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Pharm Exam I > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

MOA of Omega 3’s

A

Unknown

dec. hepatic circulation vs. dec. TG synthesis

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2
Q

ADE Omega 3’s

A

FISHY BURP
indigestion
altered taste

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3
Q

Omega 3’s Lab effects:

A

Dec. TG by 60%

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4
Q

Cholesterol Absorption Inhibitors

drug name

A

Ezetimibe

Zetia, Vytorin (from the ppt)

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5
Q

MOA Cholesterol Absorption Inhibitors

ezetimibe, zetia, vytorin

A

dec. intestinal absorption of DIETARY and BILIARY cholesterol

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6
Q

ADE Chol. Absorption Inhibitors

A

Diarrhea, upset stomach, musculoskeletal, sinusitis and infections

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7
Q

Metabolism of Ezetimibe, Zetia, Vytorin

A

Glucuronidation active metabolite

NOT CYP450- advantage

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8
Q

Lovaza
Supplements
Fatty Fish
Drug class?

A

Omega 3 Fatty Acids

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9
Q

Fibrates Drug names

A

Gemfibrozil
Fenofibrate

Lofibra, Lipoforr, Trilipix, Tricor (from ppt)

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10
Q

MOA Fibrates

A

Activate PPAR-a, which modulates metabolism and catabolism of lipids
(RNA/DNA transcription)

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11
Q

ADE Fibrates

A

Abd. pain, nausea, inc SCr, inc transaminases, Myopathy

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12
Q

Metabolism Pathway of Fibrates

A

Hepatic metabolism, renal excretion (conjugated)

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13
Q

Fibrates place in therapy

A

2nd line for pts who can’t take Statins

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14
Q

Nicotinic Acid class

A

Nicotinic Acid
Niacinamide
Niacin
Niaspan (from ppt)

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15
Q

MOA Nicotinic Acid

A

? in adipose tissue, dec. TG synthesis

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16
Q

ADE Nicotinic Acid

A

FLUSHING

n/v, inc. transaminases, myopathy

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17
Q

How to dec. the flushing of nicotinic acid?

A

Take aspirin (325 mg) 30 min prior to nicotinic acid

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18
Q

Metabolism of Nicotinic acid

A

Hepatic Conjugation

renal excretion

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19
Q

Classes that use hepatic metabolism and renal excretion?

A

Fibrates and Nicotinic Acid

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20
Q

Bile Acid Sequestrants

drugs

A 
Cholestyramine (powder- mix in 8 oz H20)
Colestipol (p, tablet)
Colesevelam (p,t)
Colestid
Questran
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21
Q

MOA Bile Acid Sequestrants

A

Anion exchange resins in GI tract that bind to bile acids

helps to excrete in feces

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22
Q

ADE Bile Acid Sequestrants

A 
Abd Pain
constipation
flatulance
n/v
**GI Effects**
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23
Q

Place in therapy for bile acid sequestrants

A

2nd line for selected pts

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24
Q

Statin drugs

A 
fluvastatin
pravastatin
lovastatin
simvastatin
atrovastatin
rosuvastatin
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25
Q

MOA statins

A

inhibit HMG- CoA reductase

at rate limiting step in chol. synthesis, block step, block pathway

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26
Q

ADE statins

A

dizzy, h/a, abd pain

nausea, inc. transaminases, myopathy

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27
Q

Bile Acid Sequestrants DI

A

interfere with many drugs so take 1-2 hours AFTER other meds or other meds 4-6 hours AFTER resin

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28
Q

Statin effects

A 
plaque stability
angiogenesis
vascular cytoprotection
anti-oxidant
immunomodulary
anti-inflammatory
anti-thrombic
endothelial fxn
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29
Q

Order statins in low to high potency

A

Fluva, Prava, Lova, Simva, Atorva, Rosuva

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30
Q

Which statins are lipophilic?

A

Fluva, Lova, Simva, Atorva

so they’re good concern w/myopathy

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31
Q

Which statins are not lipophilic?

A

Prava, Rosuva

32
Q

Which statin is not metabolized through the CYP450 pathway?

How it is metabolized?

A

Pravastatin

by sulfation

33
Q

Long half life statins?

A

Atorva, Rousuva

34
Q

Dose which statins at night?

A

The lower doses:

Fluva, prava, lova, simva!

35
Q

Which statin has an inactive metabolite?

A

Pravastatin

36
Q

High intensity statins lower LDL by

A

> 50%

again: atorva, rosuva

37
Q

Moderate Intensity Statins lower LDL by

A

30-50%

38
Q

Low Intensity lower LDL by

A
39
Q

Old way of Tx

A
  • set LDL goal
  • Tx to target
  • use whatever works until LDL
40
Q

New way of Tx

A

Follow the high quality evidence from RCTs

41
Q

Lifestyle Modifications:
Diet
Exercise

A

Always: veggie, fruit, whole grains
Sometimes: low fat dairy, poultry, fish, legumes, nontropical oil, nuts
Rarely: sweets, sweet beverage, red meat
Exercise: 3-4x/wk, 40 min, mod to vigorous intensity

