dyslipidemia Flashcards
what is the process of enterohepatic recycling
bile acid from the liver seeps into the intestines which converts them to salts and returned to the liver
bile seeping into the intestines contain fats
what is considered high LDL
> 190
what is considered high TG
> 500
friedewald equation
LDL=TC-HDL- TG/5
9-12 hours of fasting required
what drugs commonly increase LDL and TG
diuretics
efavirenz
steroids
immunosupressants
atypical antipsychotics
protease inhibitor
what drugs increase LDL only
fish oil
what drugs increase TG only
IV lipids
propofolol
bile acid sequestrants
what are the essentials in ASCVD calculations
age race
TC HDL
SBP and HPT meds if yes or not
diabetes or smoking?
what natural products help with dyslipedimia
red yeast rice
garlic
OTC fish oils ( can increase LDL)
what are some cholesterol lowering drug that can cause liver damage
Fibrates
Statins
ezetimibe
niacin
high intensity statin is for pepople with
high ascvd risk >20%
secondary prevention
multiple ASCVD RISK
ELEVATION OF >190
MODERATE INTENSITY STatin is used in
low risk patients <20
diabetes regardless of ASCVD
what are high intensity statin
atorvastatin 40-80
rosuvastatin 20-40
what are low intensity statin
not atorvastatin or rosuvastatin
simva 10
pravastatin 10-20
lova 20
fluvastatin 20-40
pitavastatin 1
how to avoid risk of myalgia
avoid gemfibrozil + statin
do not use simva 80mg
avoid OTC drug interaction
hold statin and start with a lower dose
how much LDL HDL and TG does statin lowers
LDL by 20-55%
hdl increase by 5-15%
TG by 10-30%
what should not be used with statins
CYP 3A4 inhibitors
Grape fruit
PI
cyclosporine
macrolide
azole antifungals
lower simva and lova to 20-40 max
amiodarone
non DHP CCB
when to add ezetimibe or PCSK9 inhibitor
when statin is max and LDL still >70
what is the MOA of ezetimibe
inhibits absorption of cholesterol in the small intestines
what is the MOA of PCSK9 inhibitor
increases LDL receptor degradation
praluent- alirocumab once every 2 weeks
repatha- evolocumab once every 2 weeks
LDL decrease 60%
non- HDL 35%
TC 36%
how are bile acids controlled
colesevelam or welchol- can lower A1C by 0.5%
choletyramine-
colestipol- NOT IN pregnant population
** AE- constipation , can increase LDL 5%
seperate other drugs 1-4 hours or 4-6 hours after
can decrease ADEK
what are the MOA of fibrates
PPARa activators to increase lipoprotein lipase activity
fenofibrate trillipix
gemfibrozil or lopid
** AE- should not be used with ezetimibe or statins
Dyspepsia
liver damage
gallbladder disease
how does niacin work
decreases TG and LDL and increase HDL bingin
also known as VIT B3
titrate slow
**AE - muscle pain, hepatoxic
which fish oil can increase LDL
lovaza Omega 3
fish oil are used to
decrease TG
**AE- dyspepsia, burping, hypersensitivity to fish or shellfish
lomitapide or juxtapid
specialty med
$$$$
evkeeza for primary hyperlipidemia
