Dyslipidemia Flashcards
Omega-3 MOA
- Lowers TG by 60%
- Unclear how exactly - decreases hepatic circulation of TGs OR decreases TG synthesis
ADEs of omega 3
Fishy burp
Indigestion
When are omega 3s given?
TG over 500 mg/dL
Cholesterol absorption inhibitor MOA and examples
Decrease intestinal absorption of dietary and biliary cholesterol
(Ezetimibe)
Metabolism of cholesterol absorption inhibitors
Glucuronidation w/an active metabolite
advantage - NO CYP
Which lipid lowering med is metabolized via glucuronidation (therefore no CYP interactions)?
Cholesterol absorption inhibitors
Cholesterol absorption inhibitors and ASCVD risk
Lowers LDL but NOT proven to lower ASCVD risk
Fibrates MOA and examples
- Activate PPAR-alpha (metabolism/catabolism of lipids)
- Gemfibrozil, fenofibrate
Nicotinic acid MOA
Decreases TG synthesis (maybe in adipose tissue?)
ADEs of nicotinic acids
Flushing, N/V, myopathy
How to combat flushing with nicotinic acid?
Take full dose of aspirin (325 mg)
Bile acid sequestrants MOA and examples
- Anion exchange resins that bind to bile acids (excreted in feces)
- Cholestyramine, colestipol
How are bile acid sequestrants metabolized?
Not absorbed or metabolized (excreted in feces)
ADEs of bile acid sequestrants
GI - flatulence, abdominal pain, constipation, N/V
Statins MOA
Inhibit HMG-CoA reductase (rate limiting step of cholesterol synthesis)
ADEs of statins
Dizziness, HA, abdominal pain, myopathy
Statins lowest to highest potency
Fat People Love Seconds At Restaurants
also the order of short to long half life
Which statin is NOT CYP metabolized?
Pravastatin (sulfation)
Which statin has LOW protein binding?
Pravastatin
Which statins are NOT lipophilic?
Pravastatin
Rosuvastatin
Substances that INCREASE statin concentrations
Nicotinic acid, fibrates Azole antifungals Macrolide abx Amiodarone Grapefruit juice ETOH
What labs should be checked at baseline prior to a lipid lowering med being added?
Fasting lipid panel
ALT
CK
Glucose (fasting or A1c)
What lab should be checked at baseline prior to adding niacin?
Uric acid
What lab should be checked at baseline prior to adding bile acid sequestrants?
TGs
What lab should be checked at baseline prior to adding fibrates?
Serum Cr or GFR
Factors useful for assessing ASCVD risk
Family hx
CRP over 2
CAC over 300
ABI less than 0.9
Factors that are NOT useful for assessing ASCVD risk
ApoB CKD Albuminuria Cardiorespiratory fitness Carotid intima media thickness (CIMT)
How should adults 20-79 yo w/o current ASCVD be screened?
Assess traditional risk factors every 4 to 6 years
How should adults 40-79 yo w/o current ASCVD be screened?
Estimate 10 yr ASCVD risk every 4-6 years
Patient education on prescribing a statin?
It is to reduce risk of heart attack and stroke
Patients on a statin should contact provider when what occurs?
Unexplained muscle pain
Change in urine color (dark brown)
Safety monitoring of statins
- ALT and AST (only as needed)
- Myopathy symptoms (test CK as needed)
What is the goal of treatment if TGs are over 1000 mg/dL?
Emergent! Avoid acute pancreatitis
- Goal is to decrease TG levels rather than long term prevention of ASCVD
- Use fibrates (niacin and omega 3 can also be considered)
How is the ASCVD 10 yr risk used?
ONLY in statin naive patients
What intensity statin in 40-75 yo and ASCVD over 7.5%?
Moderate OR high intensity
What intensity statin in 40-75 yo with DM?
Moderate intensity
What intensity statin in 21 yo or older and LDL over 190?
High
