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Pharm I ( Melicia) > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

Where is cholesterol made? From what?

A

in the liver

made from Acetyl CoA, breakdown product of free fatty acid

rate limiting step: HMG-CoA reductase

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2
Q

Risk factors for dyslipidemia

A

FLASH

  • fam hx
  • low HDL
  • Age (men >45, women >55)
  • smoking
  • HTN, CKD

risk equivalent to CHD= DM, CAD< PAD, AAA

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3
Q

Who benefits from statin therapy?

A

pts with clinical ASCVD

LDL >190

DM age 40-75 with LDL 70-189

LDL 70-189 + 10 yr ASCVD risk >7.5%

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4
Q

TLC to lower LDL and reduce CHD risk

A

reduce intake of saturated fats/cholesterol

increase fiber intake

weight loss

increase physical activity

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5
Q

Fibrates MOA

A

upregulate lipoprotein lipase

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6
Q

Statins MOA

A

interfere with HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol

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7
Q

Niacin MOA

A

decrease VLDL and LDL

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8
Q

Bile acid resins MOA

A

bind bile acids, thus increasing the secretion of cholesterol in the stool

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9
Q

Ezetimibe MOA

A

blocks the absorption of cholesterol from the small intestine

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10
Q

Which drugs provide high intensity statin therapy?

A

Atrovastatin 80 mg

Rosuvastatin 40 mg

lower LDL ~50%

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11
Q

Which drugs provide moderate intensity statin therapy?

A

Atrovastin 10 mg

Rousvastatin 20 mg

Simvastatin 20-40mg

Pravastatin 40mg

Fluvastatin 40 mg

Lower LDL ~30-50%

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12
Q

Which drugs provide low intensity statin therapy?

A

Pravastatin 10-20mg

Lovastatin 20mg

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13
Q

Which Statin has the greatest efficacy?

A

Rosuvastatin

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14
Q

Side effects of statin therapy

A

severe: rhabdomyolysis, hepatic failure
mild: arthralgia, myalgia, musculoskeletal pain, increase ALT/AST

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15
Q

Contraindications for statin therapy

A

liver disease, unexplained persistent elevation in ALT/AST, pregnancy, breast feeding

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16
Q

What should you monitor in a pt on a Statin?

A

LFTS, fasting plasma glucose

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17
Q

Atrovastatin drug interactions

A

3A4 inhibitors and inducers

avoid use with: antihepacivirals, Posaconazole, red yeast rice

  • also increases the effects of many drugs, which is why Rosuvastatin is generally the better choice
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18
Q

Rosuvastatin drug interactions

A

2C9 inducers and inhibitors

Avoid use with: Gemfibrozil, Read yeast rice, Ledipasvir or Voxilaprvir (antihepacivirals)

increases effect of Warfarin–> consider Atrovastatin if they need to be on Warfarin

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19
Q

What drug can you add in a pt currently on maximally tolerated statin therapy when additional LDL lowering is desired?

A

Ezetimibe- for <25% additional LDL lowering

PCSK9 inhibitor- >25% lowering ($$$)

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20
Q

Name a cholesterol Absorption Inhibitor (CAI), MOA?

A

Ezetimibe

inhibits cholesterol absorption in the small intestine

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21
Q

Ezetimibe contraindications

A

active hepatic disease, unexplained persistently elevated LFTs

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22
Q

How is Ezetimibe excreted?

A

~ 80% excreted in feces

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23
Q

Side effects of Ezetimibe?

A

severe: cholithiasis
mild: diarrhea, fatigue

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24
Q

What should you monitor in pts on Ezetimibe?

A

LFTs

myositis (rare)

