

Atorvastatin brand name

51
Q

Lovastatin brand name

52
Q

What time of day is Fluvastatin taken

53
Q

How is Lovastatin IR taken

A

with evening meal

remember - i lov to eat in the evening

54
Q

Pravastatin brand name

55
Q

Rosuvastatin brand name

56
Q

Simvastatin brand name

57
Q

What time of day is simvastatin taken

58
Q

Statin CIs

A
  • Do not use in pregnancy, breastfeeding

- Do not use with liver disease

59
Q

Do not use strong CYP3A4 inhibitors with which 2 statins

A

simvastatin and lovastatin

60
Q

Statin warnings

A
  • muscle damage: increased CPK; higher risk with higher dose, advanced age, niacin and 3A4 inhibitors
  • Diabetes: increased A1C/FBG
61
Q

How often should a lipid panel be monitored when patient is on a statin

A

4-12 weeks after starting treatment and then annually

62
Q

Which statins can be taken at any time of day

A 
Crestor (rosuvastatin)
Lipitor (atorvastatin)
Livalo (Pitavastatin)
Lescol XL (Fluvastatin XL)
Pravachol (pravastatin)
63
Q

What are the lipid effects of statins

A

Decreases LDL, increases HDL, decreases TG

64
Q

Which two statins have less drug interactions compared to the others

A

Rosuvastatin and pravastatin

65
Q

Which meds/drug classes should not be used with simvastatin and lovastatin

A 
Grapefruit
Protease inhibitors
Azole antifungals
Cyclosporine, cobicistat 
Macrolides (except azithromycin)
66
Q

Max daily dose of simvastatin with Amiodarone

67
Q

Max daily dose of lovastatin with Amiodarone

68
Q

Max daily dose of simvastatin with non-DHP CCBs

69
Q

Max daily dose of lovastatin with non-DHP CCBs

70
Q

Add on therapy for Very high risk [Multiple ASCVD events or one ASCVD event in a high-risk patient (i.e. diabetes)], statin at max dose & LDL remains > 70 mg/dL

A

Ezetimibe (preferred) or PCSK9 Inhibitor

71
Q

Add on therapy for Primary hypercholesterolemia (LDL > 190 mg/dL), statin at max dose & LDL remains > 100 mg/dL

A

Ezetimibe (preferred) or PCSK9 Inhibitor

72
Q

Ezetimibe MOA

A

inhibits absorption of cholesterol in the small intestine

73
Q

Ezetimibe brand name

74
Q

Ezetimibe SE

75
Q

Ezetimibe lipid effects

A

decreases LDL

76
Q

What formulation do PCSK-9 inhibitors come in

A

SC injection

77
Q

PCSK-9 inhibitors lipid effects

A

Decreases LDL ~60% (but are $$$)

78
Q

Bile acid sequestrant/Bile Acid Binding Resins MOA

A

bind bile acids in the intestine, forming a complex that is excreted in the feces

79
Q

Which drugs are Bile acid sequestrant/Bile Acid Binding Resins

A

Cholestyramine, colesevelam, colestipol

80
Q

colesevelam brand name

81
Q

colesevelam is also approved for

A

glycemic control in T2DM

82
Q

How is colesevelam taken

A

with a meal and liquid

83
Q

colesevelam CI

A

bowel obstruction

84
Q

BAS/Bile acid resin side effects

A

Constipation, abdominal pain, cramping, bloating, gas, increased TG

85
Q

Cholestyramine packets may cause

A

changes in surface of teeth resulting in discoloration, erosion of enamel or decay

86
Q

Which BAS can be considered as an option in pregnant patients

A

colesevelam

think of a baby lamb

87
Q

For Cholestyramine or colestipol, take all other drugs at least ____ hours before or ___ hours after the BAS

A

1-4 hrs before

4-6 hours after

88
Q

Which medication should be taken 4 hours prior to colesevelam

A

Levothyroxine

89
Q

Bile acid sequestrants can decrease the absorption of which vitamins

A

Fat-soluble (A, D, E, K)

90
Q

Fibrate MOA

A

PPARa activators, which upregulate the expression of apoC-II and apoA-I. ApoC-II increases lipoprotein lipase activity leading to increased catabolism of VLDL particles, ↓ TG significantly

91
Q

Fenofibrate, Fenofibric Acid brand names

A

Antara, TriCor, Trilipix

92
Q

Fenofibrate (Fenoglide & Lipofen) are taken how

A

with meals

93
Q

Gemfibrozil brand name

94
Q

Fibrate CI

A

Severe liver disease including primary biliary cirrhosis, gallbladder disease

95
Q

Fibrate warnings

A

Myopathy, ↑ when co-administered with a statin

96
Q

Fibrate SE

A

Dyspepsia (gemfibrozil), ↑ LFTs

97
Q

Fibrate lipid effects

A

Decreases TGs, but can increase LDL when TG are high

98
Q

Gemfibrozil should not be given with ____ or ____ d/t ↑ risk of myopathies

A

ezetimibe or statins

99
Q

Fibrates can ↑ the effects of ___ and ____

A

sulfonylureas & warfarin

100
Q

Niacin MOA

A

decreases the rate of hepatic synthesis of VLDL (decreases TG) and LDL

101
Q

What are other names for niacin

A

nicotinic acid or Vitamin B3

102
Q

Special consideration for niacin

A

Titrate slowly

103
Q

How should niacin IR be taken

104
Q

How should niacin ER be taken

A

at bedtime after a low-fat snack

105
Q

How should niacin CR/SR be taken

106
Q

Niacin warnings

A
  • Rhabdomyolysis with niacin doses > 1 gram/day combined with statins
  • Hepatotoxicity
  • ↑ BG, ↑ uric acid
107
Q

Niacin SE

A

Flushing, pruritis, vomiting, diarrhea, ↑ BG, hyperuricemia (or gout)

108
Q

IR niacin has poor tolerability d/t what side effects

A

flushing/itching

109
Q

CR/SR niacin has less flushing but more

A

hepatotoxicity

110
Q

What is the best clinical choice for niacin

A

ER Niaspan, with less flushing and less hepatotoxicity

111
Q

How to reduce flushing associated with niacin

A

take ASA 325 mg (or ibuprofen 200 mg) 30-60 min before the dose; take with food, but avoid spicy food, alcohol and hot beverages

112
Q

T/F: Formulations of niacin (IR vs ER) are NOT interchangeable

113
Q

Lipid effects of niacin

A

Increases HDL

114
Q

Take niacin ____ hrs after bile acid sequestrants

115
Q

Fish oils are indicated as an adjunct to diet when TG > ___ mg/dL

116
Q

Omega-3-Acid Ethyl Esters brand name

117
Q

Icosapent ethyl brand name

118
Q

Fish oil SE

A

Eructation (burping), dyspepsia, taste perversions (Lovaza)

119
Q

Fish oils lipid effects

A

Decreases TG, can increase LDL (Lovaza only)

120
Q

Omega-3-FA can

A

prolong bleeding time

121
Q

Which drug approved for use in homozygous familial hypercholesterolemia (HoFH)

A

Lomitapide

122
Q

Lomitapide BW

A

hepatotoxicity

123
Q

Lomitapide CI

A

Active liver disease, pregnancy

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