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Pharmacology 2 > Exam 1 - Lipids > Flashcards

Exam 1 - Lipids Flashcards

1
Q

What is Primary Prevention?

A

Treatment of a patient before they have had an MI or stroke.

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2
Q

What is Secondary Prevention?

A

Treatment of a PT after they have had an MI or stroke.

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3
Q

What is the MOA of Omega-3 Fatty Acids?

A

Unknown. Reduces Triglyceride synthesis vs Reduces hepatic circulation of triglycerides

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4
Q

What is the clinical application for Omega 3 Fatty Acids?

A

Very high Triglycerides, over 500. Can reduce TG by 60%. Not first line.

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5
Q

What percent can Omega 3 Fatty Acids reduce TGs by?

A

60%

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6
Q

At what TG level do you use Omega 3 Fatty Acids?

A

500 or above

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7
Q

What is the name of an Omega 3 Fatty Acid medication/supplement?

A

Lovaza

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8
Q

What are three possible adverse effects of Omega 3 Fatty Acids?

A

Fishy burps, indigestion, altered taste

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9
Q

What is the MOA of Cholesterol Absorption Inhibitors?

A

Blocks absorption of biliary and dietary cholesterol from GI tract

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10
Q

What is a drug name of a Cholesterol Absorption Inhibitor?

A

Ezetimibe (only one)

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11
Q

What are three adverse reactions from Cholesterol Absorption Inhibitors?

A

Diarrhea, Musculoskeletal pain, Sinusitis

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12
Q

What is the pathway/active metabolite of the Cholesterol Absorption Inhibitor Ezetimibe?

A

Glucuronidation

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13
Q

Is the cholesterol absorption inhibitor Ezetimibe taken in combination with a moderate dose statin?

A

Yes. Vytorin=Simvastatin + Ezetimibe

statin + cholesterol absoprtion inhibitor

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14
Q

What is the MOA of Fibrates?

A

Activates PPAR-alpha which modulates metabolism and increases catabolism of lipids. Modulates genetic transcription to increase lipid metabolism.

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15
Q

What is the clinical application for Fibrates?

A

TG over 500. Used as a second line for select patients.

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16
Q

What is the TG required to be for initiating Fibrates?

A

500 or above. Second line treatment in select patients.

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17
Q

Where in line for treatment of high TGs are Fibrates?

A

Second line treatment in select patients.

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18
Q

What are three treatments for TGs over 500?

A

Omega 3 Fatty Acids, Fibrates, Niacin

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19
Q

What can TGs over 1000 cause? Treatment?

A

Acute pancreatitis. Fibrates are first line, Niacin & Omega-3 can be considered.

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20
Q

What are two examples of Fibrates?

A

Gemfibrozil, Fenofibrate

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21
Q

What are five possible adverse reactions to Fibrates?

A

Nausea, abdominal pain, myopathy, increased Serum Cr, increased Transaminases

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22
Q

What does the hepatic system to do Fibrates?

A

Metabolizes

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23
Q

Which system/where are Fibrates secreted?

A

Renal system

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24
Q

What is the MOA for Nicotinic Acid class medications?

A

Decreases TG synthesis. Unclear in adipose.

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25
Q

What are three drugs in the Nicotinic Acid class?

A

Niacin, Nicotinic Acid, Niacinamide

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26
Q

What are five adverse effects of the Nicotinic Acid drugs?

A

Nausea, vomiting, flushing, myopathy, increased transaminases

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27
Q

What happens to Nicotinic Acid class medications in the Hepatic system/pathway?

A

Conjugated

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28
Q

Where/how are Niacin-class drugs excreted?

A

Renal system

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29
Q

Where does flushing occur in patients on Niacin-class drugs?

A

Neck

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30
Q

How do you treat/prevent the flushing associated with Niacin-class drugs?

A

Give 325 ASA 15-20 minutes before Niacin

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31
Q

What is the MOA for Bile Acid Sequestrants?