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25
Name 2 PCSK9 inhibitors, MOA?
Alirocumab, Evolocumab (Repatha) abs that inhibits PCSK, reduce LDL in dose dependent manner (can lower up to 70%) give SQ every 2 weeks
26
Indications for PCSK9 inhibitors
adults with familial hypercholesterolemia those with ASCVD who need additional LDL lowering intolerance of statins
27
Side effects of PCSK9 inhibitors
hypersensitivity (rare), local rxn, URI sxs
28
Name a Microsomal Triglyceride Transfer Protein (MTP) inhibitor, MOA?
Juxtapid (Iomitapide) binds directly to and inhibits MTP, prevents assembly of apo-B containing-lipoproteins, reduces the production of chylomicrons and VLDL. Reduces LDL concentrations
29
Indication for MTP inhibitor?
homozygous familial hypercholesterolemia
30
Juxtapid (Iomitapide) side effects?
CP, GI, dyspepsia, V, abd pain, weight loss, constipation/flatulence
31
Contraindications for Juxtapid (Iomitapide)?
pregnancy, hepatic impairment
32
Juxtapid (Iomitapide) PK?
99.8% protein bound hepatic metabolism CYP3A4 renal elimination
33
Boxed warning for Juxatapid (Iomitapide)?
hepatotoxity only prescribed through restricted program called the Juxtapid Rems Program
34
What should you monitor in pts on Juxtapid?
transaminases (liver enzymes) baseline preg test
35
Why should someone on Juxtapid maintain a low fat diet?
to avoid GI effects
36
Mipomersen sodium (Kynamro) MOA?
inhibits apolipoprotein B-100 synthesis, used with other lipid lowering meds
37
Indication for Mipomersen sodium?
pts with homozygous familial hypercholesterolemia
38
Adverse rxns of Mipomersen sodium?
injection site rxn (Admin 200mg SQ/wk) flu like sxs
39
Mipomersen sodium contraindications?
hepatic impairment, unexplained persistent elevated LFTS, sensitivity to produce components
40
Boxed warning for Mipomersen sodium?
hepatotoxicity prescribed only through restricted program called Kynamro rems
41
What should you monitor in a pt taking Mipomersen sodium (Kynamro)?
ALT, AST, alkaline phosphatase, total bilirubin
42
fibrates MOA?
Upregulates lipoprotein lipase-> increases catabolism of VLDL, eliminates TG rich particles, fatty acid oxidation Modulation of apolipoproteins - increases catabolism/clearance of TG rich particles
43
Effects of fibrates?
35-50% lowering of TG 5-20% decrease in LDL (may increase in pts with elevated TG) 5-20% increase in HDL
44
Name 2 fibrates
Fenofibrate, Gemfibrozil
45
Side effects of Fenofibrate
Severe: acute renal failure, cholelithiasis mild: increase LFTs, abd pain, dyspepsia, HA< drowsiness
46
Fenofibrate contraindications
hepatic dysfunction, severe renal impairment, existing gallbladder disease, pregnancy, breast feeding
47
What should you monitor in pts taking Fenofibrate?
LFTs, renal function, Lipid panel
48
Fibrates drug interactions?
Statins- avoid combo (increases risk of myopathies) Sulfonylureas Warfarin
49
Nicotinic Acid MOA?
Inhibits synthesis & secretion of VLDL and LDL useful in most dyslipidemias
50
Effects of Nicotinic Acid?
LDL lowering 10-15% Increases HDL 15-35% TG lowering 25-30%
51
Niacin formulations?
OTC: Niacin (immediate and slow release) Rx: Niaspan (extended release)
52
Side effects of Nicotinic Acid?
severe: hepatotoxicity Mild: flushing/warmth/tingling (can take with NSAID), hyperglycemia, hyperurecemia
53
Contraindications of Nicotinic Acid
active hepatic disease, unexplained persistent elevated LFTs, active peptic ulcers, arterial hemorrhage
54
What should you monitor in a pt on a Nicotinic Acid?
LFTs, Lipid panel
55
Nicotinic Acid drug interactions?
anticoagulants (may increase bleeding time) Statins
56
Bile Acid Substrates (BASs) MOA?
cholesterol is a precursor to bile acids, BASs bind with bile acids in the intestine --> eliminates via feces
57
Effect of BASs?
decreases LDL 15-30% minimally increases TG and HDL
58
Name 2 BASs, when should they be taken?
Cholestyramine (Questran, Prevalite), Colestipol with meals
59
BASs contraindications? Side effects?
hypersensitivity Severe: bleeding with chronic use mild: abd pain, bloating, constipation, flatulence, nausea
60
What should you monitor in a pt taking BAS? Drug interactions
lipid panel will bing with other meds, decreasing their absorption administer meds 1 hr before or 4 hrs after BASs
61
Omega 3 Fatty Acids MOA? Name one.
uncertain, thought to inhibit VLDL and triglyceride synthesis in the liver Omega 3 Acid Ethyl Esters (Lovaza)
62
O3FA side effects? Contraindications?
Eructation "fish burp", dypepsia, increase in LFTs fish hypersensitivity
63
O3FA drug interactions?
anticoagulants and antiplatelets (may enhance bleeding time)
64
What should you monitor in a pt taking O3FA?
LFTs, lipid panel

Pharm I ( Melicia) (18 decks)

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