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NAPLEX 2021 > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

Explain enterohepatic recycling

A

bile acids from the liver travel through the bile ducts along with cholesterol into the small intestine where they help with fat absorption.
Intestines have an acidic environment so the bile acids are converted to bile salts here which are recycled from the intestine and then return to the liver

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2
Q

How does disrupting the enterohepatic recyling process lead to lowered cholesterol?

A

By blocking absorption of free cholesterol in the intestine (ezetimibe) or the enterohepatic recirculation of bile salts (colesevelam) cholesterol then decreases

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3
Q

How do statins help with cholesterol?

A

they reduce the formation of cholesterol by inhibiting HMG-CoA reductase to stop conversion of HMG-CoA to mevalonate (rate limiting step in cholesterol synthesis)

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4
Q

Describe HDL

A

good cholesterol
delivers cholesterol from blood to the liver where it is removed from the body
want Hdl to be High

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5
Q

describe lipoprotein

A

genetic variant of LDL, when elevated=elevated ASCVD risk

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6
Q

At what level can TGs cause pancreatitis

A

> 500 mg/dl

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7
Q

What are primary hypercholesterolemias

A

genetic defect that causes cholesterol elevations

HeFH and HoFH

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8
Q

When is LDL considered severely elevated?

A

> 190

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9
Q

What is the Friedewald equation?

A

LDL = Tc - HDL - (TG/5)

*only use if TG is <400

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10
Q

Desirable HDL levels

A

men: >/= 40
women: >/= 50

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11
Q

What is the desirable level for TGs?

A

<150

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12
Q

What does ASCVD risk tell us?

A

estimate of patient’s risk of having their first CV event in the next 10 years

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13
Q

What are parameters are assessed when calculating ASCVD risk?

A 
gender, age, race
TC and HDL
Systolic blood pressure 
use of HTN meds 
diabetes 
smoking status
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14
Q

What CAC score indicates a statin should be initiated?

A

CAC >/= 100

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15
Q

Drug of choice for high non-HDL and LDL

A

statins!

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16
Q

Drug options if statin-intolerant or additional cholesterol-lowering needed

A

ezetimibe

PCSK9 inhibitors

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17
Q

What lab parameter should be monitored when patients are using cholesterol-lowering medication due to side effect profile

A

AST and ALT

liver damage is possible

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18
Q

What drugs can cause liver damage?

A

niacin, fibrates, statins, ezetimibe

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19
Q

When should we not initate cholesterol medication in regards to liver function

A

AST or ALT are >3x upper normal limit

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20
Q

High intensity statin indications

A

clinical ASCVD
LDL >/=190
diabetes + age 40-75 + LDL >70 + multiple risk factors
40-75yo + LDL >70 + ASCVD risk >/= 20%

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21
Q

moderate intensity statin indications

A

diabetes + age 40-75 + LDL >70

40-75yo + LDL >70 + ASCVD risk >7.5% + risk factors

22
Q

High intensity statins

A

Atorva: 40 +
Rosuva: 20 +

23
Q

moderate intensity statins

A 
atorv 10 - 20 
rosuva 5-10
simvastatin 20+
pravastatin 40+
lovastatin 40+
pitavastain: 2 +
24
Q

low intensity statins

A

sim: 10
prav: 10-20
lova 20
pita: 1

25
Q

statin equivalents

A

Pharmacists Rock At Saving Lives & Preventing Fatty-deposits

pita: 2
rosu: 5
ator: 10
simva: 20
lova: 40
prava: 40
fluvastatin: 80

26
Q

Is statin-induced muscle soreness symmetrical or asymmetrical?

A

symmetrical

27
Q

What CPK value can indicate rhabdomyolysis

A

CPK > 10,000 + muscle in urine

28
Q

What can rhabdomyolysis lead to?

A

acute kidney failure

29
Q

Can we rechallenge with a statin if myalgias occur?

A

yes after 2- 4 weeks of holding with same statin at same or lower dose

30
Q

CIs of statin therapy

A

pregnancy, breastfeeding
liver disease or unexplained elevated LFT
use with cyclosporine

31
Q

which statins interact with CYP34A inhibitors

A

simva

lova

32
Q

Which drug needs to be started at a low dose in Asian patients due to risk of higher exposure

A

rosuvastatin

33
Q

which statins should be taken in the evening

A

fluvastatin
lovastatin
simvastatin

34
Q

which statins have less drug interactions

A

rosuvastatin

pravastatin

35
Q

Statin drug interactions

A 
Ghosts love PACMAN 
Grapefruit
Protease inhibitors
Azole
Cyclosporine/Cobicistat 
Macrolides 
Amiodarone 
Non-DPH CCBs
36
Q

Side effects with ezetimibe

A

myalgias
diarrhea
sinusitis

37
Q

Which drug should not be used with ezetimibe due to risk of cholelithiasis

A

gemfibrozil

fenofibrate (caution)

38
Q

PCSK9 Inhibitor MOA

A

Mabs that block PCSK9 from binding to LDL receptors and therefore increases LDL degradation by decreasing their receptor degradation

39
Q

Bile acid sequestrants MOA

A

bind bile acids in the intestine forming a complex that’s excreted in feces, disruption enterohepatic circulation

40
Q

List of bile acid sequestraants

A

cholestyramine
colesevelam
colestipol

41
Q

Which drug can be considered for cholesterol control in a pregnant patient?

A

colesevelam

42
Q

Counseling points for bile acid sequestrant

A

good oral hygeine needed due to possilbe tooth decay
separate from other meds by about 4 hours
take a multivitamin and separate from these meds

43
Q

Fibrates MOA

A

PPAR alpha activators: increase expression of apolipoprotein and thus lipase activity. This leads to catabolism of VLDL particles and decreases TG

44
Q

CI fibrates

A 
liver disease
gallbladder disease 
renal disease
breastfeeding 
use with simvastatin!
45
Q

What fibrate can not be given with ezetimibe or statins

A

gemfibrozil

46
Q

niacin MOA

A

decreases synthesis of VLDL and LDL and increases the rate of TG removal from plasma

47
Q

other names for niacin

A

B3

nicotinic acid

48
Q

Is niacin a good options for patients with hepatic dysfunction?

A

NO! CI!

49
Q

When are fish oils indicated

A

when TG > 500 they can be used as an adjunct to diet changes

50
Q

Interaction concern with fish oils

A

warfarin, they can prolong bleeding so watch INR

51
Q

How long can PCSK9s be kept out of the fridge?

A

30 days

NAPLEX 2021 (28 decks)

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