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Pharm I Fall 2016 NUNM Jensen > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

What is the MOA for statins?

A

They inhibit HMG-CoA reductase, a vital step in cholesterol synthesis. The liver then increases cholesterol uptake by increasing the number of LDL receptors

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2
Q

Statin: indications?

A

First-line therapy for primary and secondary prevention of ASCVD
Familial hypercholesterolemia

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3
Q

Statin: contraindications?

A

Active liver disease, pregnancy (cat. X), breast feeding

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4
Q

Statin: side effects?

A

Myopathy, increase in liver enzymes, nausea, ha

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5
Q

Statin: onset?

A

Varies, peak effect in a few weeks

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6
Q

Statin: interactions?

A

Red yeast rice (redundant), Niacin, alcohol, grapefruit, st. john’s wort, sweet orange

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7
Q

Ezetimibe: MOA?

A

Prevents absorption of dietary and biliary cholesterol

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8
Q

Ezetimibe: indications?

A

Adjunctive therapy in homozygous familial hypercholesterolemia and primary hyperlipidemia
Typically used when statin intolerant

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9
Q

Ezetimibe: contraindications?

A

Pregnancy (cat. C) or breast feeding

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10
Q

Ezetimibe: side effects?

A

Increase in liver enzymes

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11
Q

Ezetimibe: metabolism?

A

~30% undergoes glucuronide conjugation in the SI and liver

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12
Q

Ezetimibe: interactions

A

It would lower effectiveness of green tea, O3FA, sitostanol and beta-sitosterol

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13
Q

Fibrates: MOA?

A

Lower production and increased clearance of VLDL
Increased HDL production
Lowers TG

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14
Q

Fibrates: indications?

A

Hypercholesterolemia or mixed dyslipidemia as adjunct therapy or monotherapy in pts who can’t tolerate statins
Hypertriglyceridemia first-line pharmacotherapy

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15
Q

Fibrates: contraindications?

A

Active liver disease, severe renal impairment or ESRD and pre-existing GB disease, and breast feeding

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16
Q

Fibrates: side effects?

A

Dyspepsia, gallstones, myopathy (increased risk with statins)

17
Q

Fibrates: interactions?

A

Red yeast rice, niacin, alcohol

18
Q

Gemfibrozil increases risk for what side effect when used with statin therapy? and how can we assess severity of this effect?

A

Myopathy

CK

19
Q

Niacin: MOA?

A

Unclear, but..it increases lipoprotein lipase activity, enhancing removal of triglycerides from plasma.
Reduces TG synthesis
Increases HDL-C levels

20
Q

Niacin: indications?

A

Hypercholesterolemia or mixed dyslipidemia as adjunct therapy for pts who do not tolerate fibrates or O3FA, or as monotherapy for pts who do not tolerate statins, BAS, or fibrates
Hypertriglyceridemia second-line pharmacotherapy

21
Q

Niacin: contraindications?

A

Active liver disease, gout, peptic ulcer disease

22
Q

Niacin: side effects?

A

Hepatotoxicity, hyperglycemia, hyperuricemia, upper GI distress, flushing itching

23
Q

Niacin: interactions?

A

Red yeast rice, alcohol

24
Q

Niacin causes flushing, the extended release form has less flushing as a side effect. However, it is not used very often because of an increased risk for what major side effect?

A

Hepatotoxicity > Acute necrosis

25
Q

Omega-3 fatty acids: MOA?

A 
Inhibits the release of FA from adipose tissue.
Inhibits beta oxidation of hepatic FA.
Inhibits FA synthesis
Increases VLDL clearance
Lowers TG and increases HDL
26
Q

Omega-3 fatty acids: indications?

A

Hypertriglyceridemia second-line pharmacotherapy

27
Q

Omega-3 fatty acids: contraindications?

A

Hypersensitivity to fish oil

28
Q

Omega-3 fatty acids: side effects?

A

Eructation, nausea, dyspepsia, taste changes, and may increase bleeding time.

29
Q

Bile Acid Sequestrants (BAS): MOA?

A

Resins bind bile acid in the intestine. This reduces enterohepatic recycling.
Increases hepatic conversion of cholesterol to bile acid. Up regulates LDL receptors on the liver

30
Q

Bile Acid Sequestrants (BAS): indications?

A

Hypercholesterolemia for high risk patient who are statin-intolerant or are on maximal tolerated doses of statins

31
Q

Bile Acid Sequestrants (BAS): contraindications?

A

TG > 300 mg/dL

complete biliary obstruction

32
Q

Bile Acid Sequestrants (BAS): side effects?

A

Constipation, abdominal discomfort, intestinal gas, dyspepsia, heartburn, diarrhea

33
Q

BAS and ezetimibe both work in the intestine to lower absorption of cholesterol. What change occurs in the liver to lower LDL?

A

Increase in LDL receptors

34
Q

Bile Acid Sequestrants (BAS): interactions?

A

Niacin absorption may be hindered

Pharm I Fall 2016 NUNM Jensen (11 decks)

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