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
