Exam 2 Lecture 3 Flashcards
Which one decreases LDL more PCSK9 or LDL
PCSK9, but more expensive.
Lovastatin generic
Pravachol
Pitavastatin generic
Livalo
Simvastatin (important) generic
Zocor
atorvastatin generic
lipitor
rosuvastatin generic
crestor
High intensity statins name and strength
atorvastatin 40-80
Rosuvastatin 20-40
Moderate intensity statins name and strength
Atorvastatin-10-20
Rosuvastatin 5-10
Simvastatin 20-40
pravastatin- 40-80
Lovastatin- 40-80
flovastatin- 40
Low intensity name and dosage
Simvastatin- 10
pravastatin- 10-20
CYP3A4 statins
Lovastatin, simvastatin, Atorvastatn
What are the two hydrophilic drugs
Pravastatin and rosuvastatin
Use of hydrophilic drugs
Patients prone to muscle toxicity/pain, consider picking hydrophilic drugs (pravastatin, rosuvastatin)
When to take statins
Once a day anytime. Simvastatin in evening.
When to dx statin
If LFT is 3X normal dx statin
When to check LFT for statin
if dark urine or yellow skin
What are some considerations when taking statins
Muscle toxicity
-myopathy
-rhabdomyolysis (more pain, causes kidney failure)
Major interaction with statins
Grapefruit juice
statins contraindicated in
pregnant/nursing
characteristics pre disposing individuals to adverse effects of statin
Impaired renal or hepatic function
prior statin intolerance or muscle disorder
unexplained ALT elevation of 3X
>75 yo
What happens when someone does experience symptoms of achy muscles from statins
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
contraindications to statins
Acute liver disease (ALT, AST levels high)
Pregnant/breastfeeding
What are some alternative dosing strategies for statins.
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.
which drugs are contraindicated with simvastatin drugs
all of the -azole drugs
all of the-mycin drugs
Relation between statins and hyperglycemia
Statins may cause increased risk of diabetes
Monitoring for statins
When statin started, wait 4-12 weeks following initiation to get another lipid panel.
then lipid panel once a year.
What is another thing to monitor for statins
Monitor baseline CK while on statin therapy for rhabdomylosis
Name bile acid resin drugs (BAR)
Cholestyramine (questran)
Colestipol (colestid)
Colesevelam (welchol)
How do Bile acid resins (BAR) work
Work by trapping bile, liver uses cholesterol to create more bile, reducing cholesterol
disadvantage of bile acid resins
May increase TG
Take other meds 1 hour before or 4 hours after BAR