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Naplex 2025 😭 > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

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1
Q

What is the importance of Cholesterol?

A
  • Used to produce BILE ACID [absorbs lipids]
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2
Q

What is the process of Enterohepatic Recycling?

A
  • Lipids go though bile ducts…
  • Then into Small intestines where its coverted into Bile Acids and Bile Salts…
  • Then back to liver
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3
Q

What risk is caused by having Increased Cholesterol?

A
  • Atherosclerosis [Increase ASCVD]
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4
Q

What are some of the things that ASCVD can cause?

A
  • MI
  • Stroke
  • Stable Angina
  • PAD
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5
Q

What are some of the way that we can decrase Cholesterol?

A
  • Reduce Formation [Statins]
  • Block Absorption [Ezetimibe]
  • Block Enterohaptic Recuculation [Colesevlam or Bile Salts]
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6
Q

What are the 3 types of cholesterol?

A
  • HDL: “Good” and lowers ASCVD Risk
  • LDL: “Bad” and increases ASCVD Risk
  • TG: Total Cholesterol [TGs > 500 = Pancreatis]
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7
Q

What is the Calculation to determine LDL levels?

Also what is the level when you WONT use this to find LDL

A
  • LDL = TC - HDL - TG/5

When TG is 400, you WONT use this

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8
Q

what are the desirable levels for HDL, LDL, and TG?

A
  • LDL < 100
  • HDL > 40 [Men] & 50 [Women]
  • TG < 150
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9
Q

What are the 2 types of Dylipidemia Classifacations?

A
  • Familial [genetic]
  • Seondary [Acquired by poor diet and exercise]
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10
Q

What are some of the drugs that can Increase LDL and TG]

A
  • Diruetics, Efavirenz, Immunosuppressants, Atypicals, Protease Inhibitors
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11
Q

What are some of the drugs that can Increase LDL only/

A
  • Fibrates, Fish Oils [except Vascepa], Anabolic Steroids, Progestins, SGLT-2 (Empag or Dapag)
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12
Q

What does the ASCVD risk try to estimate?

A
  • The risk of having a first cardiovascular event during the next 10 years
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13
Q

What are some of the drugs that can increase TG only?

A
  • IV Lipid Emulsions, Propofol, Clvidipine, Bile Acid Sequestrants (~5%), Estrogen, Tamoxifen, Beta-Blockers
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14
Q

What are some of the factors that are associated with ASCVD?

A
  • Sex, Age, Race, SMOKING
  • TC, HDL, LDL, & on a Statin
  • Blood Pressure & on HTN medications
  • Diabetes & on Aspirin
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15
Q

If still unsure based on ASCVD risk, what is another score you can look at to determine if a statin is right or not?

A
  • Coronary Artery Calcium Score > 100
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16
Q

What are some non-pharm treatments for Dyslipidemia?

A
  • Good Diet [Vegetables, Fruits, Whole Grains, High-Fiber, Healthy Proteins]
  • LIMITED saturated fats, trans fats, sweets
  • Physical activity 3-4 times per week
  • AVOID tobacco
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17
Q

What are some Natural Products used for Dyslipidemia?

A
  • Red Yeast Rice [natural HMG-CoA inhibitor]
  • Fish Oils [lower TGs]
  • NO GARLIC
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18
Q

What are the drugs of choice for Dyslipidemia?

A
  • STATIN +/- Ezetimibe or PCSK-9 Inhibitors
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19
Q

If a patient has Liver Damage, what are some things we should note?

A
  • Niacin, Ezetimibe, Statins, Fibrates can cause Liver Damage
  • IF AST/ALT is > 3x the upper normal limit; do NOT give any listed above
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20
Q

What is the MOA for Statins?

A
  • Inhibit HMG-CoA Reductase, stopping HMG-CoA to Mevaloate
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21
Q

What are the High Intensity Statins?

