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NAPLEX Review > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

Triglycerides > _____ can cause pancreatitis

A

500

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2
Q

How to calculate non-HDL cholesterol

A

Non-HDL = Total - HDL

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3
Q

How to calculate LDL cholesterol and when should this equation not be used

A

LDL = TC - HDL - TG/5

Do NOT use this if TG > 400

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4
Q

What drugs can increase LDL and TG?

A

Diuretics, efavirenz, steroids, immunosuppressants, atypical antipsychotics, protease inhibitors, retinoids

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5
Q

What drugs can increase LDL

A

Fish oils (except Vacepa), anabolic steroids, fibrates, progestins, STLG2 inhibitors

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6
Q

What drugs can increase TG

A

IV lipid emulsions, propofol, bile acid sequestrants (~5%), estrogen, tamoxifen, clevidipine, beta-blockers

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7
Q

Goal levels for Non-HDL, LDL, HDL, TG

A

Non-HDL: <130
LDL: <100 (>190 is very high)
HDL: >40 (men) >50 (women)
TG: <150 (>500 is very high)

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8
Q

What lipid test can be falsely elevated if the patient did not fast?

A

TG

Can cause incorrect LDL calculation

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9
Q

What does ASCVD risk calculation estimate? What is the cutoff for a low score?

A

Risk of having a first CV event in the next 10 years

<7.5% is low

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10
Q

A coronary artery calcium score of ____ indicated a statin should be initiated

A

> 100

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11
Q

What 3 patient populations should always have a statin initiated

A

Clinical ASCVD
Diabetes
LDL > 190

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12
Q

OTC fish oils can reduce ____ but raise ____

A

lower TG

Increase LDL

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13
Q

Statins are the drug of choice in treating what?

A

High non-HDL and LDL

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14
Q

What are second line therapies if statins cannot be used?

A

ezetimibe and PCSK9 inhibitors

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15
Q

What are the statin benefit groups?

A

Clinical ASCVD - High intensity
LDL >190 - High intensity
Diabetes and 40-75 with LDL 70-189 - moderate/high
40-75 with LDL 70-189 - moderate (ASCVD risk 7.5-19.9%) or high (ASCVD risk >20%)

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16
Q

Which cholesterol lowering medications should not be used if AST/ALT are >3 times ULN?

A

niacin, fibrates, statins and ezetimibe

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17
Q

Statin MOA

A

inhibit HMG-CoA reductase, preventing conversion of HMG-CoA to mevalonate (rate limiting step for cholesterol synthesis)

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18
Q

What are the moderate intensity statin doses?

A

Pharmacists Rock AT Saving Lives and PReventing Fatty-deposits

Pitava 2
Rosuva 5
Atorva 10
Simva 20
Lova 40
Prava 40
Fluva 80
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19
Q

When can you see muscle pain from statins?

A

Any time but usually within 6 weeks

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20
Q

Myalgias vs myopathy vs myositis vs rhabdo?

A

Myalgias: soreness and tenderness
Myopathy: weakness +/- CPK elevations
Myositis: inflammation
Rhabdo: CPK >10,000 + muscle protein in the urine (myoglobinuria) which can lead to acute renal failure

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21
Q

What simvastatin dose is associated with myalgias?

A

Simva 80mg/d

22
Q

What cholesterol lowering medication interacts with statins and causes myalgias?

A

Gemfibrozil

23
Q

Statin contrindications

A

Pregancy
Use with strong CYP3A4 inhibitors (simva and lova)
Liver disease

24
Q

What factors increase risk of myopathy with statins?

A

higher dose, advanced age (>65), niacin, CYP3A4 inhibitors, hypothyroidism (uncontrolled), renal impairment