A

Anion exchange resins that bind bile acids

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32
Q

What is the biggest adverse reaction in Bile Acid Sequestrants?

A

Flatulence. (Others are abd pain, constipation, nausea, vomiting. Bile=Bum=Fart)

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33
Q

What does the liver and kidneys do to Bile Acid Sequestrants?

A

Nothing. Not metabolized or absorbed.

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34
Q

What can Bile Acid Sequestrants do to vitamins? How do manage this?

A

Can inhibit vitamins absorption. Can interaction with many drugs. Take resin 1-2 hours after other meds OR take other meds 4-6 hours after resin.

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35
Q

What are three examples of Bile Acid Sequestrants?

A

Cholestyramin (P), Colestipol (P,T), Colesevelam (P,T)
P=powder
T=tablet

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36
Q

Bile Acid Sequestrants are where in line for treatment of XXX (she didn’t say, ask her and come back)

A

Second line in selected patients for XXX (she didn’t say, elevated TGs?, ask her and come back)

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37
Q

What is the MOA for statins?

A

Inhibiting HMH-CoA, rate limiting step of HMG CoA to Mevalonate (KNOW THIS!)

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38
Q

What do statins end in?

A

“-statin”

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39
Q

What are some adverse reactions of statins?

A

Nausea, vomiting, dizziness, abd pain, myopathy, elevated transaminases

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40
Q

What order are statins in for treatment of hyperlipidemia?

A

First

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41
Q

What is the mnemonic for remembering the six types of statins?

A

Fat People Love Subs And Ribs

Fluva, Prava, Lova, Simva, Atrova, Rosuva -statin

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42
Q

What are the only two statins to be high intensity and dose?

A

Atorvastatin 80mg, Rosuvastatin 20mg

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43
Q

What are the two low-intensity statins and dose?

A

Lovastatin 20mg, Pravastatin 10mg or 20mg

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44
Q

What are three special things unique to Parvastatin?

A

Parvastatin is not Lipophilic, does not use CYP450 system, has an inactive metabolite

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45
Q

Vyrotin is a combo of what two drugs?

A

Simvastatin and Ezetimibe

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46
Q

Which two statins have high intensity but no low intensity?

A

Atrovastatin and Rosuvastatin

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47
Q

Which two fats can elevate LDL?

A

Saturated and trans fats

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48
Q

What happens to LDL and TGs during pregnancy?

A

Rise

49
Q

Which three lipid drugs are contraindicates during pregnancy and lactation

A

Statins,Niacin,andEzetimibearecontraindicatedduring pregnancyandlactation

50
Q

Multiple or serious ______ may predispose one to adverse effects to statins

A

Comorbidities

51
Q

A history of previous _____ _____ _____ may predispose one to adverse effects to statins

A

intolerance to statins

52
Q

Unexplained ____ 3x normal upper limit may predispose one to adverse effects to statins

A

ALT

53
Q

Drug interactions that _____ statin concentration may predispose one to adverse effects to statins

A

Increase

54
Q

Age over ____ may predispose one to adverse effects to statins

A

75 years

55
Q

What four things would cause you to start a PT on a lower statin dose than normal?

A
  1. Hx of hemorrhagic stroke
  2. hx of alcohol abuse
  3. Asian ancestry
  4. small body frame/frailty
56
Q

Which four labs should be checked before starting statins?

A

Fasting Lipid panel, ALT level, CK, fasting BGL/A1c

57
Q

Before starting Niacin for hyperlipidemia what blood test should be checked?

A

Uric Acid

58
Q

Before starting Bile Acid Sequestrants for hyperlipidemia what blood test should be checked?

A

Triglycerides

59
Q

Before starting Fibrates for hyperlipidemia what blood test should be checked?

A

Serum Creatinine/GFR

60
Q

What are 7 important criteria used in calculating ASCVD in addition to gender and race (Pooled Risk)?

