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Pharm 586 > MCP: Lipid Management and Anticoagulation > Flashcards

MCP: Lipid Management and Anticoagulation Flashcards

1
Q

Pravastatin

A

Pravachol

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2
Q

Lovastatin

A

Mevacor

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3
Q

Simvastatin

A

Zocor

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4
Q

Atorvastatin

A

Lipitor

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5
Q

Rosuvastatin

A

Crestor

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6
Q

Pravachol

A

Pravastatin

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7
Q

Mevacor

A

Lovastatin

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8
Q

Zocor

A

Simvistatin

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9
Q

Lipitor

A

Atorvastatin

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10
Q

Crestor

A

Rosuvastatin

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11
Q

Statin MOA

A
  • Inhibit conversion of HMG-CoA to mevalonate
  • Reduces hepatic cholesterol synthesis
  • Lowers intracellular cholesterol
    • Stimulates the up-regulation of the LDL receptor
    • Increases the uptake of non-HDL particles from systemic circulation
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12
Q

Statin Benefits

A
  • Lipid Effects
    • Decrease LDL
    • Decrease TG
    • Increase HDLs
  • Pleiotropic effects
    • Improve endothelial dysfunction
    • Inhibit platelet aggregation
    • Decrease LDL oxidation
    • Reduce vascular inflammatory responses
    • Stabilize atherosclerotic plaques
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13
Q

Statin SE

A
  • Common
    • GI upset
    • Headache
    • Elevated hepatic transaminases
    • Non-specific muscle and joint pain
  • Rare
    • Rhabdomylysis (muscle weakness)
    • Cognitive impaiement
    • Hyperglycemia
    • Hyeptatoxicity
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14
Q

Statins CI in what populations

A
  • Pregnancy
  • Lactation
  • Liver disease
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15
Q

Statin Interactions

A
  • Cyp 450
    • Cyp 3A4
      • Lovastatin, Simvistatin, Atorvastatin
        • Grapefruit juice, amplodipine, diltiaxem, veramapil, azoles, macrolides
    • Minor CYP 2C9 metabolism
      • Rouvastatin
  • Antacids
  • Increase myopathy with fibrates and niacin
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16
Q

Prodrug, Hydophilic and Potency of Statins

A
  • Prodrug
    • Lovastatin
    • Simvistatin
  • Hydrophilic
    • Pravstatin
    • Fluvastatin
    • Rouvastatin
  • Potency (high to low)
    • Rouvastatin, atorvastatin, simvastatin, pravastatin, lovastatin, fluvastatin
17
Q

Niacin (Vitamin B3) MOA

A
  • Lipid lower efffect is independent as role as vitamin
  • Inhibits hepatic synthesis of LDL, VLDL
  • Reduces plasma concentration of TG, VLDL
  • Change LDL composition from small dense particles to large buoyant particles
18
Q

Niacin Benefits

A
  • Decrease LDL
  • Decrease TG
  • Increase HDL
  • Small dose to change HDL and TG, large doses to lower LDL
19
Q

Niacin SE

A
  • Common
    • Flushing
      • due to prostaglandin release and vasodialation
      • more common in IR products
    • GI
  • Rare
    • Hyperglycemia
    • Hyperuricema and gout
    • Hepatotoxiciyt
    • Myopathy
20
Q

Niacin Flushing Management

A
  • Slow titration
  • ASA 325mg or Ibuprofen 200mg 30-60 min before niacin
  • Avoid spicy food, hot beverage, alcohol
  • Do not skip doses
21
Q

Niacin Products (interchangability and SE association)

A
  • Dosing is not interchangable
  • Long-acting associated with hepatotoxicity
  • Short acting associated with worse flushing
22
Q

Fibrates Benefits

A
  • Primary Indication (TG over 400)
    • Decreases TG (Main benefit)
    • Increases HDL (Main benefit)
    • Decreases LDL
      • may increase when used in patients with high TG
23
Q

Fibrates MOA

A
  • PPAR-alpha actiation
  • Increases synthesis of apolipoproteins and enzymes of lipoprotein metabolism
  • Increase expression of several genes involed in fibrinolysis and inflammation
24
Q

Fibrates: CI, Interaction, Precautions

A
  • CI
    • Hepatic dysfunction
    • Severe renal dysfunction
    • Preexisiting gallbladder disease
  • Statins increase risk of muscle weakness
  • Anticoagulants increase risk of bleeding
  • Gemfibrozil may interact with diabetes medications like pioglitazon, repglinide, SFU and result in hypoglycemia
25
Q

Fibrates SE

A
  • Common
    • Well toleerated
    • GI
  • Rare
    • Elevated liver enzymes, creatinine
    • Myopathy
    • Gallstones
26
Q

Omega-3 Fatty Acids: MOA, Active Ingredients

A
  • MOA:
    • Inhibit hepatic secretion TG
    • Promote TG metabolism
  • Active Ingredients
    • EPA
    • DHA
27
Q

Omega-3 Fatty Acid: Benefits, SE, Interactions

A
  • Benefits
    • Reduce TG used as alternative to niacin or fibrates
    • Lower overall mortality
    • May reduce inflammation, inhibit atherosclerosis
  • SE
    • Fishy burn
    • Methylmercury toxicity
    • LDL can increase by 40% in patient with TG >500
  • Interaction
    • Anticoagulation (when >3g)
28
Q

Which Statins have long half life? (can take them at anytime)

A
  • Atorvastatin
  • Rouvastatin
  • All others are PM because cholesterol made at night
29
Q

Warfarin Indication

A
  • Afib
  • Pulmonary embolism
  • Venous thromboembolism
  • Post MI
  • Prophylaxis in knee and hip replacement surgeries
30
Q

Warfarin MOA

A
  • Inhibits synthesis of vitamin K dependent clotting factors II, VII, IX, X
  • Inhibits anticoagulatnt proteins C and S
  • Hlaf life 36-72 hours
  • Cyp2C9, 1A2, 3A4
  • Highly protein bound
31
Q

Warfarin Monitoring

A
  • Measure INR weekly to monthly
  • Target is 2-3 (normal=1)
  • Higher #= longer clotting time
  • INR=Pt PT/control PT
32
Q

Warfarin Education

A
  • Tablets color coded
  • Daily dose may vary
  • Frequent changes by anticoag clinic
  • NEVER double up
33
Q

Signs of clotting and bleeding

A
  • Bleeding
    • Significant bruising
    • Nosebleed
    • Coughing up blood
    • Blood in stool/urine
  • Clotting
    • Sever pain in calf
    • Cheft pain
    • One sided weakness
    • Severe HA
    • Sudden change in speech and vision
34
Q

Drugs that increase INR

A
  • Fluroquinolones
  • Macrolides
  • TMP/Sulfa
  • Metornidazole
  • Azole
  • Amiodarone
35
Q

Drugs that decrease INR

A
  • Diclozacillin
  • Nafcillin
  • Rifampin
  • Cabamazepine
36
Q

Effect of Warfarin Interaction

A

Effect seen in 3-14 days; need to adjust warfarin dose by 30-50%

37
Q
A

Pharm 586 (5 decks)

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