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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
What statins are high intensity?
atorvastatin (40-80mg) and rosuvastatin (20-40mg)
26
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 ```
27
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 ```
28
what is the most common adverse effect of statins?
SYMMETRICAL muscle damage | in 6 weeks of starting
29
what level CPK indicates rhabdomyolysis?
CPK >10,000 can lead to acute renal failure
30
how can you avoid myalgia?
avoid DI, including OTC do not use simva 80/day do not use gemfribozil + statin
31
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
32
Brand: lipitor
generic: atorvastatin
33
Brand: Altoprev
generic: Lovastatin
34
Brand: Pravachol
generic: pravastatin
35
Brand: Crestor
generic: rosuvastatin
36
Brand: Zocor
Simvastatin
37
Which statins are taken in the evening?
fluvastatin lovastatin + evening meal simvastatin
38
What is the dilema with statins and diabetes?
inc a1c and FBG with statins; outweighs the risk tho
39
how often lipid panel?
4-12 weeks after starting, then every year
40
what is the dose of rosuvastatin with cyclosporine?
10mg
41
what is the dose of atorvastatin with cobicstat?
40mg day
42
which statins have less DI?
rosuvastatin and pravastatin
43
simva/lova dose with amiodarone
simva - 20 | lova - 40
44
simva/lova dose with non-DHP ccbs
simva 10 | lova 40
45
A patient with very high risk and is at statin max dose, LDL remains >70... what do you add on?
ezetimibe > PCSK9 inhibitors
46
a patient with primary hypercholesterol, statin at max dose, LDL remains >100
ezetimibe > PCSK9 inhibitors
47
MOA: inhibits absorption of cholesterol in the small intestine
ezetimibe
48
Brand: Zetia
Generic: ezetimibe dec LDL by 18-23%
49
most common side effect with Zetia?
myalgia too
50
MOA: increases LDL receptor degradation
PCSK9 inhibitor (enzyme)
51
Brand: Praluent
generic: alirocumab
52
Brand: Repatha, Pushtronex
generic: evolocumab
53
administration of PCSK9i are via?
SC | every 2 weeks, monthly
54
lipid effects by PCSK9i
LDL dec 60%
55
MOA: bind bile acids in the intestine forming a complex that is excreted in the feces
bile acid sequestrates/bile acid binding resins
56
Brand: Welchol
generic: colesevelam
57
common side effects of bile acid sequestrates
constipation, abdominal pain, bloating, inc TG
58
What can happen with long term use of Welchol
discoloration of teeth
59
lipid effects of Welchol (bad)
inc TG 5%
60
what vitamins are needed with bile acid sequestrates?
ADEK
61
MOA: PPAR-alpha activators which up regulate the expression of apocII and apoa-I
fibrates
62
Brand: Antara, Tricot, Trillipix
generic: fenofibrate
63
Generic: gemfibrozil
Brand: Lopid
64
Fibrates are contraindicated in
severe liver disease gallbladder disease
65
fibrates warnings
increase myopathy + statin
66
Common side effects of fibrates
dyspepsia (gem), inc LFTs
67
lipid effects of fibrates
dec TG 20-50%, can increase LDL when TG are high
68
gemfibrozil (Lopid) should not be used with
ezetimibe or statins
69
fibrates can increase what drugs
SU and warfarin
70
MOA: decreases the rate of hepatic synthesis of VLDL (dec TG) and LDL
niacin
71
niacin is also known as
nicotinic acid and vitamin B3
72
Warnings for niacin
rhabdomyolysis hepatotoxicity inc BG inc uric acid
73
common side effects of niacin
flushing, itching, V/D, inc BG, gout
74
what do you take to reduce flushing?
aspirin 325mg 30-60min before dose IR (TID) and ER (bedtime) not interchangeable
75
lipid effects of niacin
inc HDL 15-35%
76
indicated as an adjunct to diet when TG >500
fish oils
77
what formulation is recommended for ASCVD risk reduction
Vascepa take with food
78
Brand: Lovaza
generic: omega-3 acid ethyl esters
79
Brand: vascepa
generic: icsapent ethyl
80
lipid effects of fish oils
dec TG lovaza increases LDL :(
81
fish oils interact with...
warfarin! prolongs bleeding time

NAPLEX 21 (60 decks)

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