Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm > Dyslipidemia meds > Flashcards

Dyslipidemia meds Flashcards

1
Q

What synthesizes cholesterol?

A

The liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do we get additional cholesterol?

A

From our diets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give two features about cholesterol

A

It has a membrane structure

It is a precursor to steroid hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the formula for total cholesterol (endogenous and dietary)?

A

Total-C = (LDL + HDL + VLDL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is your bad cholesterol? What is the shorthand for this?

A

Low density lipoproteins

LDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is your good cholesterol? What is the shorthand for this?

A

High density lipoproteins

HDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the shorthand for triglycerides?

A

VLDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the optimal LDL measurement?

A

< 100 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What LDL measure is classified as high?

A

160-180 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 2018 ACC/AHA adult recommendations

A

See slide 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some causes of secondary dyslipidemia?

A 
Diabetes
Hypothyroidism
Obstructive liver disease
Chronic renal failure
Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List some lifestyle changes that can lower LDL

A

TLC diet (reduced intake of cholesterol-raising nutrients and LDL lowering therapeutic options)
Weight reduction
Increased physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Choice of lipid lowering drugs

A

See slide 17

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the most commonly prescribed drugs for increased cholesterol?

A

HMG CoA Reductase Inhibitors

AKA statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

By what % do statins tend to reduce LDL and TG by?

A

18-55% (LDL)

7-30% (TG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

By what % do statins increase HDL?

A

5-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some major side effects of statins?

A

Myopathy (increased CK)

Increased liver enzymes (increased AST/ALT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some contraindications for statins?

A

Absolute: liver disease
Relative: use with certain drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give some examples of things that statins have demonstrated therapeutic benefits for.

A

Reduced major coronary events
Reduce CHD mortality
Reduce stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the MOA of statins?

A

Block rate -> limiting step in cholesterol synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When do we see statin induced myopathy?

A

Serum CK >10x ULN with unexplained muscle pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When do we see statin induced rhabdomyalysis?

A

Serum CK > 40x ULN with unexplained muscle pain or weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When do pts at risk of statin induced myopathy tend to present?

A

In the first 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which statin poses the highest risk for induced myopathy?

A

High dose simvastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What internal element causes simvastatin to pose the risk for induced cardiomyopathy?

A

CYP3A4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What should you do if pts experiences SEs on a statin?

A

Try a different one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Give two examples of statins?

A

Atorvastatin

Rosuvastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is an issue with pitavastatin?

A

Its very expensive and not generically available as of 2/11/19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

By what percent does rosuvastatin lower LDL??

A

63%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

By what percent does atorvastatin lower LDL?

A

57%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

By what percent does simvastatin lower LDL?

A

46%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How many high dose pts developed myopathy while on simvastatin?

A

52

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How many low dose pts developed myopathy while on simvastatin?

A

22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How many high dose pts developed rhabdo while on simvastatin?

A

22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How many low dose pts developed rhabdo while on simvastatin?

A

0

36
Q

What is the FDA simvastatin black-box warning?

A

Restricting dosing of 80 mg of simvastain

37
Q

When can pts be put on 80 mg of simvastatin?

A

When they have been taking it for >12 months

38
Q

What should pts on an 80 mg dose w/o adverse effects do when they need to take a contraindicated drug?

A

They should switch to another statin

39
Q

What should pts who’s LDL goal cannot be reached on the 40 mg dose of simvastatin?

A

They should be switched to a statin w/ less risk of cardiomyopathy

40
Q

List some drugs that are contraindicated with simvastatin

A 
Itraconazole
Eythromycin
HIV protease inhbitors
Nefazodone
Gemfibrozil
Cyclosporin
Danazol
41
Q

With what drugs should we not exceed 10 mg simvastatin with?

A

Amiodarone
Verapamil
Diltiazem

42
Q

With what drugs should we not exceed 20 mg simvastatin daily?

A

Amlodipine

Ranolazine

43
Q

What is an odd contradiction with simvastatin?

A

Not ingesting > 1 quart of grapefruit juice daily

44
Q

Are elevated transaminases on statins a reason to dc?

