Heart Disease Flashcards
Drugs that increase LDL and TG
Diuretics
Efavirenz
Steroids
Immunosuppressants- Cyclosporine, Tacrolimus
Atypical antipsychotics
Protease inhibitors
Increase LDL only
Fish oils (except Vascepa)
Increase TG only
IV lipid emulsions
Propofol
Bile acid sequestrants
Desirable TG range
<150
Friedewald equation
LDL=TC-HDL-TG/5
OTC fish oils can be used to
lower TG, but some can raise LDL
Which cholesterol lowering drugs cause liver damage?
Niacin
Fibrates
Statins
Ezetimibe
Statin benefit groups
-Clinical ASCVD
-Primary elevation of LDL >/=190
DM 40-75 yo with LDL 70-189 (if multiple RF- high, no RF-mod)
Age 40-75 with LDL between 70-189 (10 year risk>20-high, <19.9-Mod)
Statin equivalent doses
Pharmacists Rock AT Saving Lives and Preventing Fat
Pitavastatin 2 mg
Rosuvastatin 5 mg
Atorvastatin 10 mg
Simvastatin 20 mg
Lovastatin 40 mg
Pravastatin 40 mg
Fluvastatin 80 mg
Statin lipid effects
Increased HDL
Decreased LDL, TG
CYP3A4 inhibitors
Grapefruit
Protease Inhibitors
Azole antifungals
Cyclosporine, cobicistat
Macrolides
Amiodarone- Simva 20mg/d max, Lova 40mg/d max
Non-DHP CCVs- Simva 10mg/d max, 20mg/d mac
Which statins have the least DDI?
Rosuvastatin
Pravastatin
Do not use statins with
gemfibrozil
Which statins should be taken in the evening?
Lovastatin (Altoprev)
Fluvastatin
SImvastatin (Zocor)
Which meds are used to target high TG?
FIsh oils
Fibrates
Bile acid sequestrants
Cholestyramine
Colesevelam (Welchol)
Colestipol
Increase TG, Decrease LDL
Which bile acid sequestrant is an option for pregnant patients?
Colesevelam
Colesevelam (Welchol) safety
Bowel obstruction
Discoloration/erosion of teeth
Colesevelam (Welchol) safety
Bowel obstruction
Discoloration/erosion of teeth
Increased TG
Lopid
Gemfibrozil
Fibrate
Antara
Fenofibrate
MOA of fibrates
PPARa activators
Increases lipoprotein lipase activity leading to increased catabolism of VLDL particles.
Trilipix
Fenofibrate
Contraindications of fibrates
Severe liver disease
Gallbladder disease
Lipid effects for fibrates
Decreased TG
Can Increase LDL
Niacin MOA
Decreases the rate of hepatic synthesis of VLDL (decreases TG) and LDL
Niacin is also called
Vitamin B3
Nicotinic Acid
Niacin lab effects
Increased BG
Increased Urica acid
Increased HDL
Decreased LDL and TG
Niacin and bile acid sequestrants DDI
Take niacin 4-6 hours after bile acid sequestrants
Niaspan
Take at bedtime after a low fat snack
Less flushing and less hepatotoxicity
Best choice
Fish oils use
Adjunct to diet with TG >/=500
Increases LDL (Lovaza, not seen with Vascepa)
Natural products used for HTN
Fish oil
Coenzyme Q10
L-arginine
Garlic
Exforge
Valsartan + Almodipine
Ziac
Bisoprolol + HCTZ
Diovan HCT
Valsartan HCT
Zestoretic
Lisinopril HCTZ
Lotrel
Benazepril + Amlodipine
Dyazide
Triamterene + HCTZ
Hyzaar
Losartan + HCTZ
Maxzide
Triamterene + HCTZ