Dyslipidemia Flashcards
PrevaLITE; Questran; Questran Light
CholesTYRAMINE
MOA: Bile ACID seq
SE: no systemic absorption
- constipation, bloating, nausea, gas
- Impaired absorption of fat-soluble vitamins
- SEPERATE FROM ALL MEDS*
Caution: may ^ TG. Dont use if > 400
Colestid; micronized colestipol HCL tab
Colestipol
Welchol
Colesevelam
MOA: BAS
TABS: max 6 tabs/day
used as add-on for TYPE 2 DM
Caution: caution in patients with HIGH TG, may increase TG
Niacin-50; Slo-Niacin; Niacor; Niaspan
Niacin/ nicotinic acid/ Vit B3
- ^ HDL
- DECREASE TC, LDL, VLDL, TG
SE: flushing and itching, GI DISTRESS, HEPATOTOXIC, HYPERGLYCEMIA, HYPERURICEMIA
- titrate slowly
- take AFTER MEALS
- 325mg of ASA 30-60 min PRIOR*
What meds can potentially increase URIC ACID?
1) Ethambutol + Pyrazinamide (TB)
2) Low dose ASA
3) Chemo drugs
Simcor
Simvastatin + Niaspan (ER)
AdviCOR
Lovastatin + Niacin
Lipitor
Max: 80mg/ day
Increase MYOPATHY w/ Inhibitors and fibrinic acid or niacin
Combos: Caduet and Liptruzet
Caduet
Amlodipine + Atorvastatin
LIPtruZET
Ezetimibe + Atorvastatin
Crestor
Max: 40mg/day
Max Asians: 20mg/day
Max: 10mg/d for RENAL pts.
- seperate from ANTAACIDS
- ^ INR
- ^ EE, , norgestrel, aldactone, tagmet, ketocon.
Only 10% met by CYP2C9
Lescol; Lescol XL
Fluvastatin
Max: 80mg/d
CYP2C9 substrate NOT 3A4 so not AS many DI!!
Mevacor; Altocor; Altoprev (ER)
Lovastatin
Max: 80mg/ d WITH FOOD in evening
$$ ME LOVE FOOD$$
DO NOT EXCEED 40mg/d when taking VERAPAMIL, AMIODARONE
Pravachol
Pravastatin
Max: 80mg/d
LESS potential for DRUG INTERACTIONS
Zocor
Simvastatin
Max: 40mg/d
Combo: vytorin (simvastatin + ezetimibe)
Vytorin
Simvastatin + zetia
Drug Interactions w/ SIMVASTATIN
DONT GIVE WITH STRONG 3A4 inhibitors: azoles, clarithromycin, erithromycin, HIV Protease inhibitors, gemfibrozil, Nefazodone, cyclosporine, danazol
Max 10mg/d: VERAPAMIL + DILTIAZEM
max 20mg/d: Amiodarone, AMLODIPINE, Ranolazine
GFJ: avoid more than 1 qrt/ d
Livalo
Pitavastatin
Max: 4mg/d
Watch out for some DI wirh rifampin and erythromycin
Dose EQUIV for STATINS
Rosuvastatin - 2.5mg
Atorvastatin - 10mg
Simvastatin - 20mg
Lovastatin - 40mg
Pravastatin - 40mg
Fluvastatin - 80mg
Pitavastatin - 2mg
Which statins should be given at NIGHT and which ones dont?
Fluvastatin, Lovastatin, Simvastatin: HS
Rosuvastatin, atorvastatin, pravastatin: ANY TIME
SE of STATINS
GI DISTRESS: most COMMON
HEPATOTOXIC: LFT AT BASELINE ONLY***
Myopathy —> leading to rhabdo
Pravastatin, fluvastatin, and low-dose rosuvastatin are LESS LIKELY to cause muscle symptoms
SE: slight ^ in sugar, REVERSIBLE MEMORY LOSS, upper RESP infections, Rash, Alopecia, HA, OCULAR EFFECTS
CONTRAINDICATIONS:
1) LIVER DISEASE
2) Alcoholism
3) CATEGORY X
4) BREAST FEEDING WOMEN
What to MONITOR for STATINS
LIPID PANEL: 4-12 wks after starting and then q3-12 months
LFT: @ baseline NO NEED FOR ROUTINE monitoring unless s/s of liver injury: Unexplained nausea, abdominal pain, jaundice, dark urine, pale stool
