Dyslipidemia 3 Flashcards
What inhibits PCSK9?
MAB - Monoclonal Antibodies
What is a side effect of MAB inhibitors PCSK9?
Influenza
Alirocumab or Evolocumab?
- SQ 75 mg once every 2 weeks
- SQ 140 mg every 2 weeks or 420 mg once monthly
- Alirocumab = 75mg
- Evolocumab = 140/420
Who would you give a monthly dose of Evolocumab to 420mg?
Adolescents
- What is an MTP inhibitor?
- What is the name of one?
- Microsomal Triglyceride Transfer Protein Inhibitor
- Juxtapid (Lomitapide)
Which drug?
Mechanism:
- Binds directly to and inhibits MTP
- **Prevents assembly of apo-B containing lipoproteins
- **Reduced production of chylomicrons and VLDL
- Reduced plasma LDL concentrations
Juxtapid (lomitapide) - MTP inhibitor
What is the indication for giving an MTP inhibitor: Juxtapid (lomitapide)?
Homozygous familial hypercholesterolemia
What is the major side effect of MTP inhibitor: Juxtapid (lomitapide)?
-
Diarrhea (79%)
- increases hepatic fat (hepatic steatosis) with or without concomitant increases in transaminases
2 contraindications of MTP inhibitor : Juxtapid (lomitapide)?
- Pregnancy (teratogenic)
- Hepatic impairment or active hepatic disease
Which drug?
Drug interactions:
- substrate of CYP3A4
- Inhibits CYP3A4 and P-glycoprotein
Lomitapide (MTP inhibitor)
- Lomitapide increases the levels of what?
- Lomitapide levels are decreased with what?
- Lovastatin
- BAS (Bile acid sequestrant)
- **What is the “Boxed Warning” of Lomitapide?**
- What is the name of the program?
- Hepatotoxicity
- JUXTAPID REMS PROGRAM
What can a patient taking Lomitapide do to avoid GI effects (diarrhea)?
Low fat diet <20%
Which drug?
MOA:
- Inhibitor of apolipoprotein B-100 synthesis
- Adjunct to lipid-lowering medications and deit to reduce low LDL, apo B, TC, and non HDL
Mipomersen sodium (Kynamro)
Indication to give Mipomersen sodium (Kynamro)?
Homozygous familial hypercholesterolemia (HoFH)
How is Mipomersen sodium (Kynamro) administered and how often?
- SQ (subcutaneously)
- Weekly
ADE/ADR of Miopmersen sodium (Kynamro)
- 84% experience what?
- 30% experience what?
- Injection site rxn
- Flu-like sxs 2 days after injection
Contraindication of Mipomersen sodium (Kynamro)
Moderate/Severe hepatic impairment or active liver disease
BOXED WARNING of Mipomersen sodium (Kynamro)
Hepatotoxicity
What 2 baseline labs should you monitor if pt is on Mipomersen sodium (Kynamro)?
- ALT (alanine aminotransferase)
- AST (aspartate transaminase)
What is the restricted program called for boxed warning of Mipomersen sodium (Kynamro)?
KYNAMRO REMS
Which drug?
MOA:
-
Upregulates lipoprotein lipase (LPL)
- Increases catabolism of VLDL
- Elimination of TG-rich particles
- Fatty acid oxidation
-
Modulation of apolipoprteins
- Decreases apolipoprotein CIII by enhancing catabolism and clearance of TG-rich particles
Fibrates
Which drug?
- Primary effect on TGs (lowers 35-50%)
- Decreases LDLs (5-20%)
- LDLs may increase in pts w/ elevated TGs
- Increase HDL (5-20%) w/ greater increase in severe hypertriglyceridemia
Fibrates
- The names of the 3 main fibrates
- Which one is important?******
- Fenofibrate
- Fenofibric acid
- _*****Gemfibrozil******_
SE of which drug?
- ****Increase LFTs (dose related)
- abd pain, HA
- *****Cholelithiasis
Fibrates (Fenofibrate, Gemfibrozil)
4 contraindications of Fibrates, which one is most important?
- Hepatic dysfunction
- ***Severe renal impairment (CrCl <30 ml/min)***
- Pre-existing gallbladder disease
- Breast-feeding
What 3 things should you monitor in pt taking Fibrates?
- LFTs (liver function tests)
- Renal function
- Lipid panel
Which drug?
Drug interactions:
- Statins* (increases risk of myopathies)
- Sulfonylureas (may enhance hypoglycemic effects)
- Warfarin (may enhance anticoagulant effect, so monitor INR)
Fibrates
Nicotinic Acid is NOT called what??
Nicotinamide
