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Therapeutics P2 > Exam 2 Lecture 3 > Flashcards

Exam 2 Lecture 3 Flashcards

1
Q

Which one decreases LDL more PCSK9 or LDL

A

PCSK9, but more expensive.

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2
Q

Lovastatin generic

A

Pravachol

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3
Q

Pitavastatin generic

A

Livalo

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4
Q

Simvastatin (important) generic

A

Zocor

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5
Q

atorvastatin generic

A

lipitor

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6
Q

rosuvastatin generic

A

crestor

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7
Q

High intensity statins name and strength

A

atorvastatin 40-80
Rosuvastatin 20-40

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8
Q

Moderate intensity statins name and strength

A

Atorvastatin-10-20
Rosuvastatin 5-10
Simvastatin 20-40
pravastatin- 40-80
Lovastatin- 40-80
flovastatin- 40

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9
Q

Low intensity name and dosage

A

Simvastatin- 10
pravastatin- 10-20

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10
Q

CYP3A4 statins

A

Lovastatin, simvastatin, Atorvastatn

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11
Q

What are the two hydrophilic drugs

A

Pravastatin and rosuvastatin

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12
Q

Use of hydrophilic drugs

A

Patients prone to muscle toxicity/pain, consider picking hydrophilic drugs (pravastatin, rosuvastatin)

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13
Q

When to take statins

A

Once a day anytime. Simvastatin in evening.

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14
Q

When to dx statin

A

If LFT is 3X normal dx statin

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15
Q

When to check LFT for statin

A

if dark urine or yellow skin

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16
Q

What are some considerations when taking statins

A

Muscle toxicity
-myopathy
-rhabdomyolysis (more pain, causes kidney failure)

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17
Q

Major interaction with statins

A

Grapefruit juice

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18
Q

statins contraindicated in

A

pregnant/nursing

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19
Q

characteristics pre disposing individuals to adverse effects of statin

A

Impaired renal or hepatic function
prior statin intolerance or muscle disorder
unexplained ALT elevation of 3X
>75 yo

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20
Q

What happens when someone does experience symptoms of achy muscles from statins

A

Dx statins and evaluate for rhabdomylosis (creatine kinase)
If it is just myopathy it resolves on its own
restart same or lower dose statin once symptoms improve

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21
Q

contraindications to statins

A

Acute liver disease (ALT, AST levels high)
Pregnant/breastfeeding

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22
Q

What are some alternative dosing strategies for statins.

A

every other day dosing and once weekly dosing has been suggested to improve tolerability

double daily dosing for atorvastatin, fluvastatin and rosuvastatin for every other day dosing.

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23
Q

which drugs are contraindicated with simvastatin drugs

A

all of the -azole drugs
all of the-mycin drugs

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24
Q

Relation between statins and hyperglycemia

A

Statins may cause increased risk of diabetes

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25
Q

Monitoring for statins

A

When statin started, wait 4-12 weeks following initiation to get another lipid panel.
then lipid panel once a year.

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26
Q

What is another thing to monitor for statins

A

Monitor baseline CK while on statin therapy for rhabdomylosis

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27
Q

Name bile acid resin drugs (BAR)

A

Cholestyramine (questran)
Colestipol (colestid)
Colesevelam (welchol)

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28
Q

How do Bile acid resins (BAR) work

A

Work by trapping bile, liver uses cholesterol to create more bile, reducing cholesterol

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29
Q

disadvantage of bile acid resins

A

May increase TG
Take other meds 1 hour before or 4 hours after BAR

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30
Q

side effects of BAR

A

GI side effects

31
Q

adverse effects of bile acid resins

A

Impaired fat soluble vitamin absorption (A,D,E,K)

32
Q

contraindications of bile acid resins

A

cholestyramine- complex biliary obstructon
Colesevelam- Hx of bowel obstruction
serum TG>500
Hx HLD induced pancreatitis

33
Q

Niancin side effects and how to counteract

A

Flushing, can be avoided if ASA 325 mg given before niacin

34
Q

Niacin contraindications

A

Active hepatic disease (peptic ulcers, elevated ALT, AST)

35
Q

cholesterol absorption inhibitor drug

A

Ezetimebe (zetia)

36
Q

Ezetimebe combined with statin name? efficacy?

