Dyslipidemia Flashcards
Pneumonic for Statin Equivalent Doses
Pharmacists Rock AT Saving Lives and PReventing Fatty-deposits
P- Pitavastatin 2 R - Rosuvastatin 5 At - Atorvastatin 10 S - Simvastatin 20 L - Lovastatin 40 Pr - Pravastatin 40 F - Fluvastatin 80
Myalgias
Muscle soreness and tenderness
Myopathy
muscle weakness +/- CPK elevations
Myositis
muscle inflammation
Rhabdomyolysis
Any muscle symptoms with a very high CPK (>10,000) + muscle protein in the urine which can lead to acute renal failure
What can be given to reduce rhabdo
Coenzyme Q10
Which two statins have the most DDI and the least DDI?
Most: Simvastatin, Lovastatin
Least: Rosuvastatin, Pravastatin
Statin S/e
HMG - Hepatotoxicity, Myalgias/Myostitosis/Rhabdp, Glucose changes
MOA statin
HMG reductase inhibitors
When to tx with statin
1) for secondary prevention when a pt has already had CVD event - high intensity
2) If LDL is >190
3) if someone is 40-75 and has LDL between 70-189
- diabetic then either high or moderate intensity
- otherwise look at ascvd risk (if above 20 then high intensity, if above 7.5 but below 20 then moderate)
ezetimbe MOA
inhibits absorption of cholesterol in small intenstine
statin effects on LDL, HDL, TG
LDL - decrease, HDL - increase, TG - decrease
ezetimibe s/e
myalgias
ezetimibe effect on LDL, HDL, TG
LDL - decrease,
HDL - increase,
TG - decrease
PKS9 MOA
an enzyme that increases the degradation of LDL receptors
PKS9 effects
drastically decreases LDL
PKS9 side effects
injection site reactions
Bile acid sequestrants MOA
bind bile acids thus forming a complex that is excreted in the feces
bile acid side effects
welchol: bowl obstruction
Cholestyramine packet: teeth discoloration/erosion of enamel, separate from drugs
class effects: cause constipation, cramping, bloating, gas, increased TG, decrease fat soluble vitamin absorption
bile acid effects on LDL, HDL, TG
decrease LDL, increase HDL, increase TG *only one
purpose of bile acid
ok to use in pregnant person to lower LDL
fibrate MOA
peroxisome proliferator receptor alpha activators which upregulate apolipoprotein thus increasing apolipoprotein lipase to catabolize TG containing VLDL particles
fibrate effects on LDL, TG, HDL
Mainly used to decrease TG, generally decreases LDL but when TG very high, increases HDL
Fibrate contraindications, warnings, s/e
C/I in severe liver disease, gallbladder disease
Warning - increase myopathy with statin
s/e - dyspepsia, increased lft
fibrate DDI
gemfibrozil aka lopid ddi with statin
niacin moa
decreases synthesis of VLDL
niacin s/e
rhabdo, hepatotoxicity, flusing, gout, itching, vomiting, diarhea, increase BG
IR vs ER vs CR niacin
not interchangeable, ER least s/e but most expensive, IR causes most flushing, CR causes most hepatotoxicity
niacin effects
decrease LDL, increase HDL, decrease TG
fish oil moa
not completely understood, mainly effects TG
fish oil d/e
burping, dyspepsia, taste perversions
effects on TG, LDL, HDL of fish oil
TG - decrease, HDL - increase, LDL can increase *
indication and s/e for lomitapide
- homozygous familial hypercholesterolemia
- hepatoxic boxed warning
- do not use in active liver disease or pregnancy
Key drugs that can increase LDL and TG
Diuretics, Efavirenz, Steroids, Immunosuppressants, Atypical antipsychotics, Protease Inhibitors
Which drugs do not need to be taken with food?
ezetimibe, pcsk9
administration of bile acid sequesterants
take at mealtime with plenty of water or other liquid
administration of niacin
take with food but avoid spicy food, alcohol, and hot beverages
Zestoretic
Lisinopril + HCTZ
Hyzaar
Losartan + HCTZ
Benicar HCT
Olmesartan/HCT
Diovan HCT
Valsartan/HCTz
Lotrel
Benazepril/Amlodipine
Exforge
Valsartan/Amlodipine
Tenortic
Atenolol/Chlorthalidone
Ziac
Bisoprolol/Hydrochlorothiazide
Dyazide
Triamterene/HCTZ (1/2)
Maxzide
Triamterene/HCTZ (2/2)