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PHARM EXAM 2 > Hyperlipidemia > Flashcards

Hyperlipidemia Flashcards

1
Q

Desired LDL

A

< 130

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2
Q

Desired HDL

A

> 60

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3
Q

Desired Total Cholesterol

A

< 200

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4
Q

Desired Triglycerides

A

< 150

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5
Q

Desired LDL/HDL ratio

A

< 3.0

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6
Q

Desired Total Cholesterol/HDL ratio

A

< 3.5

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7
Q

Desired Apo B

A

< 80

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8
Q

Four Major Statin Benefit Groups

A
  1. Individuals with ASCVD
  2. Individuals with LDL > 190 without ASCVD
  3. Individuals with DM, 40-75yo, LDL 70-189, without ASCVD
  4. Individuals without ASCVD or DM with LDL 70-189 and established 10 year ASCVD risk > 7.5%
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9
Q

ASCVD

A
  • acute coronary syndrome
  • history of MI
  • stable angina
  • PCI or other revascularization
  • stroke/TIA
  • PAD
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10
Q
  1. Individuals with ASCVD
A

High Risk: HIGH INTENSITY STATIN

Very High Risk: (over 75) HIGH + EZETIMIBE or HIGH + EZETIMIBE and PCSK9 INHIBITOR

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11
Q
  1. Individuals with LDL > 190 without ASCVD
A

Over 21

HIGH INTENSITY STATIN

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12
Q
  1. Individuals with DM, 40-75yo, LDL > 70 and without ASCVD
A

MODERATE INTENSITY STATIN
or if
1) Multiple risk factors or 2) 50-75yo and want to decrease LDL by more than 50% then HIGH INTENSITY STATIN

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13
Q
  1. Individuals without DM or ASCVD but with LDL 70-189 and 40-75yo and 10 year ASCVD risk > 7.5%
A

MODERATE - HIGH INTENSITY STATIN

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14
Q

Drug Interactions for Statins - What to use what not to use

A
  • Most likely to interact are the CYP3A4 metabolizers (atorvastatin, lovastatin, simvastatin)
    • instead use fluvastatin, pravastain, pitavastatin,
      rosuvastatin
  • Increases risk of myopathy + rhabdo
    • Antifungal agents (-conazoles)
    • HIV and HCV protease inhibitors
    • CCB: amlodipine, dilt, verapamil
    • Antiarrhythmic agents: amiodarone, dronedarone
    • Antibiotics: clarithromycin, erythromycin,
      telithromycin
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15
Q

Drugs that decrease statin levels

A

ONLY CYP3A4 Metabolizers

- carbamazepine, oxcarbazepine, phenytoin, rifampin, st johns wort

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16
Q

Drugs that interact with ALL statins that increase risk of Rhabdo/Myopathy

A
  • colchicine
  • *** gemfibrozil (rhabdo)
  • cyclosporine
  • niacin
  • daptomycin
  • red yeast rise
  • fenofibrate
17
Q

Statins that increase AC effect of warfarin

A

fluvastatin, rosuvastin, lovastatin, simvastatin, pravastatin,
** consider using atorvastatin **

18
Q

Statin Therapy Monitoring (8)

A
  1. Check ALT at baseline. Repeat only if symptoms of hepatotoxicity occur
  2. Document any pre existing muscle symptoms before starting a statin to establish a baseline
  3. Consider checking Cr Kinase at baseline in patients at increased risk of myopathy (ie drug interactions). Repeat only if symptomatic
  4. If severe muscle symptoms or fatigue of unknown cause develop, hold the statin and check Cr and UA to rule out rhabdo
  5. *** check fasting lipid panel 4-12 weeks after statin initiation then every 3 to 12 months after stabilized
  6. Check adherence to statin and lifestyle interventions if LDL drop less than expected
  7. Consider statin dose reduction if two consecutive LDL measurements are < 40
  8. Monitor for new onset diabetes per diabetes screening guidelines
19
Q

Non Statin Therapy

A

Ezetimibe
Bile acid sequestrant
Fibrates (do not add gemfibrozil to statin therapy)
PCSK9 Inhibitor ( only 3yrs, bene uncertain in pts without ASCVD)
no proof adding non statin to a statin prevents events in patients without clinical ASCVD

20
Q

Who to use Non statin therapy on

A
  • Pts at very high risk of ASCVD who do not reach LDL of 70 with statin
    • add ezetimibe
    • failing that, may add PCSK9
  • Patients 20-75yo with LDL > 190 who cannot achieve a 50% LDL reduction and/or LDL < 100 with statin
    • Add ezetimibe
    • LDL threshold still not met and fasting triglycerides < 300
      = add on bile acid sequestrant
      = failing that, may add PCSK9
  • Patients 30-75yo with genetic hypercholesterolemia and LDL 100 despite statin and ezetimibe
    • add PCSK9
  • Primary prevention in adults 40-75yo with LDL 70-189 and estimated 10 year risk of ASCVD of 7.5% or higher and CKD
    • combine ezetimibe to statin
  • Triglycerides 500-1000 despite lifestyle changes (ver low fat diet with increased ome3 consumption, cutting refined carbs and alcohol) and ruling out secondary causes
    • Fibrate
21
Q

HIGH INTENSITY DOSAGES

A

Atorvastatin 40-80mg

Rosuvastatin 20-40mg

22
Q

MODERATE INTENSITY DOSAGES

A

Atorvastatin 10-20mg
Rosuvastatin 5-10mg

Fluvastatin 40mg BID 
Fluvastatin XL 80mg
Lovastatin 40-80mg
Pravastatin 40-80mg
Simvastatin 20-40mg

Pitavastatin 1-4mg

23
Q

LOW INTENSITY DOSAGES

A

Fluvastatin 20-40mg
Lovastatin 20mg
Pravastatin 10-20mg
Simvastatin 10mg

PHARM EXAM 2 (19 decks)

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