A

No

45
Q

Are statin side effects agent specific or class specific?

A

Agent specific

46
Q

What should you do with unexplained myalgias w/o CK elevation?

A

Try a different statin

47
Q

How many pts receive new scripts for simvastatin?

A

Very few

48
Q

What is the MOA of bile acid sequestrants?

A

Bind dietary cholesterol

49
Q

What are the major actions of bile acid sequestrants (BAS)?

A

Reduce LDL 20-25%
Raise HDL 3-5%
May increase TG

50
Q

What are some SEs of BAS?

A

GI distress/constipation, diarrhea, bloating

Decreased absorption of other drugs

51
Q

When are BAS agents contraindicated?

A 
Severe hepatic impairment
Raise TG (esp > 400 mg/dL)
52
Q

Give some examples of BAS

A

Cholestyramine
Colestipol
Colesevelam

53
Q

What is an issue with colesevelam?

A

Its very exepnsive ($561)

54
Q

When do we usually give BAS?

A

As add on therapy to max dose statins

55
Q

What are the major actions if Niacin?

A

Lowers LDL by 5-25%
Raises HDL by 15-35%
Lowers TG by 10-50%

56
Q

What is a major SE of niacin?

A

Flushing

57
Q

How do we minimize flushing with Niacin?

A

Pretreatment with NSAIDS 30-60 minutes prior to ingestion

58
Q

When is niacin usually used?

A

As add on therapy
Not monotherapy
Not often used

59
Q

What was needed to prove the efficacy of niacin?

A

A new large trial

60
Q

What did the niacin trial show?

A

Niacin did not reduce incidence of primary composite endpoint (??)

61
Q

What happened with the niacin trial?

A

Trial was stopped early

62
Q

What was an unexpected increase in the niacin trial?

A

Strokes increased

63
Q

What was the basic conclusion of the niacin trial?

A

Niacin doesnt reduce CVA risk but does increase risk CVA risk so its little used

64
Q

How much do fibric acids decrease TG and VDL by?

A

25-50%

65
Q

How much do fibric acids lower LDL?

A

5-20%

66
Q

Might fibric acids raise LDL?

A

Yes, with high TG

67
Q

How much might fibric acids raise HDL by?

A

10-20%

68
Q

What are two fibric acids?

A

Gemfibrozil

Fenofibrate

69
Q

What class is ezetimibe a part of?

A

A drug of a new class that inhibits intestinal absorption of cholesterol

70
Q

How much does ezetimibe lower LDL?

A

2-25%

71
Q

What is the effect of ezetimibe with statins?

A

Increases effects of statin by 10-15% w/o side effects

72
Q

When is ezetimibe well tolerated?

A

At 10 mg/d

73
Q

What is vytorin?

A

Exetimibe + simvastatin

74
Q

What are PCSK9 inhibitors?

A

New class of monoclonal antibodies

75
Q

What do PCSK9 inhibitors do when they are added to statins?

A

Reduce LDL by 50-60%

76
Q

How do you administer PCSK9 inhibitors?

A

SC injection q2-4 weeks

77
Q

What place do PCSK9 inhbitors have in therapy?

A

Add on to max dose statins

78
Q

What is a new class of drug not yet FDA approved?

A

Bempedoic acid

FDA labeling requested in Feb 2019

79
Q

How often do you give bempedoic acid?

A

Daily

80
Q

What is the MOA of bempedoic acid?

A

Inhibits ATP citrate lyase (key enzyme in chol synthesis)

81
Q

What is the PO dose of bempedoic acid?

A

180 mg once daily

82
Q

Did bempedoic acid show a decrease in LDL?

A

Yes

83
Q

Did bempedoic acid decrease non-HDL?

A

Yes

84
Q

Did TC decrease on bempedoic acid?

A

Yes

85
Q

What are two other things that bempedoic acid decrease?

A

Apolipoprotein B

High-sensitivity CRP

86
Q

Fixed dose statin therapies

A

See slide 46

Pharm (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions