EOR pharm exam part 1 Flashcards
MOA of statins
Inhibit HMG-CoA reductase
Effects on lipid profile of statins
Decrease LDL by 25-62%
Moderate reduction in TG
Minor increase in HDL
`Most common SEs of statins
Constipation Abdominal pain Diarrhea Dyspepsia Nausea
Other SEs of statins
Myopathy including rhabdomyolysis
Increased BG/HbA1c
Cognitive impairment
Pregnancy category X
Monitoring of statins
LFTs -Baseline for all pts -Fu only if clinically indicated Creatinine Kinase -Baseline in those at risk for myopathy -Fu if clinical signs or sx of myopathy -Assess for sx of myopathy 6-12 after drug initiation and at each visit thereafter
Dose ranges of atorvastatin
10-80 mg
Dose ranges of fluvastatin
20-80 mg
Special considerations of atorvastatin
Preferred in renal impairment
Special considerations of fluvastatin
Preferred in renal impairment
Dose ranges of lovastatin
20-80 mg
Special considerations of lovastatin
Increased absorption with food
Adjust starting doses if severe renal impairment
Dose ranges of pitavastatin
1-4 mg
Special considerations of pitavastatin
Decreased absorption with food
Adjust starting dose if severe renal impairment
Dose ranges of pravastatin
10-40 mg
Special considerations of pravastatin
Decreased absorption with food
Adjust starting doses if severe renal impairment
Hydrophilic
Dose ranges of rosuvastatin
10-40 mg
Special considerations of rosuvastatin
Adjust starting doses if severe renal impairment
Hydrophilic
Dose ranges of simvastatin
10-40 mg
Special considerations of simvastatin
Adjust starting doses if severe renal impairment
What statin should you consider switching your pts to if they experience myopathies?
Pravastatin and rosuvastatin
Gemfibrozil and statins
Contraindicated with statins but if use necessary, pravastatin is necessary
Grapefruit juice and statins
Moderate amount of grapefruit juice is ok
<8 oz grapefruit juice daily OR 1/2 grapefruit is ok
What drugs are contraindicated with simvastatin?
Itraconazole Ketoconazole Posaconazole Erythromycin Clarithromycin Tesithromycin HIV protease inhibitors Nefazodone Gemfibrozil Cyclosporine Danazol
What should be done for statin intolerance?
Change to another statin, preferably pravastatin
Alternate day dosing
-Give 2x the daily dose but administer every other day
-No daily doses >40 mg daily have been tested
Equivalent doses to 40 mg fluvastatin
20 mg lovastatin
20 mg pravastatin
10 mg simvastatin
1 mg pitavastatin
Equivalent doses to 80 mg fluvastatin
40-80 mg lovastatin 40 mg pravastatin 20 mg simvastatin 2 mg pitavastatin 10 mg atorvastatin
Equivalent doses to 80 mg lovastatin
80 mg pravastatin 40 mg simvastatin 4 mg pitavastatin 20 mg atorvastatin 5 mg rosuvastatin
Equivalent doses to 40 mg atorvastatin
10 mg rosuvastatin
Equivalent doses to 80 mg atorvastatin
20 mg rosuvastatin
What are examples of ACE inhibitors?
Benazepril
Linsinopril
Enalapril
Common SEs of ACE inhibitors
Hyperkalemia
Dry cough
Decrease in GFR upon initiation
What is a rare but serious SE of ACE inhibitors?
Angioedema
Pregnancy category of ACE-Is
X
MOA of ACE-Is
Prevent conversion of angiotensin I to angiotensin II
Monitoring for ACE-Is
Bring pt back in one week to see change in renal function
Ser creatinine, BUN, GFR
Serum creatinine increasing by 30% is indicative of renal artery stenosis
What do H2 receptor antagonists treat?
Mild to moderate GERD
For symptomatic relief of mild GERD, low-dose, non-prescription or standard doses given BID may be beneficial
Most common SEs of H2 receptor antagonists
HA Somnolence Fatigue Dizziness Constipation Diarrhea Can develop tolerance with prolonged therapy
Special considerations for cimetidine (Tagamet)
Has the most drug interactions
Avoid with Plavix
Non-Rx dose of cimetidine
200 mg BID
Rx dose of cimetidine
400 mg BID
Non-Rx dose for famotidine (Pepcid)
10 mg BID
Rx dose for famotidine
20 mg BID
Non-rx dose for nizatidine
75 mg BID
Rx dose of nizatidine
150 mg BID
Non-Rx dose of ranitidine
75 mg BID
Rx dose of ranitidine
150 mg BID
Special considerations for ranitidine
Less drug-drug interactions than cimetidine (Tagamet)
Use of proton pump inhibitors (PPIs)
Moderate to severe GERD
SEs of PPIs
HA Dizziness Somnolence Diarrhea Constipation Nause Vit B12 deficiency C. difficile Fx (long-term usage)
Drug interactions with PPIs
Include:
Ketoconazole
Itraconazole
Reyataz
How much of a trial should PPIs be given?
8 wks
Then, stop and see if sx have resolved
Use an H2 blocker PRN if sx are mild, continue PPI if sx are still severe
Which PPI is preferred with clopidogrel?
pantoprazole (Protonix)
Special considerations for lansoprazole
Packet for oral suspension should not be placed through a nasogastric tube
