Dyslipidemia 2 Flashcards
1
Q
Which drug?
- MOA: Decrease LDL and VLDL synthesis
- Effects on lipids: Decreases TG and Cholesterol
- Effects on lipo: Increases HDL
- Misc: Issues w/ pt acceptance, extended release causes less flushing and is less hepatotoxic than sustained release
A
Niacin
2
Q
Which drug?
- MOA: Increase LDL catabolism and Inhibit LDL synthesis
- Effect on lipids: decrease cholesterol
- Effects on lipo: decrease LDL
- Misc: highly effective in heterozygous familial hypercholesteremia and in combo w/ other agents
A
- Atorvastatin
- Rosuvastatin
3
Q
Which drug?
- MOA: PCSK9 inhibitor
- Effect on lipids: decreases cholesterol and Lpa
- Effects on lipo: decreases cholesterol and LDL
- Misc: Given by SQ injection, injection site pain, low risk of hepatotoxicity
A
- Alirocumab
- Evolocumab
4
Q
Which drug?
- MOA: Blocks cholesterol absorption across the intestinal border
- Effects on lipo: decreases LDL
- Misc: Few adverse effects
A
Ezetimibe
5
Q
MOA of which drug class?
-
Inhibition of HMG-CoA reductase
- Directly reduces production of cholesterol
-
LDL receptors upregulated in liver
- Indirectly increases LDL catabolism
- Has “pleiotropic effects” such as improving endothelial function, enhances stability of atherosclerotic plaques, decreases oxidative stress, inhibits thrombogenic response
-
Prevention of atherosclerosis
- Controls inflammatory response
A
Statins
6
Q
Which class of drugs?
- Primary effect is on LDL
- Increases HDL 5-10%
- Decreases TGs 10-30%
- Prevention of atherosclerosis (controls inflammatory response)
A
Statins
7
Q
- Which Statin is the most potent?
- Which Statin have the greatest efficacy?
(to reduce % of LDL)
A
Rosuvastatin
8
Q
Which Statin is the worst at reducing LDL?
A
At 80mg, Fluva
9
Q
- A high-Intensity Statin Therapy lowers LDL on average by what %?
- How many mg are in high-intensity statins?
A
- 50% or greater
- Atorvastatin 40 - 80 mg
- Rosuvastatin 20 - 40 mg
10
Q
- Moderate Intensity Statin Therapy lowers LDL on average by what %?
- 4 names of these drugs apart from Atorv and Rosuv?
A
- 30 - <50%
- Simvastatin 20 - 40mg
- Pravastatin 40 - 80mg
- Lovastatin 40mg
- Fluvastatin 40mg
11
Q
- Low - Intensity Statin Therapy lower LDL on average by what %?
- 2 names of these?
A
- <30%
- Pravastatin 10-20mg
- Lovastatin 20mg
12
Q
CYP Hepatic Enzyme (3A4) is associated w/ which Statin?
A
Atorvastatin
13
Q
CYP Hepatic Enzyme (2C9) is associated w/ which Statin?
A
Rosuvastatin
14
Q
Which statin has a higher bioavailability?
Atorvastatin or Rosuvastatin?
A
Rosuvastatin = 20
Atorvastatin = 14
15
Q
Which class of drugs?
- Contraindications: Active liver disease & pregnancy
- SE: arthralgia, myalgia, rhabdomyolysis, hepatic failure, musculoskeletal pain (low back)
- Caution: possibly reduced dosage in patients w/ hepatic parenchymal disease, north Asians, and elderly
A
Statins
16
Q
What is the lipid goal of LDL levels for patients at very high risk of Atherosclerotic Cardiovascular Disease?
A
<70
17
Q
What is considered “very high” triglyceride level?
A
500 or above
18
Q
Which drug?
- Interfere w/ HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol
A
Statins
19
Q
Which drug?
- Blocks the absorption of cholesterol from the small intestine
A
Ezetimibe
20
Q
Which drug?
- Bind bile acids, thus increasing the excretion of cholesterol in the stool
A
Bile acid resins
21
Q
Which drug?
- Decreases both VLDL and LDL levels
A
Niacin
22
Q
Which drug?
- Upregulate LPL
A
FIbrates
23
Q
Which statin has the highest bioavailability?
A
Pitavastatin = 43-51
24
Q
Which Statin is “lipophilic?”
A
Atorvastatin
25
Which Statin is **"hydrophilic?"**
Rosuvastatin
| (Row, row, row your boat)
26
What lab value tends to increase w/ use of statins?
