Dyslipidemia Pt. 1 Flashcards
What are desirable Non-HDL, LDL, HDL, Triglycerides
Non-HDL: Less than 130 mg/dL
LDL: Less than 100 mg/dL
HDL: Greater 40 mg/dL (men), greater than 50 mg/dL (women)
Triglycerides: Less than 150 mg/dL
What are very high LDL and triglycerides levels
LDL: Greater than 190 mg/dL
Triglycerides: Greater than or equal to 500 mg/dL
T/F: Engage in aerobic physical activity 3 to 4 times per week for 40 minutes/session (decreases LDL 3 to 6 mg/dL)
True
What are examples of non drugs that lower TG
Red yeast rice, OTC fish oils, niacin
What are the statin equivalent doses (HINT: PRASLPF)
Pitvastatin-2 mg Rosuvastatin- 5 mg Atorvastatin- 10 mg Simvastatin- 20 mg Lovastatin- 40 mg Pravastatin- 40 mg Fluvastatin- 80 mg
T/F: Symptoms of muscle damage from statins occurs in the first TWO WEEKS
False: Symptoms of muscle damage from statins occurs in the first 6 weeks
What are the most common Statins
Atorvastatin (Lipitor) Lovastatin (Altoprev) Pravastatin (Pravachol) Simvastatin (Zocor) Rosuvastatin (Crestor)
What are the contraindications to using statins
Pregnancy/breastfeeding, CYP3A4 inhibitors, liver disease
What are warnings associated with Statins
Muscle damage, High creatine phosphokinase, age greater than 65 years, use of niacin, CPY3A4 inhibitors, Possible increase in FBG and A1C
T/F: Statins can potentially cause an increase in blood sugar and A1C
True
What and how should be monitored after someone starts a statin
Lipid panels should be taken 4 to 12 weeks after starting treatment then every 3 months or annually
What are symptoms associated with statin use, what labs should be taken due to these symptoms
Myalgia: Check Creatine Phosphokinase
Little to no urine: Scr/BUN
Abdominal Pain or jaundice: LFTs for liver toxicity
What are statin drug interactions that should be avoided (HINT G PACMAN
G: Grapefruit
P: Protease inhibitors A: Azole Antifungals C: Cyclosporine M: Macrolides (except Azithromycin) A: Amiodarone N: Non-DHP CCBs
Which statins are most likely to have drug drug interaction problems, less
Simvastatin and Lovastatin// Rosuvastatin and Pravastatin
What is the MOA of Ezetimibe
Inhibits absorption of cholesterol in the SMALL INTESTINE
T/F: If using concurrent bile acid sequestrants give Ezetimibe two hours before or four hours after bile acid sequestrants
True
What is the MOA of bile acid sequestrants
BIND BILE ACIDS in the intestine forming a complex that is EXCRETED IN THE FECES
What is the most commonly used bile acid sequestrants, why is it used most often
Colesevelam (Welchol): less drug interactions than other bile acid sequestrants
What are the side effects of Colesevelam (Welchol)
CONSTIPATION, Abdominal Pain, Cramping, bloating, increased gas
What is the key note for Colesevelam (Welchol)
Prolonged use can cause teeth discoloration, erosion of enamel or decay
What drug antibiotic should be taken 4 hours prior to Colesevelam (Welchol)
Levofloxacin
What absorption is affected by bile acid sequestratnt-s
Fat soluble vitamins: ADEK
What is the MOA of Fibrates
Activation of Peroxisome Proliferator Receptor Alpha (PPAR alpha activator) increasing lipoprotein lipase activity catabolism of VLDL and decrases TG significantly
What are the two main Fibrates
Fenofibrate (Antara, Tricor, andTrilpix)
Gemfibrozil (Lopid)
What are the contraindications of fibrates
Severe liver disease including primary biliary cirrhosis, Gallbladder disease, CrCl less than or equal to 30 ml/min
What is the warning associated with fibrates, side effects
Myopathy is higher risk when co administered with a statin// Dyspepsia (indegestion) and increased LFTs
Which fibrate cannot be taken with statins and ezitimbi
Gemfibrozil
T/F: Fibrates can increase the effects of sulfonyureas and warfarin
True
What is the MOA of niacin
Decreases the rate of HEPATIC SYNTHEISIS OF VLDL
What are warnings of niacin, side effects
Rhabdomyolysis with doses greater than or equal to 1 gram, Hepatotoxicity, Increased blood glucose and increased uric acid// Flushing, pruritus, vomiting. diarhhea, increased blood glucose, gout
When should name brand Niacin (Niaspan) be taken
At bedtime after a low-fat snack
In low risk patients how often should risk factors be assessed
Every 4 to 6 years
What patients should receive a high intensity statin
History of CAD Stroke MI or TIA, LDL greater than 190 mg/dL, Age 40 to 75 with diabetes AND LDL BETWEEN 70 to 189 with comorbidities, Age 40 to 75 with LDL BETWEEN 70 TO 189 with an ASCVD risk greater than or equal to 20%
What patients should receive a moderate intensity statin
Age 40 to 75 with diabetes LDL between 70 to 189, Age 40 to 75 with a ASCVD risk of 7.5 to 19.9%
