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Pharmacology II Exam 1 > Lipid Lowering Medications > Flashcards

Lipid Lowering Medications Flashcards

1
Q

Which drug class is thought to work by either decreasing hepatic circulation or decreasing TG synthesis

A

Omega 3

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2
Q

What is the major side effect of Omega 3’s?

A

Fishy burp
indigestion
altered taste

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3
Q

What are the medications included in Omega 3?

A

Fish oil supplements
Fatty fish’s
Lovaza

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4
Q

When are Omega 3’s given and what is the desired effect?

A

When TG are greater than 500 mg/dL

Desired effect: Decrease TG by 60%

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5
Q

Which medication’s MOA is a decrease in intestinal absorption of dietary and biliary cholesterol?

A

Cholesterol Absorption inhibitors

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6
Q

What are some of the major side effects of ezetimibe? (and what class is it?)

A

Cholesterol absorption inhibitors
Diarrhea and musculoskeletal
(also sinusitis and infections)

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7
Q

What class are the drugs Gemfibrozil and Fenofibrate in?

A

Fibrates

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8
Q

Which of the fibrates is easier to tolerate for the pt in that it is only dosed QD for the most part as opposed to it’s sister medication

A

Fenofibrate is given QD

Gemfibrozil is given BID *so you would probably chose fenofibrate.

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9
Q

When are fibrates used?

A

2nd line for selected pt’s (those who can’t take statins)

and when TG is greater than 500mg/dL

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10
Q

What medications are considered Nicotinic Acids?

A

Nicotinic acid
Niacinamide
Niacin

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11
Q

What is the Mechanism of action for fibrates?

A

Activate PPAR-alpha which modulates metabolism and catabolism of lipids (works on the genes)

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12
Q

What drug is assumed to work in adipose tissue and decreases TG syntesis

A

Nicotinic acid

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13
Q

Which drug class is known for causing flushing?

A

Nicotinic acid

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14
Q

How can you minimize the effects of flushing when taking a drug in the class nicotinic acid?

A

Full dose of ASA (325mg) along with
or
switching to extended release NA

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15
Q

When are Nicotinic acids used

A

when TG is greater than 500mg/dL

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16
Q

What 2 medication classes are second lines for those with hyperlipidemia who cannot tolerate statis?

A

Bile Acid Sequestrants

Fibrates ** (MC used)

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17
Q

What medication works in the GI tract to exchange resins that bind to bile acids

A

Bile acid sequestrants

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18
Q

What medications are considered bile acid sequestrants?

A

Chelestyramine
Colestipol
Colesevelam

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19
Q

What is good to know when prescribing a pt a BAS (bile acid sequestrant)

A

Cholestyramine comes only in powder form the other 2 BAS come in table form
PT’s will probably prefer to take the tablet

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20
Q

What medication may cause extreme constipation, flatulence, nausea, vomitting thus making the action in the GI the rate limiting step for these pt’s.

A

BAS

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21
Q

What is the mechanism of action of Statins?

A

Inhibit CoA reductase

22
Q

Which statins are the highest potency?

A

Atorvastatin(lipitor)

Rosuvastatin(crestor)

23
Q

What are the names of the statins?

A 
Fluvastatin (Lescol)
Pravastatin (Pravachol)
Lovastatin (Mevacor)
Simvastatin (Zocor)
Atorvastatin (Lipitor)
Rosuvastatin (Crestor)
24
Q

Which statin is best for use in those who might be at risk of other drug interactions. This drug has a lower risk of mypotahy and other comorbidies.

A

Pravastatin (Pravachol)

25
Q

What characteristic makes Pravastatin a good choice for a person who is at risk of drug interactions?

A

It is metabolized by sulfation (the rest go through different CYP systems).

26
Q

T/F Pravastatin is a good high potency choice for patients requiring a statin.

A

False-Pravastatin is a low potency med.

27
Q

What Statins are low potency statins?

A

Pravastatin

Lovastatin

28
Q

Which statins are moderate potency statins?

A 
Atorva
Rosuva
Simva
Prava
Lova
Fluva
29
Q

Which statins are high-intensity statins?

A

Atorva

Rosuva

30
Q

What is the expected % LDL decrease of High-intesity statins?

A

50% or more

31
Q

What is the expected % LDL decrease of moderate intensity statins?

A

30-50%

32
Q

What is the expected % LDL decrease of low-intensity statins?

A

Less than 30%

33
Q

What are the recommended time guidelines for exercise weekly?

A

3-4 sessions per week
40 minutes per session
Moderate to vigorous intensity

34
Q

What factors put a patient at risk of developing dyslipidemia?

A

Diet
Drugs
Diseases
Altered metabolism

35
Q

What factors have been proven to predispose an individual to complications from dyslipidemia?

A 
Age
Gender
Race
Systolic BP 
Smoking
DM
HDL
Total cholesterol
Meds for BP
36
Q

What factors have been proven to predispose an individual to adverse events while on a statin?

A

Multiple comorbidities
Hx of previous statin intolerance or muscle d/o
Unexplained ALT elevations greater than 3x ULN
Drug interactions
Age over 75yo

37
Q

What labs should be ordered at baseline in patient who are considering taking a statin?

A

Fasting lipid panel
ALT
CK
A1C

38
Q

What labs should be ordered at baseline if prescribing a class of drugs for hyperlipidemia that is NOT a statin?

A

Uric acid
Triglycerides (can’t use BAS if TG are high)
sCr/GFR (fibrates)

39
Q

What is the ASCVD cutoff for starting a statin?

A

7.5%

40
Q

What is the cutoff for starting meds for elevated TG?

A

1,000 mg/dL (reasonable to start at 500mg/dL as well)

41
Q

If headaches, dizziness or stomach upset occur while on statin patient may take it ________ to decrease symptoms. If these symptoms occur they will probably improve _______.

A

At night

With time

42
Q

If the patient is unable to tolerate the statin it is ok to start first by trying to ______?

A

Lower the dose

43
Q

Patients should be instructed to report directly to the ER and stop taking their statin immediately if they notice ________?

A

Change in urine color to dark brown.

44
Q

What should be monitored (and how often) to determine the efficacy of a newly initiated statin?

A

Signs and symptoms of heart disease:

Check Lipid panel (should start to decrease) 6-8wks after starting.

45
Q

when is it reasonable to decrease level of statin intensity in follow up with a patient?

A

If LDL goes below 40mg/dL

46
Q

In regards to safety what levels should we monitor as needed?

A

AST, ALT for signs of liver disease

Ask pt about signs of myalgia (check CK if suspect)
CK greater than 10x ULN-d/c immediately
CK 3-10x ULN - d/c and switch pt to a different statin or a lower dosage.

47
Q

If you have a pt with a hx of cardiac event/stroke what intensity statin should this pt take?

A

High intensity

48
Q

For pt’s with LDL greater than 190mg/dL and age of 21+ years what intensity statins should this pt be started on?

A

High intensity

49
Q

Pt’s who have diabetes and are between 40-75 with a ASCVD risk of 7% what intensity statin should this pt be started on?

A

Moderate

50
Q

For a patient with DM aged 40-75 who has an ASCVD risk of 7.5% what intensity statin should this pt be started on?

A

High

51
Q

For a pt with a ASCVD risk of 7.5% and is age 40-75 what intensity statin should this pt be started at?

A

Moderate-high

Pharmacology II Exam 1 (2 decks)

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