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OU Module Cardio Spring 2018 > Dyslipidemia drugs > Flashcards

Dyslipidemia drugs Flashcards

1
Q

statin MOA

A

primarily works by interruption of the conversion of HMGCoA to mevalonate, which is the rate limiting step in cholesterol biosynthesis; Also reduce CoQ10; if pt takes CoQ10 supplements, that can reduce chance of myalgia

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2
Q

bile acid sequestrants MOA

A

Binds bile acid in the intestinal lumen, which reduces enterohepatic circulation of bile acids. Indirectly increases clearance of LDL and decreases absorption; can bind co-administered drugs in the gut -> take 1hr before or 4hr after dimer

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3
Q

niacin MOA

A

Reduces hepatic synthesis of VLDL which leads to reduces synthesis of LDL; Reduces HDL catabolism; Nicotinic acid affects lipids but nicotinamide does not

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4
Q

fibrates MOA

A

Not fully understood, but appears related to PPARα which may increase lipoprotein lipase enhancing TG clearance and increase apoA expression which will increase HDL

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5
Q

ezetimibe MOA

A

blocks cholesterol absorption across intestinal border

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6
Q

omega-3 fatty acids MOA

A

EPA and DHA compete for the enzymes that cause TG synthesis  less TG synthesis, enhance TG clearance

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7
Q

PCSK9 inhibitors MOA

A

Human monoclonal antibody to PCSK9 (proprotein convertase subtilisin kexin type 9, a protein that degrades the LDL receptor). Binds to PCSK9 and increases the number of LDL receptors available to clear circulating LDL.

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8
Q

omega-3-acid ethyl esters brand name

A

Lovaza

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9
Q

omega-3-acid ethyl esters dose

A

2-4 g/day (in 1 or 2 daily doses)

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10
Q

omega-3-acid ethyl esters ADR’s

A
  • Dyspepsia and belching

- Thrombocytopenia and bleeding disorders (especially in high doses)

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11
Q

omega-3-acid ethyl esters precautions / contraindications

A
  • Caution with agents which can increase bleeding risk (drug interaction)
  • CI: allergy to fish or shellfish
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12
Q

safety monitoring for omega-3-acid ethyl esters

A

monitor LFTs at baseline and 6-12 months after initiation

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13
Q

cholestyramine brand name

A

Questran

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14
Q

cholestyramine dose

A
  • initial: 4 g 1 to 2 times/day
  • maintenance: 8 to 16 g/day divided in 2 doses
  • max 24g/day
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15
Q

cholestyramine ADR’s

A
  • constipation
  • bloating
  • epigastric fullness
  • nausea
  • flatulence
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16
Q

cholestyramine precautions / contraindications

A
  • constipation

- complete biliary obstruction

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17
Q

safety monitoring for cholestyramine

A

no specific labs required b/c no systemic effects; completely in gut (no liver)

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18
Q

drug interactions with cholestyramine

A

decreases F

  • warfarin
  • niacin
  • ezetimibe
  • thyroxine
  • acetaminophen
  • hydrocortisone
  • HCTZ
  • loperamide
  • iron
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19
Q

vitamin B3 (aka nicotinic acid) brand name

A

Niacin

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20
Q

vitamin B3 dose

A
  • Start at 500 mg QHS
  • titrate up 250-500 mg monthly
  • target 1.5-2g daily
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21
Q

vitamin B3 ADR’s

A
  • cutaneous flushing and itching
  • dyspepsia
  • elevated LFT’s
  • hyperuricemia
  • hyperglycemia
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22
Q

vitamin B3 precautions / contraindications

A
  • Active liver disease
  • Active peptic ulcer disease
  • Active bleeding
  • Pregnancy
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23
Q

How can you manage flushing caused by vitamin B3?

A
  • take ASA 325 30min before niacin
  • take with food
  • titrate dose
  • use SR
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24
Q

drug interactions with vitamin B3

A
  • Bile acid sequestrants bind niacin and must separate administration
  • statins w/ niacin increase risk of myopathy
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25
Q

safety monitoring for vitamin B3

A
  • measure CK at baseline and if clinically indicated based on signs and symptoms
  • measure LFTs, uric acid, and glucose at baseline and repeated in 6-12 weeks if on 1000 mg/day or more
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26
Q

fenofibrate brand name

A

Tricor

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27
Q

fenofibrate dose

A

48 and 145 mg daily

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28
Q

fenofibrate ADR’s

A
  • Cholesterol gallstones (0.5-7%)
  • GI complaints (3-5%)
  • rash (2%), transient increases in LFTs
  • myositis
29
Q

fenofibrate precautions / contraindications

A
  • inhibitor of CYP2C9 -> increased INR
  • Gallbladder disease
  • Severe renal disease
  • Active liver disease
30
Q

drug interactions with fenofibrate

A
  • warfarin (b/c Tricor inhibits CYP2C9 -> increase activity of warfarin)
  • should not be used with statins (increased side effects)
31
Q

safety monitoring with fenifibrate

A
  • Safety monitoring: LFTs at baseline and 6-12 weeks after initiation
  • CK (b/c of muscle break down) and renal function
32
Q

atorvastatin brand name

A

Lipitor

33
Q

atorvastatin dose

A

10-80 mg daily

34
Q

atorvastatin ADR’s

A
  • Myalgia
  • myositis
  • Rhabdomyolysis (increased Scr, discolored urine)
  • elevation in LFT
  • small increase in glucose levels
  • interacts with CYP3A4
35
Q

