Dyslipidemia Flashcards
What classifies a drug/strength has high intensity statin?
What about moderate?
They can lower the LDL by >50%
They lower by 30-49%
What is the first statin group?
Therapy?
Goal?
Patients with clinical ASCVSD
High intensity
LDL <70 and reduce by >50%
What is the Second statin group?
Therapy?
Goal?
Familial hypercholesteremia with LDL >190
HIgh intensity
LDL <100 , and reduce by >50%
What is the third statin group?
Therapy?
Adults 40-75 with DM w/ LDL >70
Moderate intensity UNLESS they have multiple risk factors, then high intensity
What is the fourth statin group?
What do you do?
Primary prevention 40-75y.o
Step 1: Calculate ASCVD, look at risk factors, and consider patient preference
If >7.5% - start moderate intensity
What are the cutoff’s for ASCVD scores?
> 20% = High risk
7.5-19.9% - Intermediate
5-7.5% - Borderline risk
<5% - Low risk
How long after starting statin do you monitor labs?
4-12 weeks after initiation or dose change then every 3-12 months
What medication classes can increase cholesterol?
Diuretics
BB
Protease inhibitors
Antipsychotics - olanzapine
SGLT2 inhibitors
What levels do statins work on?
They can lower LDL and hs-CRP (protein that rise in response to inflammation)
Pitavastatin
Brand
Dose
Renal dose
Interaction
Livalo ; zypitamag
1,2,4mg with MAX 4mg
GFR<59 - max 2mg
Erythromycin, rifampin, fibrates
Rosuvastatin
Drug interactions
Separate from aluminum and magnesium antacids
Can increase INR
What is a combo with atorvastatin and the brand name?
What about with simvastatin?
Amlodipine and atorvastatin - Caduet
Ezetimibe + simvastatin (Vytorin)
What are drug interactions with simvastatin and max doses?
Max 10mg with verapamil and diltiazem
Max 20mg with amiodarone, amlodipine, and ranolazine
Lovastatin
Brand
SIG
Max dose
Drug interactions w/max dose
Altoprev
Take IR with FOOD
80mg
Max 20mg with verapamile and diltiazem
Max 40mg with amiodarone and dronaderone
Pravastatin
Max dose
80mg
Fluvastatin
Brand
Counseling for IR
Lescol XL
Dont open IR caps and take in the evening
What are statin interactions?
Red yeast rice is similar to lovastatin and may increase toxic effects
Can increase INR
Which statins are given at night?
Fluvastatin IR
Lovastatin IR
Simvastatin
(you FLS (floss) at night)
Dose equivalents for LDL reduction
PRASLPF
Pitavastatin 2
Rosuvastatin 5
Atorvastatin. 10
Simvastatin. 20
Lovastatin 40
Pravastatin 40
Fluvastatin 80
What are the statins metabolism?
CYP3A4 - Lovastatin, atorvastatin, simvastatin (inhibitors will increase statin levels)
CYP2C9 - Fluvastatin, rosuvastatin
Hepatic - pravastatin
Ezetimibe
Brand
MOA
Dose
MOnitor
Zetia
Cholesterol absorbtion inhibitor
10mg QD
Monitor LFT’s
What are the four contraindications of statins?
Liver disease
Alcoholism
Pregnancy
Breastfeeding
Alirocumab and evolucumab
Brand
ROA and frequency
Dose
MOA
Indication
Administration instructions
Praluent and Repatha
SUBQ every 2 weeks
Praluent - 75-150mg
Repatha - 140mg Q2weeks or 420mg monthly
Inhibit degradation of liver LDL receptors by PCSK9
Adjunt to lower LDL after already on high intensity statin
Wait 30 min to allow it to come to room temp
Niacin
AKA
Effects of lipids
ADE and how to fix
Interaction
Vitamin B3
Increase HDL and lower TC/LDL/VLDL
Flushing and itching - Titrate slow, take after meals, and take 325mg ASA before
Can also see GI upset, hepatotoxicity, hyperglycemia, hyperuricemia
Can increase myopathy with statins
Bile acid sequestrant ADE
Increase TG
GI distress - constipation, bloating, nausea, flatulence
Impaired fat-soluble vitamins (ADEK)
What are your fibric acid derivitatives and how do they affect lipid levels?
What are ADE’s?
Gemfibrozil and fenofibrate
Decrease TG
Cholelithiasis
Gemfibrozil
Brand
Dose and counseling
Drug interaction
Lopid
600mg BID 30 minutes before meals
Increases myopathy with statins and increase INR
Which fibric acid derivative is preferred if on a statin?
Fenofibrate
When would you avoid fenofibrate?
Hepatic impairment
CrCL <30
When do you recommend omega 3 fatty acids?
What are your options?
For TG >500
Lovaza
Epanova
Vascepa
How do the different vascepa forms differ?
EPA does not increase LDL
DHA DOES increase LDL
Bempedoinc acid
Brand
MOA
Dose
Monitor
Combo
Nexletol
ACL inhibitor that inhibits cholesterol synthesis in liver
180mg QD
Increased uric acid, tendon rupture , URTI
Bempedoic and ezetimbe - Nexlizet
Evinacumab
Brand
ROA and dose
MOA
Effect on lipid
Indication
Evkeeza
IV every 4 weeks
Monoclonal antibody that binds and inhibits angiopoietin-like protein 3
Decreases LDL, TG AND HDL
Homozygous familial hypercholesteremia