Muscle ACHES: check CPK if experiencing muscle aches
Statin METABOLISM & DI
CYP3A4: Lovastatin
Atorvastatin
Simvastatin
CYP2C9: Fluvastatin
Rosuvastatin
Hepatic: Pravastatin
**RED YEAST RICE: identical to LOVASTATIN. Concurrent use can increase ADVERSE EFFECTS.
- Increase BLEEDING w/ Warfarin
- May increase DIGOXIN levels
3A4 Inhibitors: antifungals, macrolides, NON-DHP CCB’s, Protease Inhibitors, GFJ
Adverse EFFECTS OF FIBRATES
Common: nausea, dyspepsia, abd pain
Less common: RASH, GALL BLADDER Stones( cholithiasis), myopathy if with STATIN
Avoid use w: SEVERE RENAL DF, LIVER DISEASE, GALL bladder disease
Lopid
Gemfibrozil
600mg BID 30 min BEFORE meals
SE: increase myopathy with STATINS
INCREASE INR
STRONG inhibitor
Trilipix; Fibricor
Fenofibric Acid
Trilipix: ONLY fibrate Approved for use with a STATIN
Tricor**,Lipofen, lofibra, Antara micronized, Triglide
Fenofibrate
Zetia
Ezetimibe
CHOLESTEROL ABSORPTION INHIBITOR
Indications: adjunct to diet, as monotherapy, or w/ statins
SE: back pain, joint pain, diarrhea, abd pain.
Lovaza
Omega-3-acid
EPA/DHA
Treats: adjunct to diet to reduce HIGH TG > 500
Dose: 4g QD or 2g BID
SE: bleeding, nausea, diarrhea, hypersen, rash
DI: may increase chance of bleeding
vascEPA
Icosapent ethyl
Eicosapentoic acid (EPA) in patients w/ TG > 500mg/dl
-only increasing EPA does not increase LDL like EPA/DHA combos cN.
Dose: 2 cap BID w FOOD
SE: Joint pain
DI: may prolong bleeding time
Caution: ShellFish ALLERGY
EPAnova
Omega-3-carboxylic acids
Indication: EPA + DHA
Dose: 4 caps QD
SE: D/N/ abd pain
Caution:** shellFISH allergy
** prolong BLEEDING time
OmTRYG
Indication: EPA/DHA
Dose: 4 caps QD or 2 caps BID
CAUTION: allergy to FISH/ SHELLFISH
Praluent
Alirocumab
MOA: Inhibit degradation of LDLR BY blocking PCSk9 from binding to LDLR
Class: PCSK9 Inhibitor
Dose: SQ once Q2 Weeks
SE: Diarrhea, LFT’s, influenza, myalgia, muscle spm
Repatha
Evolocumab
PCSK9 inhibitor -SQ- stored in refrigerator
Dose: 140mg Q2 weeks or 420mg once monthly
Administration: SQ
ACC/AHA GUIDELINES FOR STATINS
If LDL > 190 recommend HIGH-intensity unless > 75 YO
If age 40-75, LDL 70-189 w/ DIABETES, then recommend MODERATE intensity
If age 40-75, LDL 70-189 w/ 10 yr ASCVD risk > 7.5%, then MODERATE INTENSITY
If age 40-75, LDL 70-189, w ASCVD risk > 7.5 + Diabetes, then recommend HIGH INTENSITY STATIN
Serum TH levels from normal to not
< 150 : Normal
150-199: Borderline HIGH
200-499: HIGH
> 500: VERY HIGH
Which drug class DECREASES TG the MOST
Fenofibric acid: 41-53%
Which statin is the LEAST potent?
Lescol(Fluvastatin) is the least potent statin, decreasing LDL by 20-25%
Which medications can cause CHOLELITHIASIS(gall-bladder stones)
1) FIBRATES**
2) estrogen and COC
3) ceftriaxone
4) octreotide (sandostatin)