A
  1. Total cholesterol,
  2. HDL,
  3. HTN or HTN meds,
  4. Systolic BP
  5. DM,
  6. Smoker
  7. Age
61
Q

What is the definition of “family hx of premature ASCVD”?

A

FamilyhistoryofprematureASCVDmeansaneventbeforethe ageof55inafirstdegreemalerelativeor65inafirstdegree femalerelative

62
Q

In Primary Prevention, what is the proper intensity statin to use in a PT age 21+ with an LDL above 190?

A

High intensity statin

63
Q

In Primary Prevention, what is the proper intensity statin to use in a PT with DM and age 40-75, but with ASCVD below 7.5?

A

Moderate intensity

64
Q

In Primary Prevention, what is the proper intensity statin to use in a PT with DM and age 40-75, but with ASCVD above 7.5?

A

High intensity

65
Q

In Primary Prevention, what is the proper intensity statin to use in a PT age 40-75 and ASCVD above 7.5?

A

Moderate to High intensity

66
Q

When is a high intensity statin used in primary prevention? (Hint: 2 situations)

A
  1. Age 21+ and LDL above 190

2. Age 40-75 with DM and ASCVD above 7.5%

67
Q

When do you use a moderate intensity statin in primary prevention?

A

Age 40-75 with DM and ASCVD below 7.5%

68
Q

When do you use a moderate to high intensity statin in primary prevention

A

Age 40-75 and ASCVD above 7.5

69
Q

In secondary prevention with clinical ASCVD what intensity statin is used?

A

High intensity

70
Q

Which three groups automatically get high intensity statin?

A

Three groups get automatic high intensity stating

  1. LDL above 90
  2. ASCVD above 7.5%
  3. Previous MI (Secondary Prevention)
71
Q

What time of day/night are statins dosed?

A

At night as liver makes cholesterol at night.

72
Q

Ten year ASCVD can be calculated in what age range?

A

40-79

73
Q

Which two statins not Lipophilic?

A

Pravastatin and Rosuvastatin (People and Ribs are not lipophilic)

74
Q

Which statins are low intensity?

A

People Love

75
Q

What is the intensity of the seven statins?

A

Fat People Love Steak And Ribs

from less to more intense

76
Q

Which statin uses sulfation? (hint: does not use CYP450 system)

A

Pravastatin (people)

77
Q

Lifetime ASCVD can be calculated for what age range?

A

20-59

78
Q

Which cholesterol meds do and don’t interact with statins?

A

Omega-3s do not interact with statins. Fibrates and niacin do interact with statins.

79
Q

If TGs are above 500 can the LDL be calculated?

A

No

80
Q

“I am prescribing this medication to you to reduce your risk of ____ and ____.”

A

Heart attack and stroke

81
Q

“Some people experience ____, _____, and ____ ____ while taking this medicine.”

A

Dizziness, headache, and upset stomach

82
Q

“If dizziness, headache, or upset stomach occur take it at _____. If it occurs it will lessen with _____.”

A

Night. With time.

83
Q

“These side effects are not harmful as long as you can ____ _____. If you cannot then I can persribe a ____ ____.”

A

Tolerate them. Lower dose.

84
Q

“Very rarely some people have _____ _____ _____. If this happens let me know and I can order tests to see if it is the medication causing this.”

A

Unexplained muscle pain

85
Q

“STOP taking this medication and go to the ER immediately if you notice ____ ____.”

A

Dark urine (rhabdomyelitis)

86
Q

Statins are prescribes for signs and symptoms of ____50

A

ASCVD

87
Q

High intensity statins reduce cholesterol by what percent in what time frame?

A

50%, 6-8 weeks

88
Q

Benefits of statins for are demonstrated after what range in years?

A

2-5 years

89
Q

What type of measure is a fasting lipid panel after being in statins?

A

Surrogate. Used to make sure they are taking the statin.