-

A
  • Atorvastatin 40 - 80 mg
  • Rosuvastatin 20 - 40 mg
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22
Q

What are the Statin Equivalent Doses?

A
  • Pitavastatin 2mg
  • Rosuvastatin 5mg
  • Atorvastatin 10mg
  • Simvastatin 20mg
  • Lovastatin 40mg
  • Pravastatin 40mg
  • Fluvastatin 80mg

Pharmacists Rock At Saving Lives and Preventing Fatty Deposits

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23
Q

Which statins should be taken with an evening meal?

A
  • Fluvastatin (IR)
  • Lovastatin (IR with food; Altoprev at bedtime)
  • Simvastatin
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24
Q

What is the most common adverse effect with statins?

What is the difference between the 3?

A
  • Muscle Damages
  • Myalgia: soreness/tenderness
  • Myopathy: weakness +/- CPK increase
  • Rhabdomyolysis: very high CPK leads to Renal Failure
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25
What is the way that we manage Myalgia?
- Hold Statin and Check CPK - After 2-4 weeks: Re-chal with same statin at lower dose - Myalgia Returns... stop statin and change to low dose of a different one - No tolerate... non statin
26
What are the contraindications for Statins?
- Breastfeeding, Liver Disease, Using CYP3A4 Inhibitors [w/ Sim & Lov]
27
What are the warnings for Statins?
- **Muscle Damages** [Increased CPK; High dose = High risk] - Age - **Using Niacin or Gemfibrizol** (increases muscle pains) - **Pregnancy** [unless high cardio risks] - Increased A1c/BG
28
What are the side effects of Statins?
- Myalgia/Myopathy
29
What are some montioring perameters for Statins?
- Lipid panel 4 - 12 w after starting then 3 - 12 m - LFTs at baseline [Hepatotoxicity] - CPK [muscle damage] & SCr/BUN for Urine output
30
What are the drug interactions for Statins? ## Footnote G PACMAN [Sim and Lova?]
- Grapefruits - Protease Inhibitors - Azoles - Cyclosproine - Macrolides - Amiodarone - Non-DHP CCBs ## Footnote DO NOT use Sim or Lova with G PACM Amiodarone [MAX 20mg Sim & 40mg Lova] Non-DHP [Max 10mg Sim & 20mg Lova]
31
Which statins generally have less drug interactions?
- Rosuvastatin and Pravastatin
32
What are some drugs that can increase muscle damage risk?
- Fibrates and Niacin - DO NOT use statins with Gemfibrozil
33
What are some of the Non-Statin thereapies used?
- Ezetimibe and/or PCSK9 Inhibitors - Bempedoic Acid and Inclisiran maybe - Fish oils and Fibrates [mainly TGs]
34
What is the MOA for Ezetimibe??
- inhibits absoprtion of cholesterol in the small intestine
35
What are some of the warning for Ezetimbie?
- Avoid use in moderate or severe hepatic impairment - Prenancy/Breastfeeding is unknown
36
what arethe side effects of Ezetimbe?
- Myalgia - Arthralgia, Pain in Extremities, Diarrhea, URTIs
37
What is the monitoring for Ezetimbe?
- LFTs at baseline
38
What is the MOA for the PCSK9 Inhibitors?
- Blocks PCSK9 from binding to the LDL receptors, GREATLY reducing LDL
39
What are the Warnings for the PCSK9 Inhibitors?
- Allergic reactions
40
What are the 2 PCSK9 Inhibitors that are used?
- Alirocumab [Praulent] - Evolocumab [Repatha]
41
What are the side effects for the PCSK9 Inhibitors?
- Injection site reactions
42
What are the Bile Acid Sequestrants that are used?
- Colesevelam [Welchol] - Cholestryramine [Prevalite] - Colestipol [Colestid]
43
What is the monitoring for the PCSK9 inhibitors?
- LDL at baseline, then at 4 - 8 w
44
