Dyslipidemia 2 Flashcards
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
Niacin
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
- Atorvastatin
- Rosuvastatin
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
- Alirocumab
- Evolocumab
Which drug?
- MOA: Blocks cholesterol absorption across the intestinal border
- Effects on lipo: decreases LDL
- Misc: Few adverse effects
Ezetimibe
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
Statins
Which class of drugs?
- Primary effect is on LDL
- Increases HDL 5-10%
- Decreases TGs 10-30%
- Prevention of atherosclerosis (controls inflammatory response)
Statins
- Which Statin is the most potent?
- Which Statin have the greatest efficacy?
(to reduce % of LDL)
Rosuvastatin
Which Statin is the worst at reducing LDL?
At 80mg, Fluva
- A high-Intensity Statin Therapy lowers LDL on average by what %?
- How many mg are in high-intensity statins?
- 50% or greater
- Atorvastatin 40 - 80 mg
- Rosuvastatin 20 - 40 mg
- Moderate Intensity Statin Therapy lowers LDL on average by what %?
- 4 names of these drugs apart from Atorv and Rosuv?
- 30 - <50%
- Simvastatin 20 - 40mg
- Pravastatin 40 - 80mg
- Lovastatin 40mg
- Fluvastatin 40mg
- Low - Intensity Statin Therapy lower LDL on average by what %?
- 2 names of these?
- <30%
- Pravastatin 10-20mg
- Lovastatin 20mg
CYP Hepatic Enzyme (3A4) is associated w/ which Statin?
Atorvastatin
CYP Hepatic Enzyme (2C9) is associated w/ which Statin?
Rosuvastatin
Which statin has a higher bioavailability?
Atorvastatin or Rosuvastatin?
Rosuvastatin = 20
Atorvastatin = 14
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
Statins
What is the lipid goal of LDL levels for patients at very high risk of Atherosclerotic Cardiovascular Disease?
<70
What is considered “very high” triglyceride level?
500 or above
Which drug?
- Interfere w/ HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol
Statins
Which drug?
- Blocks the absorption of cholesterol from the small intestine
Ezetimibe
Which drug?
- Bind bile acids, thus increasing the excretion of cholesterol in the stool
Bile acid resins
Which drug?
- Decreases both VLDL and LDL levels
Niacin
Which drug?
- Upregulate LPL
FIbrates
Which statin has the highest bioavailability?
Pitavastatin = 43-51
Which Statin is “lipophilic?”
Atorvastatin
Which Statin is “hydrophilic?”
Rosuvastatin
(Row, row, row your boat)
What lab value tends to increase w/ use of statins?
Fasting plasma glucose
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
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
Atorvastatin may increase levels/effects of which cardiac drugs?
- Aliskiren
- Digoxin
- Spironolactone
- Diltiazem / Verapamil (consider switching to Rosuvastatin)
- Atorvastatin may increase levels/effects of which GI drug?
- Which Abx?
- Which Psych drugs?
- GI: Cimetidine
- Abx: Ketoconazole
- Psych: Aripiprazole
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)
Which drug?
- Drug interactions: 2C9 inducers and inhibitors
- Avoid concomitant use w/ Gemfibrozil, Red Yeast Rice, Antihepacivirals such as Ledipasvir or Voxilaprevir
Rosuvastatin
Rosuvastatin may increase the levels/effects of which drug?
Vitamin K antagonist (Warfarin)
Levels/effects of Rosuvastatin may be increased by which:
- Cardiac drugs
- Abx**
- Cardiac: Clopidogrel, Colchicine, Fenofibrates, Gemfibrozil, Niacin
- **Abx: Conazole: Itra
Which drug should you not use in combo/with any Statin?
Gemfibrozil
Which drugs can be used w/ statin using a risk-mitigation strategy?
- Amiodarone
- Amlodipine
- Diltiazem
- Erythromycin
- Itraconazole
- Verapamil
- Warfarin
