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6020 Advanced Pharm Test 3 COMPLETE ☑️ > Module 7: (c) Special Population Considerations; Lipids > Flashcards

Module 7: (c) Special Population Considerations; Lipids Flashcards

1
Q

Resistant HTN

-Considerations

A
  1. Sequentially combine agents w/ different MOA
  2. Meds are dosed at maximally tolerated doses
  3. Effective diuretic use almost always necessary
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2
Q

Resistant HTN

-Triple Combo option?

A
  1. ACEi or ARB PLUS long-acting Di-hydropyridine CCB (Amlodipine) PLUS long-acting thiazide diuretic (Consider Chlorthalidone)
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3
Q

Resistant HTN

-Adding a 4th medication?

A
  1. If HTN is still resistant to triple combo
    - Add MRA such as Spironolactone
  2. WATCH POTASSIUM**
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4
Q

Resistant HTN

-When a loop diuretic is better?

A
  1. Add a loop to a thiazide-diuretic for patient with PERSISTENT EDEMA
  2. Add Loop to thiazide or switch to loop for patients with eGFR < 30 (Watch potassium)
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5
Q

HTN in Older Adults

-

A
  1. Individualize goals and shared decision making***
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6
Q

HTN in Older Adults

-Orthostatic Hypotension consideration?

A
  1. Consider Orthostatic hypotension
    - Potential limiting factor to the use of antihypertensive drugs in older adults
    - Hip fracture is a risk
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7
Q

HTN in Older Adults

-Potential A/E’s

A
  1. Potential of impairment of mental function, such as confusion or sleepiness
  2. Think about cardiovascular risk in older adults prior to lowering diastolic pressures too low.
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8
Q

HTN in Older Adults

-Meds to consider?

A
  1. Consider starting with a low dose of:
    - Thiazide-type diuretic
    - Long-acting dihydropyridine CCB
  2. In combo therapy, start with LOW DOSES
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9
Q

Non-Emergent Pediatric HTN

-Meds to consider?

A
  1. ACEi or ARB (AVOID in pregnancy risk)
  2. Long acting CCB (Amlodipine)
  3. Thiazide diuretics are not first choice with peds
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10
Q

Non-Emergent Pediatric HTN

-Drugs NOT to use in Peds

A
  1. Beta Blockers are NOT RECOMMENDED as initial therapy in children
    - Impaired glucose tolerance
    - interference in lipid metabolism
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11
Q

HTN in Pregnancy

-Severe Level of BP?

A
  1. SBP >/= 160 mmHg and/or diastolic BP >/= 110 mmHg
  2. PROMPT treatment is recommended to reduce risk of maternal stroke
  3. SEND TO ER for IV meds
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12
Q

HTN in Pregnancy

-Meds to Consider?

A
  1. Labetalol (alpha/beta blocker)
  2. Nifedipine, extended-release (Dihydropyridine CCB)
  3. Methyldopa (alpha agonist; milder agent; sedation)
  4. ALL HTN meds cross the placenta
    - NO large scale study data is available
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13
Q

HTN in Pregnancy

-Meds to AVOID?

A
  1. ACEi, ARB’s
  2. Direct Renin inhibitors
  3. Mineralocorticoid receptor antagonists (MRA’s)
  4. Spironolactone
  5. Eplerenone
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14
Q

Conditions that Increase Total Cholesterol and LDL-C?

A
  1. Progestin

2. Protease inhibitors for treatment of HIV infection

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15
Q

Conditions that Increase Triglycerides and VLDL-C?