90
Q

Can you increase intensity of statin after confirming the current dose is tolerable?

A

Yes

91
Q

Once reaching lipid target should you order repeat labs?

A

No

92
Q

If LDL drops below 40 while on statins what should change?

A

Reduce intensity

93
Q

Asymptomatic elevations of ____ occur in 0.5 - 2% of cases

A

Liver transaminases (specifically ALT)

94
Q

If a PT begins to look jaundice (yellow) after starting statins what should be checked?

A

ALT

95
Q

In what time frame does statin-induced liver transaminase elevation occur?

A

Within 3 months of starting

96
Q

Mild to moderate myalgia without CK increase occurs in what percentage of cases?

A

5%

97
Q

Severe myalgias with CK 10x UNL are rare but can progress into what two things?

A
  1. Rhabdomyelitis

2. Kidney failure

98
Q

What most commonly causes severe myalgias while statins?

A

Drug interactions which increase statin concentration

99
Q

Which cholesterol lowering medication can interact with statins and cause severe myalgias leading to rhabdomyelitis and kidney failure?

A

Fibrates

100
Q

If PT has 10x UNL CK what to do?

A

Stop statins, go to ER for supportive care

101
Q

If PT has 3-10 ULN CK with tolerable symptoms what do you do?

A

Closely monitor sx and CK

102
Q

Which two statins are less likely to cause myopathy and why?

A

Pravastatin and Rosuvastatin. Not lipophilic.

103
Q

What to do if PT cannot take recommended intensity of statin?

A

Take a reduced intensity and monitor closely. Might consider adding Zettia + moderate dose statin if they have CAD.

104
Q

Men at risk for ASCVD who cannot take a statin should take what primary and secondary alternatives?

A

Primary=Colestipol 5g TID before meals

Secondary=Gemfibrozil 600mg BID

105
Q

Men at high risk for ASCVD who cannot take a statin should take what alternative?

A

Cholestyramine 24g/day in 2-4 doses

106
Q

Men and women with T2DM who cannot take statins should take what?

A

Micronized Fenofibrate 200mg QAM (every morning)

107
Q

Men and women with established ASCVD who can’t take statins should take what as primary and secondary alternatives?

A

Primary: Gemofibrozil 1200mg QD or 600mg BID
Secondary: Colestipol TID before meals

108
Q

Can you use the Pooled Cohort Equation for people already taking lipid lowering medications?

A

No. Not designed for it.

109
Q

What to do if a PT is taking a statin but they should be on a higher intensity?

A

Counsel PT about possible side-effects, titrate up dose as tolerated

110
Q

What to do if a PT is on combo statins and non-statins?

A

Discuss risks/benefits, can continue if low-risk and tolerating well, very reasonable to discontinue to reduce pill burden

111
Q

Which class has an unknown MOA but perhaps decreased hepatic circulation vs TG synthesis?

A

Omega 3 FAs

112
Q

Which drug class blocks absorptions of biliary and dietary cholesterol?

A

Cholesterol Absorption Inhibitors

113
Q

Which drug class activates PPAR-alpha which genetically modifies catabolism of lipids?

A

Fibrates

114
Q

Which drug class has an unknown effect on adipose tissue but can reduce TG synthesis?

A

Nicotonic acid

115
Q

Which drug class has anion exchange resins which binds to bile acids?

A

Bile Acid Sequestrants

116
Q

Which drug class inhibits HMG-CoA reductase rate limiting step to prevent Mevalonate conversion?

A

Statins

117
Q

Which drug class works best when ASA is taken 15-20 minutes before the drug?

A

Nicotinic acid

118
Q

Which drug class can inhibit vitamin absorption requiring to be taken 1-2 hours before or 4-6 hours after other drugs?

A

Bile Acid Sequestrants

119
Q

Which statin used sulfation as it’s metabolism?

A

Parvastatin

Pharmacology 2 (17 decks)

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