Met 1: Dyslipidemia Tx Flashcards
Name 3 groups that could use high-intensity statin therapy.
- Hx of CVD
- LDL over 190
- Diabetes pts 40-75 yo
Name 1 group who could use moderate intensity statins
40-75 yo adults who don’t have diabetes but do have a 7.5% 10-year risk based on the calculator
What are the two HIGH-intensity statins?
Atorvastatin and rosuvastatin
high intensity statins are needed to rescue and atone for bad lipids
MOA of Statins
Inhibit HMG-coA Reductase
this depletes the liver’s pool of cholesterol, so it upregulates the LDL receptor to take more LDL from the blood
What is the 6% rule of statins?
Every doubling of the statin dose will lower LDL by 6%
ADR of statins (3)
elevated AST/ALT
myopathy
new onset T2D
MOA of bile acid sequestrants
BAS drugs bind to bile in GI tract and prevent its reabsorption.
So, the liver needs to make more bile using cholesterol. This depletes the liver’s cholesterol stores and upregulates LDL receptor to clear more LDL from blood
ADR of bile acid sequestrants (3)
Prevents absorption of other drugs
Raises TG’s some
GI upset
Why don’t you give BAS drugs if pt has hyperTGemia?
BAS drugs elevate TG’s even more
MOA of ezetimibe
Blocks cholesterol uptake at instestinal brush border. Inhibits LPC1L1
This depletes cholesterol stores in liver, causing upregulation of LDL receptor and increased LDL clearance from blood
ADR of ezetimibe
Trick question: none!
What is the effect of plant sterols?
Plant sterols reduce LDL
BUT, no evidence that this lowers CVD
What is the indication for PCSK9 inhibitors?
If additional LDL-lowering is required beyond statins in pts who have CVD
How does risk level influence our goal LDL for a pt?
Higher risk pts should have a lower LDL goal
(they can’t afford to have higher LDL)
Do statins lower TG’s?
High dose statins do lower TG’s
Low/moderate dose statins do NOT
