Lipid lowering drugs Flashcards
ASCVD risk factors
- family hx of ASCVD
- gender
- age
- race
- chronic LDL > or = 160 mg/dL
- HDL cholesterol
- SBP
- DM
- smoker
- renal disease
- metabolic syndrome
- hx of preeclampsia
Statin drug interactions: What are other drugs known to induce myopathies?
- niacin
- gemfibrozil
**if using these drugs with a statin, risk of rhabdo increases**
What is the concern of cyclosporine with statin use?
- cyclosporine increases concentration of all statisn and the risk of myopathy
What is the concern of dabigatran with simvastatin or lovasatin?
- increase risk of MAJOR hemorrhage!!
- mechanism unclear
List drugs that reduce metabolism/increase concentration of simvastatin and lovastatin.
- itraconzaole (sporanox)
- ketoconazole (nizoral)
- erythromycin
- clarithromycin (biaxin)
- grapefruit juice
- cyclosporine
- HIV protease inhibitors
- verapamil
- amiodarone
**these drugs are CYP3A4 inhibitors**
A patient is at increased risk for ___________ if taking both a statin and Niacin.
hepatic dysfunction
What isi the MOA and effect of PCSK9 Inhibitors?
- PCSK9 is an enzyme that binds to LDL receptors and promotes lysosomal degradation of the receptors
- agents are monoclonal antibodies that bind PCSK9 preventing subsequent binding of PCSK9 to LDL receptors
- “inhibit degradation of LDL receptors - now have more LDL receptors”
- end result: high concentration of LDL receptors and enhanced clearance of LDL - C
What are the two PCSK9 inhibitors and what is their efficacy?
- Alirocumab (praluent)
- evolucumab (repatha)
- redueced median LDL - C from 92 - 30 mg/dL
- FOURIER clinical trial
- lower risk of MI, CV death, stroke, unstable angina, PCI (9.8% vs 11.3%)
- ODYSSEY clinical trial
- when added to statin reduces death from CV causes (9.5% vs 11.1%)
What are adverse effects and interactions of PCSK9 inhibitors?
- appear well tolerated with no significant interactions
- muscle aches
- rash
- uticaria
- mild injection site reactions
- so effective that they can cause abnormally low LDL < 25 mg/dL - does not appear to be problematic based on current information
- MAY CAUSE NEURAL TUBE DEFECTS - unclear at this time
- AVOID IN PREGNANCY
What is the only fibrate associated with beneficial CV outcomes?
gemfibrozil (lopid)
Are PCSK9 inhibitors safe in pregnancy?
- NO, avoid in pregnancy!!
- may cause neural tube defects - unclear at this time
What are potential drug interactions of fibric acid derivatives?
- can potentiate oral anti-hyperglycemic drugs
- can increase serum concentration of statins
- displaces warfarin from plasma albumin
- can increase the risk for bleeding in patients on warfarin
- measure INR frequently
What are considerations for combination therapy of statins and fibric acid derivatives.
- primarily assist in decreasing triglycerides
- increased risk of myopathies
- contraindicated with severe hepatic disease
What are drug interactions of ezetimibe (zetia)?
- may increae bleed risk with warfarin
- is increaed by and will increase concentration of cyclosporine
- when used with gemfibrozil, increased risk of gallstones (combo is contraindicated)
- absorption is inhibited by bile acid sequestrants
Which combo of drugs in contraindicated for increased risk of gallstones?
ezetimibe and gemfibrozil