A

ezetimebe with simvastatin is called vytorin.
can reduce LDL 12-20%

37
Q

side effects of zetia

A

fatigue, diarrhea, GI upset

38
Q

contraindications of zetia

A

active hepatic disease
pregnancy/breast feeding

39
Q

Fibrates use

A

elevated triglycerides

40
Q

side effects of fibrates

A

GI disturbance, rash, dizziness

41
Q

contraindication of fibrates

A

Hx of gallbladder disease
ESRD or dialysis
liver disease

42
Q

Fibrates increase levels of

A

Statins, ezetimebe, warfarin

43
Q

PCSK9 drug names with generic important

A

Alirocumab (praluent)
Evolocumab (repatha)

44
Q

indication for PCSK9 drugs

A

reduced LDL in HeFH or ASCVD

45
Q

Side effects of PCSK9 drugs

A

influenza, inj site rxn
myalgia

46
Q

Inclisiran (lequivo) indication

A

Lowers LDL and cholesterol for HeFH and ASCVD pts

47
Q

side effects of Inclisiran

A

UTI
Inj site rxn

48
Q

Indication for bempedoic acid (Nexletol)

A

lowers LDL in HeFH and ASCVD pts

49
Q

side effects of bempedoic acid (nexletol)

avoid use in

A

May cause gout

avoid in use in simvastatin>20
pravastatin>40

50
Q

Red yeast rice use

A

Can lower LDL

51
Q

Lomitapide (juxtapid) blackbox warning

A

Hepatotoxicity

52
Q

what is a drug used for HoFH that can be used in pediatric pts

A

Evinakumab (evkeeza)

53
Q

5 questions to ask ourselves to assess what category pt is in for dyslipidemia

A
  1. is this primary prevention
  2. Is this secondary orevention
  3. What is their LDL (is it over 190?)
  4. does patient have diabetes
  5. Age and ASCVD risk
54
Q

If patient has not had previous ASCVD event and LDL>190 what instensity statin

A

High intensity

55
Q

If patient has not had previous ASCVD event and patient had DM and aged 40-75 years.

A

moderate intensity

56
Q

If patient has not had previous ASCVD event and If ASCVD risk>20%

A

high intensity

57
Q

If patient has not had previous ASCVD event and if age>75

A

not high intensity

58
Q

risks enhancing factors for primary orevention

A

FH of premature ASCVD
CKD
Elevated TG (>175)
Premature menopause

59
Q

For secondary prevention, ASCVD events include

A

MI, stable/unstable angina, Revascularization, stroke, PAD (peripheral artery disease)

60
Q

If patient has had an ascvd ebent, what intensity?

A

Strat on high intensity statin.

61
Q

follow up and monitoring recommendation for statins

A

Initiate statin
follow up in 4-12 weeks
follow up 3-12 months

62
Q

What is a CAC test

A

Coronary artery calcium test.
Tests how much calcium is built uo

63
Q

CAC>100 initiate which type of statin

A

atleast moderate intensity

64
Q

LDL requirements for primary prevention and no clinical ascvd vs secondary prevention

A

LDL<100
for secondary prevention LDL goal is <70

65
Q

What to do if patient is on statin and is not meeting LDL requirements

A

Maximize dose of statin

If they still have not reached LDL requirements, add a secondary agent (zetia)

66
Q

What are non-statin recommendations (after maximally tolerating statins)

A

1st line- Zetia (ezetimebe)
2nd- PCSK9 inhibitors (also used if pts can not tolerate statin and ezetimebe)

other- bile acid resin

67
Q

What are the 3 different types of hypertriglyceridemia and define them

A

Persistent- fasting TG>150 following 4-12 weeks of SM and statin

moderate- 150-499

severe>500 (concerned about pancreatitis)

68
Q

Secondary causes for elevated triglyceride

A

Obesity (Diabetes mellitus), alcohol , metabolic syndrome,

69
Q

LSM to reduce TG

A

5-10% weight loss= 20% reduction in TG
low fat diet
moderate or high intensity physical activity (>150 min per week)

70
Q

Pharmacologic treatment of TG >150

A

start statin and intensify it (maximize it)
recheck lipid panel in 4-12 weeks
add fibrates or fish oils as supplements

71
Q

If LDL>100 and Tg between 150-499 how to treat

A

Maximize statin therapy and non-statin (fishoil and fibrate)

72
Q

If LDL<70 and TG between 150-499, how to treat

A

LSM, consider fish oils

Therapeutics P2 (41 decks)

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