25
When to check lipid panel after starting statin
4-12 weeks then every 3-12 months
26
What statins MUST be taken at night?
Lovastatin, fluvastatin and simvastatin
27
What statins have less drug interactions than other statins?
Rosuva and prava
28
Significant drug interactions with statins
``` G-PACMAN Grapefruit Protease inhibitors Azole antifungals Cyclosporine/cobicistat Macrolides (except azithromycin) Amiodarone Non-DHP CCBs ```
29
What should you add on if a patient is on a statin max dose and their LDL is still > 70?
Ezetimibe (preferred) or PCSK9 inhibitor
30
What should you add on if a patient is on a statin max dose and has primary hypercholesterolemia (LDL >190) and their LDL remains >100?
Ezetimibe (preferred) or PCSK9 inhibitor
31
What do fish oils and fibrates target?
high TG
32
Ezetimibe drug interactions
Cyclosporine: increases concentration of both statin and cyclosporine Bile acid sequestrants: decrease ezetimibe concentration, separate 2 hours before or 4 hours after bile acid sequestrants Increased risk of gallstones with fenofibrate and gemfibrozil (do NOT use with gemfibrozil)
33
Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) inhibitors MOA
LDL receptors clear the circulating LDL PCSK9 enzyme increases LDL receptor degredation PCSK9 inhibitors prevent the degradation of LDL receptors resulting in dramatic reduction in LDL (60%)
34
PCSK9 inhibitor medications and biggest downfall
Alirocumab (Praluent) Evolocumab (Repatha) EXPENSIVE (~$14,000 per year)
35
How are PCKS9 inhibitors administered and what are the most common side effects?
SQ every 2 weeks or monthly | SE: injection site reactions
36
Bile acid sequestrant/binding resins MOA
binds to bile acid and forms a complex that is not reabsorbed by enterohepatic circulation and is excreted in the feces
37
What drugs are bile acid sequestrants/binding resins?
Cholestyramine Colesevelam (Welchol) Colestipol
38
Contraindications for bile acid binding resins
Cholestyramine: biliary obstruction Colesevelam: bowel obstruction, TG > 500, hx of hypertriglyceridemia induced pancreatitis
39
Bile acid binding resin side effects and clinical pearls
SE: constipation, abdominal pain, cramping, bloating, gas, INCREASED TG Not recommended if TG > 300 Colesevelam can be used in pregnancy
40
Bile acid sequestrant drug interactions
Colesevelam - fewest drug interactions For cholestyramine or colestipol - take all other drugs 1-4 hours before or 4-6 hours after Warfarin: can affect INR Decrease absorption of fat soluble vitamins (ADEK), folate, and iron
41
Fibrates MOA
peroxisome proliferator receptor apha activators which upregulate expression of apolipoprotein C2 and A1. ApoC-II increases lipoprotein lipase activity leading to catabolism fo VLDL particles (decreases TG)
42
Fibrate contraindications
severe liver disease CrCl <30 Gallbladder disease concurrent use of repaglinide or simvastatin (gemfibrozil only)
43
Fibrate warnings, SE
Myopathy (esp when given with statin), cholelithiasis, reversible increase in SCr SE: dyspepsia (gemfibrozil), increased LFTs, increased LDL when TG are high
44
What medications are fibrates?
fenofibrate, gemfibrozil
45
Fibrate drug interactions
Gemfibrozil should not be given with ezetimibe or statins - myopathy and rhabdo Colchicine - increase risk of myopathy Repaglinide - contraindicated d/t hypoglycemic effects Sulfonylureas and warfarin - increased effects when administered with fibrates
46
Niacin contrindications
Active liver disease | PUD o arterial bleeding
47
Niacin Warnings SE, clinical pearls
Warnings: rhabdo, hepatotoxicity, increased BG, increased uric acid SE: flushing, pruritus, vomiting, diarrhea, increased BG, hyperuricemia IR niacin - flushing/itching CR/SR - more hepatotoxicity
48
How to reduce flushing/itching with niacin
ASA 325 mg (or ibuprofen 200mg) 30-60 minutes before the dose With food Avoid spicy food, alcohol, and hot beverages
49
When are fish oils indicated?
in addition to diet changes when TG > 500
50
Lomitapide MOA and indication
decreases apoB by binding to and inhibiting microsomal triglyceride transfer protein Indication: homozygous familial hypercholesterolemia
51
Bempedoic acid MOA adn indication
inhibits cholesterol synthesis by inhibiting adenosine triphosphate-citrate lyase (ACL) Indication: heterozygous familial hypercholesterolemia and in ASCVD requiring additional LDL lowering
52
Lomitapide boxed warning and contraindications
BBW: hepatotoxicity Contraindication: active liver disease, pregnancy

NAPLEX Review (79 decks)

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