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NAPLEX 21 > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

what does total cholesterol include?

A

LDL + HDL + VLDL

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2
Q

Non-HDL calculation

A

TC - HDL

this helps determine the lipoproteins that contribute to atherosclerosis

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3
Q

What TG level can cause acute pancreatitis?

A

TG >500

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4
Q

what is the genetic defect that causes severe cholesterol elevations?

A

primary (familial) hypercholesterolemia (HeFH, HoFH)

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5
Q

what conditions can cause poor cholesterol?

A

hypothyroidism

diabetes

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6
Q

How do you calculate for LDL?

A

LDL = TC - HDL - TG/5

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7
Q

When is the LDL formula not used?

A

when TG >400

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8
Q

What are drugs that can increase LDL and TG?

A

diuretics

efavirenz

steroids

immunosuppressants

atypical antipsychotics

protease inhibitors

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9
Q

fish oils increase what level?

A

LDL (SGLT2, TZD, fibric acids)

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10
Q

IV lipids, propofol, and bile acids increase what level?

A

TG

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11
Q

What is a desirable non-HDL level?

A

<130

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12
Q

what is a desirable LDL level?

A

<100

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13
Q

What is a very high LDL level?

A

> 190

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14
Q

what is a desirable HDL level in women and men?

A

women - >40

men - >50

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15
Q

what is a desirable TG level?

A

<150

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16
Q

what is a very high TG level?

A

> 500

*needs to be fasted or can cause falsely high levels

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17
Q

What factors are used for the ASCVD risk?

A

age, race

TC and HDL

BP/if blood pressure meds are used

diabetes

smoking status

*repeated every 4-6 years

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18
Q

What natural product contains naturally occurring HMG-CoA reductase inhibitors in low amounts?

A

Red yeast rice

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19
Q

Before prescribing niacin, fibrates, potentially statins and ezetimibe.. what level needs to be checked?

A

LIVER - AST/ALT – cannot be used if >3x ULN

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20
Q

What statin intensity should be used in person with LDL >190?

A

high

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21
Q

What statin intensity should be used in person with

  • diabetes
  • 40-75
  • LDL 70-189
  • multiple ASCVD risk factors
A

high

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22
Q

What statin intensity should be used in person with

  • diabetes
  • 40-75
  • LDL 70-189
  • regardless of ASCVD risk factors
A

moderate

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23
Q

What statin intensity should be used in person with

  • 40-75
  • LDL 70-189
  • ASCVD >20%
A

high

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24
Q

What statin intensity should be used in person with

  • 40-75
  • LDL 70-189
  • ASCVD 7.5-19.9% + risk enhancing factors
A

moderate

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25
Q

What statins are high intensity?

A

atorvastatin (40-80mg) and rosuvastatin (20-40mg)

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26
Q

What statins are moderate intensity?

A

ALL!

pravastatin 40-80mg
fluvastatin 40 BID / 80 XL
lovastatin 40mg
simvastatin 20-40mg
atorvastatin 10-20mg
rosuvastatin 5-10mg
pitavastatin 2-4mg
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27
Q

What are the statin equivalent doses?

A

Ms. Pras, LPF
phone number: 251 - 2448

pitavastatin 2
rosuvastatin 5
atorvastatin 10
simvastatin 20
lovastatin 40
pravastatin 40
fluvastatin 80
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28
Q

what is the most common adverse effect of statins?

A

SYMMETRICAL muscle damage

in 6 weeks of starting

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29
Q

what level CPK indicates rhabdomyolysis?

A

CPK >10,000

can lead to acute renal failure

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30
Q

how can you avoid myalgia?

A

avoid DI, including OTC
do not use simva 80/day
do not use gemfribozil + statin

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31
Q

How do you manage myalgia?

A

hold statin, check CPK

re-challenge after 2-4 weeks same or dec dose

if return, use a different statin, gradually increase dose

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32
Q

Brand: lipitor

A

generic: atorvastatin

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33
Q

Brand: Altoprev

A

generic: Lovastatin

34
Q

Brand: Pravachol

A

generic: pravastatin

35
Q

Brand: Crestor

A

generic: rosuvastatin

36
Q

Brand: Zocor

A

Simvastatin

37
Q

Which statins are taken in the evening?