Fasting plasma glucose
27
**Hx of which 3 things** would lead you to check a baseline CK on a patient who takes Statins?
* Family hx of HLD
* Diabetes Insipidous
* Renal Insufficiency
28
**Which drug?**
* **Drug interactions:** 3A4 inhibitors and inducers
* **Avoid concomitant** use w/ Antihepacivirals such as Hep C tx, Posaconazole, Lovastatin, Red yeast rice
(Some **red yeast rice** products contain "citrinin" which can cause kidney failure.)
Atorvastatin
29
Atorvastatin may increase levels/effects of which cardiac drugs?
* Aliskiren
* Digoxin
* Spironolactone
* **Diltiazem / Verapamil (consider switching to Rosuvastatin)**
30
* Atorvastatin may _increase levels/effects_ of which **GI drug?**
* Which **Abx?**
* Which **Psych drugs?**
* **GI:** Cimetidine
* **Abx:** Ketoconazole
* **Psych:** Aripiprazole
31
**Atorvastatin levels may be increased by which**
* Cardiac drugs
* GI drugs
* Abx \*\*
* Dietary \*\*
* **Cardiac:** Amiodarone, Fenofibrate, Gemfibrozil, Niacin
* **GI:** Aprepitant
* **\*\*Abx:** Antihepaciviral, erythromycin, Conazole
* **\*\*Dietary:** Grapefruit juice (switch to Rosuv or Pitavastatin)
32
**Which drug?**
* **Drug interactions:** 2C9 inducers and inhibitors
* **Avoid concomitant use** w/ Gemfibrozil, Red Yeast Rice, Antihepacivirals such as Ledipasvir or Voxilaprevir
Rosuvastatin
33
Rosuvastatin may increase the levels/effects of which drug?
Vitamin K antagonist **(Warfarin)**
34
**Levels/effects of Rosuvastatin may be increased by which:**
* Cardiac drugs
* Abx\*\*
* **Cardiac:** Clopidogrel, Colchicine, Fenofibrates, Gemfibrozil, Niacin
* \***\*Abx:** Conazole: Itra
35
Which drug should you not use in combo/with any Statin?
Gemfibrozil
36
Which 7 drugs can be used w/ statin using a risk-mitigation strategy?
(**ADA** was in the **V**ietnam **W**ar, where he got **IE**)
* Amiodarone
* Amlodipine
* Diltiazem
* Erythromycin
* Itraconazole
* Verapamil
* Warfarin
37
What does CAI mean?
Cholesterol Absorption Inhibitors
38
**Which type of drug and name of drug?**
* **MOA:** inhibits cholesterol absorption in the small intestine
* Lowers LDL by 18% and w/ statin lowers additional 25%
* Can be used alone or w/ Simvastatin
* **CAI** (Cholesterol Absorption Inhibitor)
* Ezetimibe
39
**Which drug?**
* **Contraindication:** active hepatic disease
* **PK:** 80% of the drug is excreted in feces
* **SE:** diarrhea, fatigue, Cholelithiasis
CAI : Ezetimibe
40
**CAI: Ezetimibe** has few significant drug interactions and is well tolerated except for which 2 drugs?:
* Increased levels w/ which drugs?
* Reduced levels w/ which drug?
* **Increased:** Fibrates
* **Reduced:** Cholesyramine
41
What does PCSK9 stand for?
Proprotein Convertase Subtilisin Kexin 9
42
**PCSK9**
* ___ is produced predominantly in the liver
* Leads to degradation of hepatocyte \_\_\_
* _Increased or Decreased_ LDL levels?
* Therapies that _increase or decrease_ circulating PCSK9 levels significantly lower LDL levels?
* Serine protease
* LDL
* Increased LDL
* Decrease circulating levels
43
What are the 2 common PCSK9 inhibitors?
* Alirocumab
* Evolocumab
44
**Which drug?**
_MOA:_
* monoclonal antibodies that inhibit PCSK9 reduce LDL in a "dose dependent manner" by as much as 70%
* TG and apo B-100 are reduced
* Lp(a) levels decreased by 25%
_PCSK9 Inhibitors_ : **Alirocumab or Evolocumab**
45
How are PCSK9 Inhibitors (Alirocumab or Evolocumab) administered and how often?
* Subcutaneously
* Every 2 weeks
* (If higher dose of Evo, given monthly)
46
**Which PCSK9 Inhibitor would you give for:**
* Adult w/ heterozygous familial hypercholesterolemia
* Adults w/ clinical ASCVD who require additional lowering of LDLs
Alirocumab
47
**Which PCSK9 Inhibitor would you give for:**
* Primary hyperlipidemia
* Homozygous familial hypercholesterolemia
Evolocumab
48
3 adverse drug rxns of PCSK9 inhibitors (Alirocumab or Evolocumab)
* Hypersensitivity rxn (rare)
* Local rxn at injection site (more frequent)
* URI sxs / Flu-like sxs
