Dyslipidemia Flashcards
drugs that causes of dyslipidemia
diuretics
immunosupressants (cyclsospirine, tacroliumus)
protease inhibitors (darunavir, ritonavir)
2nd gen antispychotics (quetiapine, olanzapine)
steroids
lipid emulsions increase tg
iv fat emulsions
propofol
clevedipine
how to calculate LDL
LDL=TC-HDL-(TG/5)
ASCVD events
ACS/MI
angina
revascuralization (stent)
stroke/tia
PAD
how to figure out what statin intensity to use
ascvd 10% risk calculator.
Lipid guideline-key points for when to choose high intensity
clinical ascvd
ldl >190 mg/dL
10 year ascvd risk >/20%
diabetes w. multiple risk factors (smoker,
moderate intensity statin
any patients w diabetes
10 year ascvd risk 7.5-19%
highest to lowest potency statins
Pitavastatin
rosuvastatin
atorvastatin
simvastatin
lovastatin
pravastatin
fluvastatin
Safety issues w statins
stop if statin if AST or alt >3x ULN, if
also be aware if pt has jaundice, or abdominal pain
muscle damage
*myalgia, myopathy-> rhabdomyolysis
*increase cpk causes renal failure
stop in most pregnant patients. do not use if breastfeeding
reducing risk of in pts who use statins
avoid drug interactions, including otc products
do not use simvastatin 80 mg/day
do not use gemfibrozil + statin
managing myalgias
hold statin, check cpk leveld, investigate other possible causes
after 2-4 weeks, re-challenge w. same statin at same dose or decreased dose. most pts who did not tolerate a statin will rechallenge , or will tollerate a different statin.
if myalgias return, use a low dose of a different statin. gradually increase dose
DDI with statins
do not use simvastatin or lovastatin w. strong cyp3a4
grapefruit, protease inhibitors, azole antifungals,cyclosporine, cobistate,macrolides (except azithromycin)
cap the daily dose of simvastatin and lovastatin w.
amiodarone
**** simvastatin 20mg/day
***** lovastatin 40 mg
Diltiazem and verapamil
** simvastatin 10 mg/day
**lovastatin 20mg/day
add on treatmetment
additional cholesterol lowering drug options for those recieving statin (at maximized dose) but still at high risk o ascvd
Ezetimibe (zetia) 2nd line-decreases ldl by ~20%
pcsk9- lowers by ~60%. 3rd line due to cost
vascepa (icosapent ethyl)- fda approved in 2019.
**can be added when on
1) max tolerated statin to reduce cv risk AND
2)tg>150 AND
3) ascvd or dm +cvd risk factors
non statin treatment for dyslipiedemia
colesevelam
niacin
lovaza
lomitapide
lopid
