Exam 1 - Dyslipidemia Drugs Flashcards
Atorvastatin
Lipitor
HMG CoA Reductase Inhibitor
Rosuvastatin
Crestor
HMG CoA Reductase Inhibitor
Simvastatin
Zocor
HMG CoA Reductase Inhibitor
Lovastatin
Mevacor
HMG CoA Reductase Inhibitor
Pravastatin
Pravachol
HMG CoA Reductase Inhibitor
Fluvastatin
Lescol
HMG CoA Reductase Inhibitor
Pitavastatin
Livalo
HMG CoA Reductase Inhibitor
What is the MOA of HMG CoA Reductase Inhibitors?
Reduces hepatic cholesterol synthesis and lowers intracellular cholesterol
Which statins must be taken in the evening due to short half lives?
1.) Lovastatin
2.) Fluvastatin
3.) Simvastatin
What enzyme metabolizes all the statins beside rosuvastatin?
CYP3A4
What enzyme metabolizes rosuvastatin? Does this have more or less drug interactions?
CYP2D6
Less Drug Interactions :)
What is the rule of 6?
For each doubling of a statin dose (i.e. simvastatin 10mg to 20mg), anticipate about 6% additional LDL-C reduction
Which statins are most effective at reducing triglycerides?
Atorvastatin and Rosuvastatin (think high intensity)
Which statins are high intensity?
Atorvastatin and Rosuvastatin
What are contraindications for statins (HMG CoA Reductase Inhibitors)?
1.) Pregnancy and Lactation
2.) Active Liver Disease
What are the adverse effects of statins? KNOW THESE
1.) Myalgias (muscle pain)
2.) Rhabdomyolysis (breaking down of the muscle, pee is usually cola color)
3.) Increased blood glucose and A1C levels
4.) CNS effects
What is the dosing for Rosuvastatin (moderate and high intensity)?
Moderate Intensity: 5-10mg daily
High Intensity: 20-40mg daily
What are some drug interactions with Crestor?
1.) Gemfibrizol (Lopid)
2.) HIV Protease Inhibitors
3.) Cyclosporine
What are some drug interactions with Lipitor?
1.) Cyclosporine
2.) Gemfibrizol (avoid)
3.) Fenofibrate (use with caution)
4.) Itraconazole
5.) Niacin (doses more than 1g)
Can a patient be newly started on Simvastatin 80mg?
No, FDA states this increases the risk of muscle toxicity. Patients already on this dose can stay on it (if they’ve been on it at least 12 months).
Pravastatin and Rosuvastatin are both hydrophilic which means…
less muscle pain
What is the statin equivalency? (this will be a test question)
Pitavastatin 2mg
Rosuvastatin 5mg
Atorvastatin 10mg
Simvastatin 20mg
Lovastatin 40mg
Pravastatin 40mg
Fluvastatin 80mg
Remember: Pharmacists Rock At Saving Lives and Preventing Flu
What is the dosing for Lipitor?
High Intensity: 40-80mg daily
Moderate Intensity: 10-20mg daily
Ezetimibe
Zetia
Cholesterol Absorption Inhibitor
Adverse Effects of Zetia
1.) GI Complaints (like diarrhea) - most common
2.) Arthralgias
3.) URTIs
4.) Mild increase in serum transaminases when used with statins
BUT generally well tolerated
Zetia is most commonly used as adjunct therapy with…
Statins
If a patient cannot tolerate a stain, they’ll likely take..
Ezetimibe
Evolocumab
Repatha
PCSK9 Inhibitors
Alirocumab
Praluent
PCSK9 Inhibitors
Adverse effects of PCSK9 inhibitors
1.) Injection-site Reactions
2.) Allergic/hypersensitivity reactions
3.) URTIs
What is the dosing for PCSK9 inhibitors?
Subcutaneous injections administered biweekly or once monthly
How do you store PCSK9 inhibitors?
Store unopened in the refrigerator (2-8 C) and may be kept at room temperature for 30 days
Major adverse effect of repatha
Back pain
Major adverse effect of praluent
Increased LFTs (liver enzymes)
Bempedoic Acid
Nexletol
ACL inhibitor
When would you add on Bempedoic Acid?
Added on after ezetimibe and/or PCSK9
Evinacumab
Evkeez
ANGPTL3 inhibitor
What is special about Evkeez?
Once monthly IV
Inclisiran
Leqvio
siRNA agent that inhibits translation of the PCSK9
How early should you pull your injectable medication out of the fridge before injecting?
30 minutes before injection (reduces side effects like irritation)
What injection sites are SUBQ friendly?
1.) Stomach
2.) Upper Arm
3.) Front of Thigh
What class of medications is first line for pregnant women with dyslipidemia?
Bile Acid Sequestrants (BSA) due to it not being systemically absorbed and local to the gut)
Cholestyramine
Questran
Bile Acid Sequestrant
Colesevelam
Welchol
Bile Acid Sequestrant
Colestipol
Colestid
Bile Acid Sequestrant
Adverse effects of bile acid sequestrants
1.) constipation
2.) cramping
3.) abdominal pain
4.) bloating
5.) gas
6) INCREASE IN TRIGLYCERIDES
How much does LDL need reduced for low intensity?
Less than 30% from baseline
How much does LDL need reduced for moderate intensity?
30 to 49%
How much does LDL need reduced for high intensity?
50% or more
Which is more concerning: elevated LDL or elevated triglycerides?
LDL
Triglycerides are more relative to..
diet
High triglycerides is linked to
Pacreatitis
Fibrates are primarily used for
lowering triglycerides and VLDL
Fibrates may increase..
LDL
Gemfibrizol
Lopid
Fibrate
Fenofibrate
Tricor
Fibrate
Fenofibric Acid
Trilipix
Fibrate (active form of fenofibrate)
*****Contraindications for fibrates
1.) GALLBLADDER DISEASE
2.) CrCL less than 30
3.) Severe liver disease
Adverse effects of fibrates
1.) Formation of gallstones
2.) Arthralgias/myalgias
3.) GI complaints
4.) Transient elevations in transaminase levels
Gemfibrizol and Statins when used together can cause..
muscle issues including rhabdomyolysis
Gemfibrizol when used with warfarin increases your risk for..
bleeding
Omega 3 Ethyl Esters
Lovaza
Fish Oil
Icosapent Ethyl
Vascepa
Fish Oil
Adverse Effect of fish oils
burping, dyspepsia, taste perversion
Fish Oils and warfarin cause an increase risk of…
bleeding
Niacin
Niaspan (ER) or Vitamin B3
Niacin Adverse Effects
1.) Hepatotoxicity
2.) Flushing/Itching *****
3.) GI Upset
4.) Hyperuricemia (gout)
5.) Increase Blood Glucose
Reduce flushing by..
Avoiding spicy foods, take with food, take aspirin 325mg prior to dose
