Dyslipidemia Flashcards
What factors are used to calculate ASCVD Risk?
- Gender, Age (20-79 yr), & Race
- Total cholesterol + HDL
- SBP + Antihypertensive Treatment
- Diabetes
- Smoking
What is ASCVD Risk?
Estimation of the risk of having a first cardiovascular event during the next 10 years
Nonpharmacologic treatment
- Diet (BMI 18.5-24.9)
- Exercise (150 min/wk mod-high intensity)
- Avoid tobacco use
Natural Products that help reduce cholesterol
- Red Yeast Rice
2. Fish oil
What is the Drug of Choice for Treatment?
Statin Therapy
Classification of Cholesterol and Triglyceride levels (mg/dl)
Non-HDL - Desirable
< 130
Classification of Cholesterol and Triglyceride levels (mg/dl)
LDL - Desirable vs Very High
Desirable: < 100
Very High: > 190
Classification of Cholesterol and Triglyceride levels (mg/dl)
HDL - Desirable in men vs women
Men: > 40
Women: > 50
Classification of Cholesterol and Triglyceride levels (mg/dl)
Triglycerides - Desirable vs Very High
Desirable < 150
Very High > 500
What medical conditions could cause dyslipidemia?
- Diabetes
- Hypothyroidism
- Smoking
- Renal/liver disease
Key Drugs that Increase LDL & Triglycerides
- Diuretics
- Efavirenz
- Steroids
- Cyclosporine/tacrolimus
- Atypical antipsychotics
- Protease inhibitors
Key Drugs that Increase LDL only
Fish oils (except Vascepa)
Key Drugs that Increase Triglycerides only
- IV lipid emulsions
- Propofol
- Bile acid sequestrants
Drug-Drug & Drug-Food Interactions with Statins
- Grapefruit
- Protease inhibitors
- Azole Antifungals
- Cyclosporine (Rosuvastatin 5 mg/d)
- Macrolides [except Azithromycin]
- Amiodarone (Simvastatin 20 mg/d, Lovastatin 40 mg/d)
- Non-DHP CCBs (Simvastatin 10 mg/d, Lovastatin 20 mg/d)
G-PACMAN (Max Daily Dose)
*Do NOT use with Simvastatin or Lovastatin [G-PACM]
Name the Non-statin (Brand/Generic)
MOA
Zetia (ezetimibe)
MOA: inhibit absorption of cholesterol in the small intestine
Name the PCSK9 Inhibitors (Brand/Generic)
- Praluent (aliromumab)
2. Repatha (evolocumab)
Name the Bile Acid Sequestrant (Brand/Generic)
MOA
colesevelam (Welchol)
MOA: bind bile acids in the intestine and excreted in feces
Take with a meal
Name the Fibrate (Brand/Generic)
MOA
- fenofibrate (Tricor)
- gemfibrozil (Lopid)
MOA: PPARα activator, increase lipoprotein lipase activity which increase catabolism of VLDL particles
gemfibrozil DDI with statins/ezetimibe
Name the Fish Oils (Brand/Generic)
- icosapent ethyl (Vascepta)
2. omega-3 acid (Lovaza)
Name the Statin Drugs & their Equivalent Doses
- Pitavastatin 2 mg
- Rosuvastatin 5 mg
- Atorvastatin 10 mg
- Simvastatin 20 mg
- Lovastatin 40 mg
- Pravastatin 40 mg
- Fluvastatin 80 mg
Pharmacist Rock At Saving Lives & Preventing Fatty deposits
Determining Statin Treatment intensity based on patient risk
Secondary Prevention: Clinical ASCVD (CHD, Stroke, TIA, PAD)
High Intensity Statin
Determining Statin Treatment intensity based on patient risk
Primary Prevention: Primary Elevation LDL > 190
High Intensity Statin
Determining Statin Treatment intensity based on patient risk
Diabetes + Age (40-75 w/ LDL btwn 70-189)
- With Multiple Risk Factors - High Intensity Statin
2. Regardless of 10 yr ASCVD - Moderate Intensity Statin
Determining Statin Treatment intensity based on patient risk
Age 40-75 w/ LDL 70-189
- 10 year ASCVD > 20% - High Intensity Statin
2. 10 year ASCVD 7.5 - 19.9% - Moderate Intensity Statin
Dose of Statin (Low/Moderate/High) + Brand Name
Atorvastatin
Brand: Lipitor
Mod: 10-20 mg
High: 40-80 mg
Dose of Statin (Low/Moderate/High) + Brand Name
Rosuvastatin
Brand: Crestor
Mod: 5-10 mg
High: 20-40 mg
Dose of Statin (Low/Moderate/High) + Brand Name
Simvastatin
Brand: Zocor
Low: 10 mg
Mod: 20-40 mg
Dose of Statin (Low/Moderate/High) + Brand Name
Pravastatin
Brand: Pravachol
Low: 10-20 mg
Mod: 40-80 mg
Dose of Statin (Low/Moderate/High) + Brand Name
Lovastatin
Brand: Altoprev, Mevacor
Low: 20mg
Mod: 40 mg
Dose of Statin (Low/Moderate/High)
Fluvastatin
Low: 20-40 mg
Mod: 40 mg BID or 80 mg XL
Dose of Statin (Low/Moderate/High)
Pitavastatin
Low: 1 mg
Mod: 2-4 mg
Friedewald equation
LDL = TC - HDL - (TG/5)
NOT used when TG > 400 mg/dL
TG > 500 mg/dL can cause what?
Acute Pancreatitis
Which agent is approved for use in homozygous familial hypercholesterolemia (HoFH)?
lomitapide (Juxtapid)
Which agents should be used with caution in patients with known hypersensitivity to fish and/or shellfish?
omega-3 acid (Lovaza)
Which drug has a MOA to decrease the rate of hepatic synthesis of VLDV (decrease TG) and LDL?
Niacin
known as nicotinic acid or Vitamin B3