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Pharmacology > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

High Intensity Statin Therapy

A

Atorvastatin

Rosuvastatin

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2
Q

Moderate Intensity Statin Therapy

A 
Atorvastatin
Rosuvastatin
Simvastatin
Pravastatin
Lovastatin
Fluvastatin
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3
Q

Low-Intensity Statin Therapy

A

Pravastatin
Lovastatin

Simvastatin
Fluvastatin
Pitivastatin

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4
Q

Lipoprotein Lowering Medications

A

Bile acid sequestrates:
Cholestyramine (Questran), colestipol, colesevelam
Nicotinic Acid
Fibric acid derivatives (incrase breakdown of VLDLs): Gembibrozil, Fenofibrate, Clofibrate
Ezetimibe (Zetia)- inhibits cholesterol absorption from BB
Combo therapy: Statin and Ezetimibe; Statin and bile acid sequestrate; statin and fibrin acid derivatives; statin and niacin

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5
Q

Drug interactions

A 
Lovastatin & Simvastatin
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Erythromycin
Clarithromycin (Biaxin)
Gemfibrozil
Grapefruit juice
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6
Q

Other drug combinations with statins

A 
Niacin
Gemfibrozil
Cyclosporin
HIV protease inhibitors
Verapamil
Amiodarone
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7
Q

Drugs to avoid with pregnant or nursing women

A 
Statins
Ezetimibe
Niacin
Fibric acid derivatives
Bile acid-binding resins are currently the only lipid-lowering medication safe to use during pregnancy
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8
Q

Potential Future Therapies

A

Cholesteryl ester transfer protein inhibitors (CETP)
Exchanges lipoprotein particles in a reverse cholesterol transport process
Significant ↓ in LDL & ↑ in HDL
Anacetrapib & Dalcetrapib
Eprotirome
Thyroid hormone analog
Mediates lipid-lowering activity of thyroid hormone
Up to 30+% reduction of LDL (& other lipoproteins) in patients on statins
Microsomal triglyceride transfer protein inhibitor
Reduces the secretion of VLDL (precursor to LDL) in the liver
Up to 50% reduction in plasma LDL levels
Mipomersen
May reduce plasma levels of lipoprotein A
Being tested in severe hypercholesterolemia & statin-intolerant patients

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9
Q

Intensity of Statin Therapy is based on

A

Presence of Clinical ASCVD
Risk of Developing ASCVD
Presence of Diabetes with/without hyperlipidemia
Presence of isolated hyperlipidemia (genetic component)

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10
Q

Combination medications for lipoprotein lowering medications

A 
Statin & Ezetimibe
Approximately 25% reduction in LDL
Statin & Bile Acid Sequestrant
Approximately 8 -16% reduction in LDL
Statin & Fibric Acid Derivatives
Primarily assist in ↓ triglycerides
↑ risk of myopathies
Contraindicated with severe hepatic disease
Statin & Niacin
↑ risk of hepatic dysfunction
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11
Q

Hyperlipidemia

A

Hypercholesterolemia
Hypertriglyceridemia
Elevated LDL

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12
Q

Physical Examination

A 
Xanthelasma
Circumferential arcus
Peripheral vascular disease
Shiny extremities
Discoloration of skin
Hairlessness
Thickened Achilles
Hypertension
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13
Q

Cholesterol Levels

A 
Total Cholesterol Level
Desirable < 200 mg/dl
Borderline 200 to 239 mg/dl
High > 240 mg/dl
HDL Level
Low < 40
High >60
LDL Cholesterol
Optimal < 100
Near optimal 100-129
Borderline High 130-159
High 160-189
Very High >190
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14
Q

Primary Hyperlipidemia

A

Genetic (or inherited) heterozygous condition resulting in elevated total cholesterol level or triglyceride level.
Total cholesterol usually > 200, triglycerides often > 500
Often referred to as
Familial hypercholesterolemia
Familial hypertriglyceridemia
Necessary to obtain a thorough family history

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15
Q

Secondary Hyperlipidemia

A 
Diabetes
Hypothyroidism
Obstructive liver disease
Chronic renal failure
Drugs that ↑ LDL & ↓ HDL
Progestins
Corticosteroids
Anabolic steroids
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16
Q

Dietary influences

A

HDL:
Elevated by alcohol, saturated fats, weight loss
Lowered by low fat diet, sugar, excess calories, excess polyunsaturated fats
LDL:
Elevated by saturated fat, trans fatty acids, & dietary cholesterol
Lowered by MUFAs, complex carbohydrates, & soy
Total cholesterol:
Elevated by saturated fats & trans fatty acids
Lowered by substituting MUFAs & complex carbohydrates for saturated fats; lowered by soy
Triglycerides:
Elevated by alcohol, sugar, high carbohydrate diet, & excess calories
Lowered by weight loss & fish oils

17
Q

Four main categories established for statin therapy for secondary prevention of ASCVD

A

Clinical ASCVD
LDL ≥ 190
Diabetes
≥ 7.5% Estimated 10-yr ASCVD risk

18
Q

Benefits of statin therapy

A

Moderate intensity statin therapy
~30-50% reduction in LDL
High intensity statin therapy
≥50% reduction in LDL
Statin therapy in general reduces the risk of ASCVD across the spectrum for all those with LDL > 70
Statin therapy recommended for all those who would experience a net benefit of ASCVD risk reduction & the potential for adverse effects

19
Q

Statin therapy

A 
Lovastatin (Mevacor)   
Rosuvastatin (Crestor)
Simvastatin (Zocor)      
Pravastatin (Pravachol)
Atorvastatin (Lipitor)    
Fluvastatin (Lescol)
20
Q

Statin therapy goals

A

Inhibit the rate-limiting enzyme in the formation of cholesterol. Effect is to ↓ LDLs, ↓ TGs, & ↑ HDLs

21
Q

Statin Therapy for Clinical ASCVD

A

Age ≤ 75 should receive high-intensity statin

Age > 75, or with contraindications to high-intensity therapy should receive moderate-intensity statin

22
Q

Statin Therapy for Primary Hyperlipidemia

A

Patients with LDL ≥ 190
Reduction of LDL by 39 mg/dl reduces ASCVD by approx 20%
May require additional use of non-statin lipid lowering agents to achieve acceptable lipid reduction
Assess need for addressing hypertriglyceridemia

23
Q

Statin Therapy for Diabetes

A

Data from RCTs is for patients 40-75 with either Type 1 or 2 DM & LDL < 190
Benefits of statin therapy are substantial
Moderate-intensity therapy acceptable
High-intensity therapy if 10yr ASCVD risk > 7.5%

24
Q

Secondary treatment goals

A

Treat elevated triglycerides
If triglycerides are > 200 & LDL goal has been achieved, add additional treatment for TGs
Treat low HDLs (<40)

25
Q

4 statin Therapy Groups:

A

Clinical ASCVD
LDL > 189
Individuals 40-75 with Diabetes & LDL 70-189 without ASCVD
Individuals 40-75 with Diabetes & LDL 70-189 & a 10-year ASCVD risk of 7.5% or higher

26
Q

Intensity of statin therapy based on:

A

Presence of Clinical ASCVD
Risk of Developing ASCVD
Presence of Diabetes with/without hyperlipidemia
Presence of isolated hyperlipidemia (genetic component)

Pharmacology (9 decks)

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