A
  1. Protease inhibitors for treatment of HIV infection
  2. Anti-hypertensive meds (Thiazide diuretics and beta blockers)
  3. Corticosteroid therapy
  4. Oral estrogen; oral contraceptives
  5. Hypothyroidism and Diabetes
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16
Q

HMG CoA Reductase Inhibitors “statins”

-Info

A
  1. Primarily used to LOWER LDL

2. AVOID in pregnancy or breastfeeding; Avoid in liver disease

17
Q

HMG CoA Reductase Inhibitors “statins”

-High Intensity Statin Meds? Don’t Memorize

A

Lowers LDL by >/= 50%

  1. Atorvastatin 40-80 mg
  2. Rosuvastatin 20-40 mg
18
Q

HMG CoA Reductase Inhibitors “statins”

-Moderate-Intensity Statins? Don’t memorize

A

Lowers LDL by 30-50%

  1. Atorvastatin 10-20 mg
  2. Rosuvastatin 5-10 mg
  3. Simvastatin 20-40 mg
  4. Pravastatin 40-80 mg
  5. Lovastatin 40 mg

MOST BENEFIT is in moderate-dose therapy

19
Q

HMG CoA Reductase Inhibitors “statins”

-A/E’s

A
  1. Elevated LFT’s, myalgias, and glucose increase
  2. Rhabdomyolysis rare but possible
    - Check baseline CK prior to starting medication
20
Q

HMG CoA Reductase Inhibitors “statins”

-Monitoring?

A
  1. Monitor Baseline LFT’s then periodic monitoring

2. Monitor LDL and check 6-8 wks after starting for adherence

21
Q

HMG CoA Reductase Inhibitors “statins”

-Common Drug interactions?

A
  1. Warfarin
  2. Non-dihydropyridine CCB’s
  3. Antibiotics, antifungals
    Etc..
22
Q

HMG CoA Reductase Inhibitors “statins”

-And Diabetes?

A
  1. First-line for individuals w/ DM and Dyslipidemia or high CV risk
  2. Can increase BG levels but benefit outweighs the risk
23
Q

PCSK9 Inhibitors

-Info?

A
  1. Most POWERFUL LDL lowering meds
  2. Expensive and require subq injections
  3. Caution in pregnancy
24
Q

Ezetimibe (Zetia)

A
  1. Alternative to Statin if a patient has statin intolerance
  2. Can also be added to a statin
  3. Monitor LFT’s
  4. Caution in pregnancy
25
Q

Bile Acid Sequestrants

-Exemplars

A

Not used a lot:

  1. Colesevelam
  2. Colestipol
  3. Cholestyramine

Commonly associated w/ GI effects

26
Q

Niacin

-Info?

A
  1. High rates of side effects and limited evidence of benefit
  2. Commonly causes FLUSHING
    - ASPIRIN given 30 minutes prior to niacin dose can prevent or reduce flushing
  3. Adverse events
    - Impaired glucose control
    - Increase uric acid concentrations
    - hepatotoxicity
    - Doesn’t mix well with other lipid therapies
27
Q

Hypertriglyceridemia

-Reason to treat?

A
  1. Can lead to pancreatitis.

2. Controlling high blood sugar can also reduce triglyceride levels

28
Q

Hypertriglyceridemia

-Statins that lower triglycerides

A
  1. Atorvastatin and rosuvastatin can lower triglycerides
29
Q

Hypertriglyceridemia

-FIBRATES

A
  1. Fenofibrate (MOST USED)

2. Can reduce TG by as much as 50-70%

30
Q

Hypertriglyceridemia

-Omega 3 fatty acids

A
  1. Idosapent ethyl (Vascepa)
    - Reduces TG by approx 20-50%
  2. Can cause GI symptoms
31
Q

Hypertriglyceridemia

-Measuring and classifying?

A
  1. Moderate TG
    - 150 to 499 mg/dL
  2. Moderate to severe
    - 500-999 mg/dL
  3. Severe
    >1000 mg/dL
32
Q

Dyslipidemia in children and adolescents

-Info?

A
  1. Consider lifestyle + Pharm for those >10 years of age w/
  • LDL >/= 130 and high-risk w/out response to lifestyle changes
  • LDL >/= 160 and moderate or high risk
  • LDL >/= 190 w/ no CV risk

Refer to lipid specialist

6020 Advanced Pharm Test 3 COMPLETE ☑️ (7 decks)

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