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Pharm 2 Exam SHEA > Dyslipidemia 2 > Flashcards

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

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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
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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
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4
Q

Which drug?

  • MOA: Blocks cholesterol absorption across the intestinal border
  • Effects on lipo: decreases LDL
  • Misc: Few adverse effects
A

Ezetimibe

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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

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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

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7
Q
  • Which Statin is the most potent?
  • Which Statin have the greatest efficacy?

(to reduce % of LDL)

A

Rosuvastatin

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8
Q

Which Statin is the worst at reducing LDL?

A

At 80mg, Fluva

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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
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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
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11
Q
  • Low - Intensity Statin Therapy lower LDL on average by what %?
  • 2 names of these?
A
  • <30%
  • Pravastatin 10-20mg
  • Lovastatin 20mg
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12
Q

CYP Hepatic Enzyme (3A4) is associated w/ which Statin?

A

Atorvastatin

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13
Q

CYP Hepatic Enzyme (2C9) is associated w/ which Statin?

A

Rosuvastatin

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14
Q

Which statin has a higher bioavailability?

Atorvastatin or Rosuvastatin?

A

Rosuvastatin = 20

Atorvastatin = 14

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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

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16
Q

What is the lipid goal of LDL levels for patients at very high risk of Atherosclerotic Cardiovascular Disease?

A

<70

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17
Q

What is considered “very high” triglyceride level?

A

500 or above

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18
Q

Which drug?

  • Interfere w/ HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol
A

Statins

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19
Q

Which drug?

  • Blocks the absorption of cholesterol from the small intestine
A

Ezetimibe

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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
Q

Which Statin is “hydrophilic?”

A

Rosuvastatin

(Row, row, row your boat)

26
Q

What lab value tends to increase w/ use of statins?

A

Fasting plasma glucose

27
Q

Hx of which 3 things would lead you to check a baseline CK on a patient who takes Statins?

A
  • Family hx of HLD
  • Diabetes Insipidous
  • Renal Insufficiency
28
Q

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.)

A

Atorvastatin

29
Q

Atorvastatin may increase levels/effects of which cardiac drugs?

A
  • Aliskiren
  • Digoxin
  • Spironolactone
  • Diltiazem / Verapamil (consider switching to Rosuvastatin)
30
Q
  • Atorvastatin may increase levels/effects of which GI drug?
  • Which Abx?
  • Which Psych drugs?
A
  • GI: Cimetidine
  • Abx: Ketoconazole
  • Psych: Aripiprazole
31
Q

Atorvastatin levels may be increased by which

  • Cardiac drugs
  • GI drugs
  • Abx **
  • Dietary **
A
  • Cardiac: Amiodarone, Fenofibrate, Gemfibrozil, Niacin
  • GI: Aprepitant
  • **Abx: Antihepaciviral, erythromycin, Conazole
  • **Dietary: Grapefruit juice (switch to Rosuv or Pitavastatin)
32
Q

Which drug?

  • Drug interactions: 2C9 inducers and inhibitors
  • Avoid concomitant use w/ Gemfibrozil, Red Yeast Rice, Antihepacivirals such as Ledipasvir or Voxilaprevir
A

Rosuvastatin

33
Q

Rosuvastatin may increase the levels/effects of which drug?

A

Vitamin K antagonist (Warfarin)

34
Q

Levels/effects of Rosuvastatin may be increased by which:

  • Cardiac drugs
  • Abx**
A
  • Cardiac: Clopidogrel, Colchicine, Fenofibrates, Gemfibrozil, Niacin
  • **Abx: Conazole: Itra
35
Q

Which drug should you not use in combo/with any Statin?

A

Gemfibrozil

36
Q

Which 7 drugs can be used w/ statin using a risk-mitigation strategy?

(ADA was in the Vietnam War, where he got IE)

A
  • Amiodarone
  • Amlodipine
  • Diltiazem
  • Erythromycin
  • Itraconazole
  • Verapamil
  • Warfarin
37
Q

What does CAI mean?

A

Cholesterol Absorption Inhibitors

38
Q

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
A
  • CAI (Cholesterol Absorption Inhibitor)
  • Ezetimibe
39
Q

Which drug?

  • Contraindication: active hepatic disease
  • PK: 80% of the drug is excreted in feces
  • SE: diarrhea, fatigue, Cholelithiasis
A

CAI : Ezetimibe

40
Q

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?
A
  • Increased: Fibrates
  • Reduced: Cholesyramine
41
Q

What does PCSK9 stand for?

A

Proprotein Convertase Subtilisin Kexin 9

42
Q

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?
A
  • Serine protease
  • LDL
  • Increased LDL
  • Decrease circulating levels
43
Q

What are the 2 common PCSK9 inhibitors?

A
  • Alirocumab
  • Evolocumab
44
Q

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%
A

PCSK9 Inhibitors : Alirocumab or Evolocumab

45
Q

How are PCSK9 Inhibitors (Alirocumab or Evolocumab) administered and how often?

A
  • Subcutaneously
  • Every 2 weeks
  • (If higher dose of Evo, given monthly)
46
Q

Which PCSK9 Inhibitor would you give for:

  • Adult w/ heterozygous familial hypercholesterolemia
  • Adults w/ clinical ASCVD who require additional lowering of LDLs
A

Alirocumab

47
Q

Which PCSK9 Inhibitor would you give for:

  • Primary hyperlipidemia
  • Homozygous familial hypercholesterolemia
A

Evolocumab

48
Q

3 adverse drug rxns of PCSK9 inhibitors (Alirocumab or Evolocumab)

A
  • Hypersensitivity rxn (rare)
  • Local rxn at injection site (more frequent)
  • URI sxs / Flu-like sxs

Pharm 2 Exam SHEA (15 decks)

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