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PHRM 211 > CV 9 > Flashcards

CV 9 Flashcards

1
Q

What is dyslipidemia defined as

A

abnormal fats in the blood

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2
Q

increased Total Cholesterol or LDL-C = ??

A

increased ASCVD

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3
Q

Increased HDL-C =

A

decreased ascvd

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4
Q

what type of lipid tests are recommended

A

non fasting lipid tests
TG increase by -.2-0.3mmol/L after eating and LDL-C decrease by 0.1-0.2mmol/L

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5
Q

when do you recommend fasting lipids

A

if TG are > 4.5mmol/L

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6
Q

Drug induced dyslipidemia 5 classes

A

Alcohol
Antiepileptics
Antipsychotics
Progestins
Thiazide Diuretics

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7
Q

Who do you screen?

A

men 40 years of age or older, women 40 years of age or older.
consider earlier in ethnic groups at increased risk such as south asian or indigenous individuals

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8
Q

two signs of dyslipidemi

A

eruptive xanthomas
corneal arcus

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9
Q

what are the two types of dyslipidemia

A

primary (familial hypercholesterolemia)
secondary (other causes)
- sedentary lifestyle
- excessive dietary fat intake
- diseases like CKD, LD, untreated hypothyroidism
- cigarette smoking
- drugs

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10
Q

0-5-30 rule

A

0 cigs, 30 mins exercise, 5 servings of fruit and vegetables

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11
Q

Atorvastatin dosing + brand name

A

Lipitor, 10-80mg PO daily

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12
Q

Rosuvastatin dosing + brand name

A

Crestor 5-40mg PO daily

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13
Q

Simvastatin dosing + brand name

A

Zocor 10-40mg PO daily

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14
Q

What does doubling a statin dose do

A

further decreases LDL C by 6%, but most benefit comes from lower doses

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15
Q

which statins can you take at any time

A

atorvastatin and rosuvastatin

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16
Q

when should other statins be taken

A

PM meal or at HS

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17
Q

is simvastatin 80mg recommended

A

NO.

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18
Q

whats the approach to statin therapy when no statin indicated condition is there

A

framingham risk score, risk category

19
Q

what are statin indicated conditions

A

LDL >/= nto 5mmol/L
Familial Hypercholesterolemia or genetic dyslipidemia
DM or CKD
ASCVD

20
Q

familial hypercholesterolemia dominant or recessive

A

dominant!

21
Q

familial hypercholesterolemia heterozygous LDL-C range and homozygous LDL-C range

A

5-13, >13

22
Q

Primary Prevention risk categories

A

low risk = <10%, no statin therapy recommended
intermediate risk = 10-19%
High risk = >/= 20%, statin therapy recommended

23
Q

when do you initiate statin therapy in intermediate risk patients

A

if LDL-C is >/= to 3.5mmol/L
Men aged over 50 w/
woman ages over 60 w/ greater than one CV risk factor

24
Q

CV risk factors

A
  • elevated waist-to-hip ratio
  • low HDL-C (less than 1 in men and 1.3 in women)
    -current or recent (5 years or less) cig smoking
    -impaired fasting glucose
    -hypertension
25
Q

what didi a high dose of simvastatin cause

A

more myopathy, no difference in LDL compared to lower dose

26
Q

which statins use the CYP3A4 mechanism

A

ALS - atorva, lova, simva

27
Q

Statin drug interactions - what do cyp3A4 inhibitors do

A

increased statin levels
macrolide ab, grapefruit juice, azole antigungals, protease inhibitors

28
Q

Statin drug interactions - CYP3A4 inducers

A

decreased statin levels
- rifampin, carbamazepine, phenytoin, phenobarbital, st johns wort

29
Q

Which drugs increased statin levels

A

amiodarone, CCB, Colchicine, Cyclosporine

30
Q

Statin CI

A

pregnancy/lactation
liver enzyme elevation
hepatic disease

31
Q

some common ADRs of statins

A

Cataracts
Diarrhea, nausea
elevated liver enzymes
DM
Myopathy, arthralgias

32
Q

statin associated myalgia CK/ULN parameters

A

CK<ULN
stop statin, resume same dose when asymptomatic. reassess symptoms and CK in 6-12 weeks

33
Q

statin associated myositis CK/ULN parameters MILD

A

CK <10 times ULN
stop statin
follow CK until CK<ULN and asymptomatic
restart statin or use lower dose or switch
monitor symptoms and enzymes for 3-6 weeks

34
Q

statin associated myositis CK/ULN parameters MOD/SEV

A

stop statin
refer

35
Q

if a pt gets rhabdomyolysis what do you do

A

D/C statin and do not rechallenge

36
Q

Did coenzyme Q10 or VD help prevent SAM

A

NO.

37
Q

PCSK9 inhibitors

A

alirocumab, praluent, 75-150mg SC q 2 weeks

Evolocumab, Repatha, 140mg SC q 2 weeks or 420 mg S q monthly

38
Q

EPA (Icosapent ethyl)

A

decreased TG by 20%

39
Q

Omega 3 works or nah?

A

NO!

40
Q

Are fibrates used for anything

A

decrease TG by 20-50% and LDL-C by 5-20$
primarily used to reduce risk of pancreatitis

41
Q

is niacin used

A

no bc of serious ADRs

42
Q

are bile acid sequesttrants used

A

no, never used.

43
Q

in patients with ASCVD, what do you do

A

max statin treatment.
If LDL-C >1.8mmol/L or ApoB >0.7g/L or non hdl c > 2.4mmol/L, use ezetimibe +/- PCSK9 inhibitor if between 1.8-2.2 or use PCSK9 +/- ezetimibe if greater than 2.2

44
Q
A

PHRM 211 (25 decks)

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