42
Q

Diet elevated LDL

A

weight gain
saturated/trans fat
anorexia

43
Q

Diet elevated TG

A

** Excess ETOH

Wt. gain, low-fat diet, refined carbs

44
Q

Drugs that elevate LDL

A

**steroids, diuretics, cyclosporine, amiordarone

45
Q

Drugs that elevate TG

A

**Glucocorticoids
**Protease inhibitors
**anabolic steroids
**sirolimus
thiazide diuretics, estrogen, bile acid sequestrant, ralozifene, tamoxifen, beta blockers

46
Q

Disease that elevate LDL

A

Nephrotic Syndrome

Biliary Obstruction

47
Q

Disease that inc. TG

A

Nephrotic syndrome
chronic renal failure
lipodystrophies

48
Q

Altered metabolism elevate LDL

A

hypothyroidism
obesity
pregnancy

49
Q

altered metabolism to elevate TG

A

hypothyroidism
obesity
pregnancy
poor controlled DM- consider stabilize DM before TG

50
Q

comorbidities- renal/hepatic dysfxn
hx of statin intolerance or muscle disorder
unexplained ALT elevation > 3x ULN
age over 75 years

A

Factors predisposing individuals to adverse events

excluding DI

51
Q

Drug interactions that increase statin concentrations

aka inc risk of ADE

A 
nicotinic acid, fibrates
cyclosporine, azole antifungals
macrolids, protease inhibitors
verapamil, amiodarone
grapefruit juice, alcohol
52
Q

baseline labs to check

A 
fasting lipid panel (for statin intensity)
alanine aminotransferase (ALT)
creatine kinase (CK)
fasting blood glucose/ A1c for DM
53
Q

drugs to check for classes other than statins

A

uric acid (niacin)
triglycerides (bile acid sequestrants bc they inc TG)
serum Cr/ GFR (fibrates)

54
Q

ACVD 10 year risk score is specific to what 4 categories?

A

Male and female

White and AA populations

55
Q

what factors are used in the pooled cohort other than gender and race?

A

Age, SBP, smoking, DM, HDL, total cholesterol, meds for BP

56
Q

asses ASCVD risk factors every:

A

4-6 yrs in adults 20-79 yo w/o hx of ascvd

57
Q

estimate 10 yr risk every 4-6 years in pts

A

40-79 yo w/o hx of ascvd

58
Q

what are the 3 statin benefit risk groups

A
  1. LDL >= 190, age 21+
  2. DM + Age 40-75 yo
  3. ASCVD >= 7.5% and age 40-75yo
59
Q

Dizziness points

A

less noticeable if take pill at night
lessens with time
SE not harmful if tolerable

60
Q

STOP taking statins if:

A

There is a change in urine color to dark brown! this is rare and shows renal failure

61
Q

How long on statin before benefit?

A

2-5 years! but it decreases LDL in 6-8 wks

62
Q

if LDL is less than _____, it is reasonable to reduce the intensity.

A

40 mg/dl

63
Q

monitor LFT’s

A

w/in first 3 months
if elevated usually resolves with d/c

ALT/AST elevation = normal

64
Q

monitor symptoms of myopathies

A

CK labs
severe if CK is 10x normal- if yes it will progress to rhabdomyolitis and kidney failure
mc with DI to inc statin conc.

65
Q

What is an alternative to statin for Men at risk for ASCVD?

A

1st Colestipol before meal

2nd Gemfibrozil

66
Q

What is a statin alternative for a HIGH risk MALE?

A

1st Cholestyramine

67
Q

Male or female with T2DM, w/ or w/out renal impairment.

Alternative to statin?

A

Micronized fenofibrate

68
Q

Male or female with established ASCVD.

Alternative to statins?

A

Gemfibrozil

Colestipol

69
Q

What is important to remember about the pooled cohort equation?

A

Only designed for naive pts.

70
Q

How do you tell if your pt on lipid lowering meds can benefit from a higher intensity?

A

-titrate up as tolerated by pt
use opposite method if you think the intensity can be lowered and consider removing the non statin if pt is on more than one drug

71
Q

TG over 1000 mg/dL

now what?

A

PREVENT PANCREATITIS. more than prevent ASCVD.
1st Line = FIBRATES
2nd Line= niacin and omega 3

lifestyle mod: d/c etoh, d/c meds that inc TG, tx uncontrolled DM

72
Q

Pt has clinical ASCVD they need _____ intensity

A

HIGH intensity

A-grade recommendation

73
Q

Pt has LDL >= 190 and over 21 yrs old

they need a ______ intensity statin

A

HIGH!!

B-grade recommendation

74
Q

Pt has DM and is 40-75 yo

They need a ______ intensity

A

MODERATE intensity
A- grade

(if same pt ASCVD risk >7.5%– HIGH intensity)

75
Q

ASCVD >= 7.5% and Age 40-75 yo

A

MODERATE or HIGH intensity
A-grade
assess the other risks!

76
Q

What can you use if the ASCVD risk assessment is unclear?

A

Family history
hs-CRP >= 2 mg/ml
CAC score >= 300
ABI

77
Q

What factors have uncertainty for the ASCVD risk calculation?

A 
ApoB
CKD
Albuminurea
Cardiorespiratory fitness
Carotid intima media thickness (CIMT)

Pharm Exam I (3 decks)

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