Exam 2 Lecture 3 Flashcards

1
Q

Which one decreases LDL more PCSK9 or LDL

A

PCSK9, but more expensive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lovastatin generic

A

Pravachol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pitavastatin generic

A

Livalo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Simvastatin (important) generic

A

Zocor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

atorvastatin generic

A

lipitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

rosuvastatin generic

A

crestor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

High intensity statins name and strength

A

atorvastatin 40-80
Rosuvastatin 20-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Low intensity name and dosage

A

Simvastatin- 10
pravastatin- 10-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CYP3A4 statins

A

Lovastatin, simvastatin, Atorvastatn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the two hydrophilic drugs

A

Pravastatin and rosuvastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Use of hydrophilic drugs

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When to take statins

A

Once a day anytime. Simvastatin in evening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When to dx statin

A

If LFT is 3X normal dx statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When to check LFT for statin

A

if dark urine or yellow skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some considerations when taking statins

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Major interaction with statins

A

Grapefruit juice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

statins contraindicated in

A

pregnant/nursing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

contraindications to statins

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which drugs are contraindicated with simvastatin drugs

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Relation between statins and hyperglycemia

A

Statins may cause increased risk of diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is another thing to monitor for statins

A

Monitor baseline CK while on statin therapy for rhabdomylosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Name bile acid resin drugs (BAR)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do Bile acid resins (BAR) work

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

disadvantage of bile acid resins

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

73
Q
A