What are the contraindications for the Bile Acid Sequestrants?
- Bowel Obstruction in Colesevelam - Billiary Obstruction in Cholestyraimine
45
What is the MOA for the Bile Acid Sequestrants?
- Binds to bile acid making a complex that gets excreated in the poop
46
What are some of the drug interactions for the Bile Acid Sequestrants?
- Take all other drugs 1-4 h before OR 4-6 h after Cholestyramine or colestipol - Levothyroxine - Decrease absorption of Vitamins [mulitvitamin but separtte]
47
What are the side effects for the Bile Acid Sequestrants?
- Constipation, Ab Pain, Cramping, Bloating, Gas, increased TGs
48
What is the MOA of the Fibrates?
- PPAPa agonist that increase ApoC-II & ApoA-I; ApoC-II will increase lipoprotein lipase activity and catabolize VLDL = LARGE decrease of LDL
49
What are the fibrates that are used?
- Fenofibrate [Tricor, Trilipix] - Gemfibrozil [Lopid]
50
What are the contraindications for Fibrates?
- Severe Liver Diseaes [Primary Biliary Cirrhosis] - Gallbladder Disease
51
What are the warnings for Fibrates?
- **Myopathy** [Increased risk with statins]
52
What are the side effects for fibrates?
- Dyspepsia [Gem], Increase LFTs, Ab pain, Increase CPK
53
What are the drug interactions for the Fibrates?
- Gem SHOUD NOT be taken with ezetimibe or statins - Fibrates can increase the effects of sulfonylureas and warfarin
54
What are the **Statins** that are used for **Dyslipidemia**? ## Footnote Brand/Generic
- **Atorvastatin [Lipitor]** - Fluvstatin [Lescol Xl] - **Lovastatin [Altoprev]** - Pitavastatn [Livalo] - **Pravastatin** [Pravachol] - **Rosuvastatin [Creator]** - **Simvastatin [Zocor]**
55
What is that **Nicain** works in the **body**? ## Footnote -
- Decreases the **rate** of **hepatic synthesis of VLDL** (Decrease TGs) **and LDL** - will **increase** HDL
56
What are the **other names** for **Niacin**?
- Nicotinic Acid - Vit B3
57
What is the **dosing** for **Niacin**? ## Footnote IR? ER? CR/SR?
- IR: 250 - 3000 mg **with food** - ER: 500 - 2000 mg at **bedtime with a low-fat snack** - CR/SR: 250 - 750 mg **with food** ## Footnote **TITRATE SLOWLY**
58
What are the **warnings** for **Niacin**?
- **Rhabdo**: when dose is > 1 g/day + Statins - **Hepatotoxicity** - **Increase BG, Uric Acid**, decrease phos
59
What are some of the **side effects** for **niacin**?
- Flushing - Itching - Vomiting - Diarrhea - Increase BG (one of the warnings) - Hyperuricemia (or gout) [one of the warnings]
60
What are some **additional notes** for **niacin**?
- ER is **preferred** due to **less flushing & hepatotoxicity** - To reduce flushing; take **325 mg aspirin** 30 - 60 mins **before dose** - **Take with food** but not **spicy food, alcohol, or hot drinks** - Niacin forms are **NOT** interchangable
61
What are some of the **fish oils** that are used for **dyslipidemia**?
- Omega 3 (Lovaza) - Icosapent Ethyl (Vascepa) ## Footnote Vascepa is BEST for **ASCVD reductions** too
62
When is it **best** to start using **fish oils** to help with lowering **TGs**?
- when TGs are above 500
63
What are some of the **Warnings** for the **Fish Oils**?
- Hypersensitivity to **fish and/or shellfish**
64
What are some of the **side effects** for **fish oils**?
- burping - Dyspepsia - Taste Perversions (Lovasa) - Arthralgias (Vascepa)
65
What are some **important drug interactions** with the **fish oils**?
- Prolong bleeding time (monitor if taking with Warfarin)

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