A

fluvastatin
lovastatin + evening meal
simvastatin

38
Q

What is the dilema with statins and diabetes?

A

inc a1c and FBG with statins; outweighs the risk tho

39
Q

how often lipid panel?

A

4-12 weeks after starting, then every year

40
Q

what is the dose of rosuvastatin with cyclosporine?

A

10mg

41
Q

what is the dose of atorvastatin with cobicstat?

A

40mg day

42
Q

which statins have less DI?

A

rosuvastatin and pravastatin

43
Q

simva/lova dose with amiodarone

A

simva - 20

lova - 40

44
Q

simva/lova dose with non-DHP ccbs

A

simva 10

lova 40

45
Q

A patient with very high risk and is at statin max dose, LDL remains >70… what do you add on?

A

ezetimibe > PCSK9 inhibitors

46
Q

a patient with primary hypercholesterol, statin at max dose, LDL remains >100

A

ezetimibe > PCSK9 inhibitors

47
Q

MOA: inhibits absorption of cholesterol in the small intestine

A

ezetimibe

48
Q

Brand: Zetia

A

Generic: ezetimibe

dec LDL by 18-23%

49
Q

most common side effect with Zetia?

A

myalgia too

50
Q

MOA: increases LDL receptor degradation

A

PCSK9 inhibitor (enzyme)

51
Q

Brand: Praluent

A

generic: alirocumab

52
Q

Brand: Repatha, Pushtronex

A

generic: evolocumab

53
Q

administration of PCSK9i are via?

A

SC

every 2 weeks, monthly

54
Q

lipid effects by PCSK9i

A

LDL dec 60%

55
Q

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

A

bile acid sequestrates/bile acid binding resins

56
Q

Brand: Welchol

A

generic: colesevelam

57
Q

common side effects of bile acid sequestrates

A

constipation, abdominal pain, bloating, inc TG

58
Q

What can happen with long term use of Welchol

A

discoloration of teeth

59
Q

lipid effects of Welchol (bad)

A

inc TG 5%

60
Q

what vitamins are needed with bile acid sequestrates?

A

ADEK

61
Q

MOA: PPAR-alpha activators which up regulate the expression of apocII and apoa-I

A

fibrates

62
Q

Brand: Antara, Tricot, Trillipix

A

generic: fenofibrate

63
Q

Generic: gemfibrozil

A

Brand: Lopid

64
Q

Fibrates are contraindicated in

A

severe liver disease

gallbladder disease

65
Q

fibrates warnings

A

increase myopathy + statin

66
Q

Common side effects of fibrates

A

dyspepsia (gem), inc LFTs

67
Q

lipid effects of fibrates

A

dec TG 20-50%, can increase LDL when TG are high

68
Q

gemfibrozil (Lopid) should not be used with

A

ezetimibe or statins

69
Q

fibrates can increase what drugs

A

SU and warfarin

70
Q

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

A

niacin

71
Q

niacin is also known as

A

nicotinic acid and vitamin B3

72
Q

Warnings for niacin

A

rhabdomyolysis
hepatotoxicity
inc BG
inc uric acid

73
Q

common side effects of niacin

A

flushing, itching, V/D, inc BG, gout

74
Q

what do you take to reduce flushing?

A

aspirin 325mg 30-60min before dose

IR (TID) and ER (bedtime) not interchangeable

75
Q

lipid effects of niacin

A

inc HDL 15-35%

76
Q

indicated as an adjunct to diet when TG >500

A

fish oils

77
Q

what formulation is recommended for ASCVD risk reduction

A

Vascepa

take with food

78
Q

Brand: Lovaza

A

generic: omega-3 acid ethyl esters

79
Q

Brand: vascepa

A

generic: icsapent ethyl

80
Q

lipid effects of fish oils

A

dec TG

lovaza increases LDL :(

81
Q

fish oils interact with…

A

warfarin! prolongs bleeding time

NAPLEX 21 (60 decks)

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