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CDM 1 Exam 2 > Hyperlipidemia: Prelecture > Flashcards

Hyperlipidemia: Prelecture Flashcards

1
Q

MOA: HMG-CoA reductase inhibitors

A

Inhibit Cholesterol Synthesis

Induce LDL receptor increase on Cell membrane

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2
Q

Low Intensity Statins

A

Lowers LDL by about <30%

Fluvastatin 20-40mg
Lovastatin 20mg
Pitavastatin 1mg
Pravastatin 10-20mg
Simvastatin 10mg
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3
Q

Moderate Intensity Statins

A

Lowers LDL by about 30-<50%

Anything that isn’t Low or High intensity

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4
Q

High Intensity Statins

A

Lowers LDL by about >50%

Atorvastatin 40-80mg
Rosuvastatin 20-40mg

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5
Q

Time course of Statin Efficacy

A

Usually helps when looking on scale over years

Lowers LDL-C, then endothelial function restored, inflam reduce, ischemic episode reduced, plaques stabilized = cardiac events reduced

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6
Q

Why is HPS important

A

Large trial 25K

Showed all had equal CHD benefit from LDL dec regardless of baseline

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7
Q

Why is PROVE-IT important

A

LDL <70 better than <100 in ACS pt

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8
Q

Why TNT important

A

LDL <70 better than <100 hyperlipidemic CHD pts

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9
Q

Why REVERSAL important

A

Statins reduce Atherosclerotic plaque size and prevent progression

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10
Q

Statin Adverse effects

A

GI
Headache
SAMS
** Rhabdomyolysis **

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11
Q

Statin Drug interactions

A

All but pravastatin metabolism via CYP450

Rosuva/Fluvastatin = few DI

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12
Q

Which drugs do you want to avoid with Statin?

A

Fibrate, risk of rhabdomyolysis risk

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13
Q

Which statin can be dosed at any time of day

A

Rosuvastatin and Atorvastatin

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14
Q

When to start low dose of statin

A 
if patient on 3A4 inhib
Renal insufficiency (Clcr <30-60, minus atorvastatin)
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15
Q

Simvastatin 80 has….

A

increased risk of Myopathy
Increased SAM

no one should start dose, but can continue if already taking

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16
Q

Drugs contraindicated with Simvastatin

A

Itra,Keto,Posaconazole
Ery,Clari,Telithromycin
Gemfibrozil

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17
Q

Drugs that shouldn’t exceed 10mg simvastatin with

A

Amiodarone
Verapamil
Diltiazem

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18
Q

Drugs that shouldn’t exceed 20mg simvastatin with

A

Amlodipine

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19
Q

Fruit that should be avoided with Simvastatin

A

Grapefruit juice >1 quart daily

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20
Q

Statin Safety

A

Caution higher intensity statins in asians/ history of hemorrhagic stroke

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21
Q

Characteristics predisposing patients to side effects of statins

A 
75yrs+
unexplained ALT elev X 3
previous statin intolerance
taking drugs affecting statin metabolism
serious comorbidities
22
Q

Rhambdomyolysis

A

Muscle pain, weakness,tenderness, dark urine

can be fatal

muscle cell breakdown and release into bloodstream

23
Q

What should you measure prior to statin that is hallmark of Rhambdomyolysis

A

CK

24
Q

How to manage myopathy

A

decrease dose of original statin and or low dose differential statin and gradually increase as tolerated

25
Q

Statins may raise….

A

Blood glucose and A1C

26
Q

Contraindications of Statins

A

Pregnancy Category X
Acute Liver disease
Lactation and breastfeeding

27
Q

Toxic monitoring parameters of statins?

A

CK level

AST/ALT

28
Q

PCSK9 Inhibitors MOA

A

inhibition of PCSK9 = increase LDL receptors, decreasing LDL in blood

29
Q

How are PCSK9 inhibitors different than statins?

A

Promote modulation of receptor that clears cholesterol, not blocking synthesis

injectable, every 2-4 weeks

30
Q

PCSK9 inhibitor Indications and agents

A

adjust to diet and max tolerated statin doses

Evolocumab (Repatha)
Alirocumab (Praluent)
Bococizumab
Inclisiran

31
Q

Assessing PCSK9 inhibitors

A

relatively safe
effective, lower LDL 43-64%
Cost is high, keeping from use

32
Q

Niacin MOA

A

decrease hepatic synthesis/secretions of VLDL
Alters metabolism and production of HDL

**Most potent agent to increase HDL, decrease TGs

33
Q

Niacin Efficacy and Safety

A

Flushing** major SE

way less effective in reducing LDL, not really recommended

34
Q

Niacin Flushing

A

Occurs in most patients
inc dose may inc flushing
most develop tolerance

35
Q

Niacin Strategies to minimize flushing

A

30-60min before dose take ASA,Ibupr 200 or other NSAID

Take at end of meals

Avoid hot liquids

ER = less flushing and hepatotoxicity

36
Q

Niacin Ease of Use

A

dose titration can be confusing for IR

OTC doesn’t equal RX

37
Q

Niacin Toxic monitoring

A

Glucose, Uric Acid, LFTs

38
Q

Fibric Acid Derivatives

A

Gemfibrozil (Lopid)
Fenofibrate (Tricor)
Clofibrate (Atromid)
Fenofibric Acid (Trilipix)

39
Q

Fibric Acid Derivatives MOA

A

PPARa agonists

increase HDL, decrease TG levels, increase LDL particle size

40
Q

Fibric Acid Derivatives Efficacy

A

small effects on LDL

Reserved for increased TGs lvls

clinical evidence decrease CHD events(less than statins)

41
Q

Fibrate side effects

A

Gi side effects

Fenofibrate better tolerated than Gemfibrozil

Never use together with Statins

42
Q

Fibrate Toxic monitoring

A

LFTs baseline and then every 6 month, signs/symptoms of myopathy or rhabdomyolysis

43
Q

Ezetimibe MOA

A

Inhibits cholesterol absorption in small intestine

works at brush border of small intestine

gets continuously recycled

44
Q

Ezetimibe efficacy

A

lowers LDL by like 10-20%, usually used as an add on. Doesn’t do much for HDL/TG

45
Q

Ezetimibe safety

A

Well tolerated, few side effects and no clinical DI

Easy to use, once daily

Cost isn’t crazy

46
Q

Bile Acid Sequestrants

A

Cholestyramine (Question)
Colestipol (Colestid)
Colesevelam (WelChol)

47
Q

Bile Acid MOA

A

Exchange CL ion for bile acid, preventing body from reabsorbing Bile acids which help cholesterol absorption.

48
Q

Bile Acid Efficacy

A

15-30% LDL reduction, primarily used for LDL and maybe as add on

Ezetimibe usually preferred add on tho

49
Q

Bile Acid Side effects

A

Not used much due to Side effects/ DI

Abdominal pain, bloating, constipation, bind to bunch of drugs

50
Q

Lomitapide (Juxtapid)

A

MTP inhibitor

prevents chylomicron formation

used only in patients with familiar hyperlipidemia. probs won’t be used often + not in current guidelines.

CDM 1 Exam 2 (16 decks)

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