Hyperlipidemia 4 (meds) Flashcards
How much do statins decrease LDL by?
20-55+%
How much do statins increase HDL by?
5-15%
How much do statins decrease TG by?
Are they effective on Tgs >400mg/dL?
TG decrease 7-30%
NOT effective on Tgs >400
What are the 3 contraindications of Statins?
- Pregnancy/breastfeeding
- Active liver disease
- Unexplained elevated LFTs
The following are side effects for which medication:
- Myalgias, up to 10%
- Myositis, myopathy
- Rhabdomyolysis
- Hepatotoxicity (LFT elevation, hepatic failure)
- Increased diabetes risk
Statins (HMG-CoA reductase inhibitors)
The following should be done at follow up for patients on which type of medication?
1. LFTs (at 12 weeks, dont need to continue monitoring unless meds are changed)
- Creatine kinase (baseline and if myalgias present)
Statins
The following is the MOA of which drug?
MOA: Decreases absorption of cholesterol in small intestine, upregulates LDL receptors on peripheral cells
Cholesterol absorption inhibitor
Contraindications of what medication?
–Caution with hepatic impairment
–Do not use with fibrates
Cholesterol absorption inhibitor
What type of medication is ezetimibe (Zetia)?
A cholesterol absorption inhibiotr
How much do cholesterol absorption inhibitors (like ezetimibe) decrease LDL by?
15-20%
You should consider adding what medication to statin when LDL > 70 in very high-risk ASCVD?
Cholesterol absorption inhibitor (ex: ezetimibe)
Which pharmacologic tx has the following MOA:
•monoclonal antibodies blocks PCSK9 effect of degrading LDL receptors
PCSK9 inhibitor (ex: alirocumab, evolocumab)
Which pharmacologic tx requires SC injection q 2-4 weeks?
PCSK9 inhibitor (ex: alirocumab, evolocumab)
alirocumab (Praluent) and evolocumab (Repatha) are examples of what types of pharmacologic tx?
PCSK9 inhibitor
How much do PCSK9 inhibitors (ex: alirocumab, evolocumab) lower LDL by?
by 50-60%
What is a draw back of PCSK9 inhibitors (ex: alirocumab, evolocumab)?
Very expensive
What pharmacologic tx should be considered in the following situations:
–Familial hypercholesterolemia
–Very high risk ASCVD, on maximally tolerated LDL therapy and LDL ≥ 70
–Statin intolerance
PCSK9 inhibitor (ex: alirocumab, evolocumab)
Which pharacologic tx?
- MOA: Reduced synthesis and increased breakdown of VLDL particles
- Drug of choice for TG >500 mg/dL on initial presentation
Fibric acid derivatives
ex: gemfibrozil (Lopid), fenofibrate (Tricor)
The following are contraindications of which medication?
–Active liver disease or permanent impairment
–Gallbladder disease
–Caution with pregnancy
–Caution with renal impairment
–Not recommended with statin use (inc. risk of hepatotoxicity and rhabdo)
Fibric acid derivatives (ex: gemfibrozil, fenofibrate)
•Lipid effects of which med?
–LDL decrease 10-15%
–HDL increase 15-20%
–TG decrease 40%
Fibric acid derivatives (ex: gemfibrozil, fenofibrate)
Which med has the following side effects?
–Cholelithiasis
–Hepatitis
–Myositis
Fibric acid derivatives (ex: gemfibrozil, fenofibrate)
Which med?
MOA: bind bile acids in the intestine
- The reduction of bile acids in the entero-hepatic circulation causes the liver to increase its production of bile acids, using hepatic cholesterol to do so.
Bile-acid binding resins
Example: cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid)
Which is the only lipid-lower medication considered safe in pregnancy?
Bile-acid binding resins
Example: cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid)
Which med?
- Best used in patients with moderate increased LDL and normal HDL/TG OR high risk pregnant women
- Contraindications:
- Current or history of GI obstruction
- Hypertriglyceridemia
- Pancreatitis
Bile-acid binding resins
Example: cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid)
Which med?
•Lipid Effects:
- LDL decreased 15-25%
- HDL – insignificant effect
- TG – little effect or may increase
•Side effects: GI symptoms
Bile-acid binding resins
Example: cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid)
Which med reduces the production of VLDL particles
-Has both short acting (OTC) and long acting (Rx) available –> long acting is better tolerated
Niacin (nicotinic acid or vitamin B3)
Examples: niacin, Niaspan, Slo-Niacin
Which med?
Lipid effects:
- LDL decreases 15-25%
- HDL increases 25-35%
- TGS decreases by up to 50%
- Best for moderately high LDL and very low HDL
Niacin (nicotinic acid or vitamin B3)
Examples: niacin, Niaspan, Slo-Niacin
Which med?
•Side effects: flushing
•Contraindications:
- Pregnancy/breastfeeding
- Active liver disease
- Active peptic ulcer
•Caution:
- Gout/hyperuricemia
- DM
Niacin (nicotinic acid or vitamin B3)
Examples: niacin, Niaspan, Slo-Niacin
Which pharmacologic treatment?
- Improve TG, lower CV risk
- Anti-inflammatory
Omega-3 fatty acids