atorvastatin precautions / contraindications

A
  • Prior myopathy with statin use
  • Chronic / dormant liver disease
  • Renal insufficiency
  • pregnancy
  • acute liver disease or elevations of liver enzymes
36
Q

drugs interactions with atorvastatin

A

avoid with gemfibrozil -> enhanced side effects

37
Q

safety monitoring for atorvastatin

A

check LFT’s and CK before therapy

38
Q

rosuvastatin brand name

A

Crestor

39
Q

rosuvastatin dose

A

5-40 mg daily

40
Q

rosuvastatin ADR’s

A
  • Myalgia
  • myositis
  • Rhabdomyolysis (increased Scr, discolored urine)
  • elevation in LFT
  • small increase in glucose levels
  • interacts with CYP2C9
41
Q

rosuvastatin precautions / contraindications

A
  • Prior myopathy with statin use
  • Chronic / dormant liver disease
  • Renal insufficiency
  • pregnancy
  • acute liver disease or elevations of liver enzymes
42
Q

drug interactions with rosuvastatin

A

avoid with gemfibrozil -> enhanced side effects

43
Q

safety monitoring for rosuvastatin

A

check LFT’s and CK before therapy

44
Q

pravastatin brand name

A

Pravachol

45
Q

pravastatin dose

A

10-40 mg at bedtime

46
Q

pravastatin ADR’s

A
  • Myalgia (small chance)
  • myositis
  • Rhabdomyolysis (increased Scr, discolored urine)
  • elevation in LFT
  • small increase in glucose levels
47
Q

pravastatin precautions / contraindications

A
  • Prior myopathy with statin use
  • Chronic / dormant liver disease
  • Renal insufficiency
  • pregnancy
  • acute liver disease or elevations of liver enzymes
48
Q

simvastatin brand name

A

Zocor

49
Q

simvastatin dose

A

5-40 mg at bedtime

50
Q

simvastatin ADR’s

A
  • Myalgia
  • myositis
  • Rhabdomyolysis (increased Scr, discolored urine)
  • elevation in LFT
  • small increase in glucose levels
  • interacts with CYP3A4
51
Q

simvastatin precautions / contraindications

A
  • Prior myopathy with statin use
  • Chronic / dormant liver disease
  • Renal insufficiency
  • pregnancy
  • acute liver disease or elevations of liver enzymes
  • CI: if patient is on ketoconazole, erythromycin, clarithromycin, HIV protease inhibitors, cyclosporine, grapefruit juice
52
Q

Which drug has a black box warning and what is it?

A
  • simvastatin

- don’t dose at 80mg because risk of myopathies were too high

53
Q

safety monitoring for simvastatin

A

check LFT’s and CK before therapy

54
Q

drug interactions with simvastatin

A
  • CI: if patient is on ketoconazole, erythromycin, clarithromycin, HIV protease inhibitors, cyclosporine, grapefruit juice
  • Do not exceed 10 mg of simvastatin when taking: verapamil, diltiazem, dronedarone
  • Do not exceed 20 mg of simvastatin when taking amiodarone, amlodipine, ranolazine, lomitapide
  • avoid with gemfibrozil -> enhanced side effects
55
Q

ezetimibe brand name

A

Zetia

56
Q

ezetimibe dose

A

10 mg daily

57
Q

ezetimibe ADR’s

A
  • Fatigue

- arthralgias

58
Q

ezetimibe precautions / contraindications

A

Pregnancy

59
Q

drug interactions with ezetimibe

A
  • If given with fibrates -> increased risk of gallbladder disease
  • cannot be combined with bile acid sequestrants because it binds to ezetimibe
60
Q

safety monitoring for ezetimibe

A

check LFT’s and CK before therapy

61
Q

evolocumab brand name

A

Repatha

62
Q

evolocumab dose

A

140 mg SQ every 2 weeks or 420 mg SQ once a month

63
Q

evolocumab ADR’s

A
  • rash
  • eczema
  • erythema
  • urticarial
  • injection site pain
  • excess LDL reduction has unknown effects
64
Q

evolocumab precautions / contraindications

A

Hypersensitivity reactions

65
Q

simvastatin + ezetimibe brand name

A

Vytorin

66
Q

simvastatin + ezetimibe dose

A
  • Familial: ezetimibe 10 mg/simvastatin 40 mg once daily in the evening
  • primary & mixed: 10/10 – 10/40 daily
67
Q

What are the high intensity statins and what are the goals?

A
  • Daily dose lowers LDL by > 50%
  • Atorvastatin 40-80mg
  • Rosuvastatin 20-40mg
68
Q

What are the moderate intensity statins and what are the goals?

A
  • Daily dose lowers LDL 30-<50%
  • Atorvastatin 10-20mg
  • Rosuvastatin 5-10mg
  • Simvastatin (Zocor) 20-40mg
  • Pravastatin (Pravachol) 40-80mg
  • Lovastatin (Mevacor) 40mg
  • Fluvastin XL (Lescol XL) 80mg
  • Fluvastatin (Lescol) 40 mg BID
  • Pitavastatin (Livalo) 2-4mg

OU Module Cardio Spring 2018 (16 decks)

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