Dyslipidemia Flashcards
what does total cholesterol include?
LDL + HDL + VLDL
Non-HDL calculation
TC - HDL
this helps determine the lipoproteins that contribute to atherosclerosis
What TG level can cause acute pancreatitis?
TG >500
what is the genetic defect that causes severe cholesterol elevations?
primary (familial) hypercholesterolemia (HeFH, HoFH)
what conditions can cause poor cholesterol?
hypothyroidism
diabetes
How do you calculate for LDL?
LDL = TC - HDL - TG/5
When is the LDL formula not used?
when TG >400
What are drugs that can increase LDL and TG?
diuretics
efavirenz
steroids
immunosuppressants
atypical antipsychotics
protease inhibitors
fish oils increase what level?
LDL (SGLT2, TZD, fibric acids)
IV lipids, propofol, and bile acids increase what level?
TG
What is a desirable non-HDL level?
<130
what is a desirable LDL level?
<100
What is a very high LDL level?
> 190
what is a desirable HDL level in women and men?
women - >40
men - >50
what is a desirable TG level?
<150
what is a very high TG level?
> 500
*needs to be fasted or can cause falsely high levels
What factors are used for the ASCVD risk?
age, race
TC and HDL
BP/if blood pressure meds are used
diabetes
smoking status
*repeated every 4-6 years
What natural product contains naturally occurring HMG-CoA reductase inhibitors in low amounts?
Red yeast rice
Before prescribing niacin, fibrates, potentially statins and ezetimibe.. what level needs to be checked?
LIVER - AST/ALT – cannot be used if >3x ULN
What statin intensity should be used in person with LDL >190?
high
What statin intensity should be used in person with
- diabetes
- 40-75
- LDL 70-189
- multiple ASCVD risk factors
high
What statin intensity should be used in person with
- diabetes
- 40-75
- LDL 70-189
- regardless of ASCVD risk factors
moderate
What statin intensity should be used in person with
- 40-75
- LDL 70-189
- ASCVD >20%
high
What statin intensity should be used in person with
- 40-75
- LDL 70-189
- ASCVD 7.5-19.9% + risk enhancing factors
moderate
What statins are high intensity?
atorvastatin (40-80mg) and rosuvastatin (20-40mg)
What statins are moderate intensity?
ALL!
pravastatin 40-80mg fluvastatin 40 BID / 80 XL lovastatin 40mg simvastatin 20-40mg atorvastatin 10-20mg rosuvastatin 5-10mg pitavastatin 2-4mg
What are the statin equivalent doses?
Ms. Pras, LPF
phone number: 251 - 2448
pitavastatin 2 rosuvastatin 5 atorvastatin 10 simvastatin 20 lovastatin 40 pravastatin 40 fluvastatin 80
what is the most common adverse effect of statins?
SYMMETRICAL muscle damage
in 6 weeks of starting
what level CPK indicates rhabdomyolysis?
CPK >10,000
can lead to acute renal failure
how can you avoid myalgia?
avoid DI, including OTC
do not use simva 80/day
do not use gemfribozil + statin
How do you manage myalgia?
hold statin, check CPK
re-challenge after 2-4 weeks same or dec dose
if return, use a different statin, gradually increase dose
Brand: lipitor
generic: atorvastatin
Brand: Altoprev
generic: Lovastatin
Brand: Pravachol
generic: pravastatin
Brand: Crestor
generic: rosuvastatin
Brand: Zocor
Simvastatin
Which statins are taken in the evening?
fluvastatin
lovastatin + evening meal
simvastatin
What is the dilema with statins and diabetes?
inc a1c and FBG with statins; outweighs the risk tho
how often lipid panel?
4-12 weeks after starting, then every year
what is the dose of rosuvastatin with cyclosporine?
10mg
what is the dose of atorvastatin with cobicstat?
40mg day
which statins have less DI?
rosuvastatin and pravastatin
simva/lova dose with amiodarone
simva - 20
lova - 40
simva/lova dose with non-DHP ccbs
simva 10
lova 40
A patient with very high risk and is at statin max dose, LDL remains >70… what do you add on?
ezetimibe > PCSK9 inhibitors
a patient with primary hypercholesterol, statin at max dose, LDL remains >100
ezetimibe > PCSK9 inhibitors
MOA: inhibits absorption of cholesterol in the small intestine
ezetimibe
Brand: Zetia
Generic: ezetimibe
dec LDL by 18-23%
most common side effect with Zetia?
myalgia too
MOA: increases LDL receptor degradation
PCSK9 inhibitor (enzyme)
Brand: Praluent
generic: alirocumab
Brand: Repatha, Pushtronex
generic: evolocumab
administration of PCSK9i are via?
SC
every 2 weeks, monthly
lipid effects by PCSK9i
LDL dec 60%
MOA: bind bile acids in the intestine forming a complex that is excreted in the feces
bile acid sequestrates/bile acid binding resins
Brand: Welchol
generic: colesevelam
common side effects of bile acid sequestrates
constipation, abdominal pain, bloating, inc TG
What can happen with long term use of Welchol
discoloration of teeth
lipid effects of Welchol (bad)
inc TG 5%
what vitamins are needed with bile acid sequestrates?
ADEK
MOA: PPAR-alpha activators which up regulate the expression of apocII and apoa-I
fibrates
Brand: Antara, Tricot, Trillipix
generic: fenofibrate
Generic: gemfibrozil
Brand: Lopid
Fibrates are contraindicated in
severe liver disease
gallbladder disease
fibrates warnings
increase myopathy + statin
Common side effects of fibrates
dyspepsia (gem), inc LFTs
lipid effects of fibrates
dec TG 20-50%, can increase LDL when TG are high
gemfibrozil (Lopid) should not be used with
ezetimibe or statins
fibrates can increase what drugs
SU and warfarin
MOA: decreases the rate of hepatic synthesis of VLDL (dec TG) and LDL
niacin
niacin is also known as
nicotinic acid and vitamin B3
Warnings for niacin
rhabdomyolysis
hepatotoxicity
inc BG
inc uric acid
common side effects of niacin
flushing, itching, V/D, inc BG, gout
what do you take to reduce flushing?
aspirin 325mg 30-60min before dose
IR (TID) and ER (bedtime) not interchangeable
lipid effects of niacin
inc HDL 15-35%
indicated as an adjunct to diet when TG >500
fish oils
what formulation is recommended for ASCVD risk reduction
Vascepa
take with food
Brand: Lovaza
generic: omega-3 acid ethyl esters
Brand: vascepa
generic: icsapent ethyl
lipid effects of fish oils
dec TG
lovaza increases LDL :(
fish oils interact with…
warfarin! prolongs bleeding time
