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Spring 22 PT HTN > Ndefo CHOLESTEROL > Flashcards

Ndefo CHOLESTEROL Flashcards

1
Q

VLDL is another indicator of

A

artherogenic cholesterol

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2
Q

High-density lipoproteins (HDL) known as “good” cholesterol because it removes cholesterol from the walls of arteries and returns them to the

A

liver for disposal

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3
Q

Friedwald equation:

Does not work if TG >400 mg/dL

A

LDL = Total cholesterol – HDL – (TG/5)

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4
Q

Key risk factors for heart disease are

A

high blood pressure

high blood cholesterol

smoking

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5
Q

______ is a mediator of immune response and serves as marker of inflammation

A

C-Reactive Protein (CRP)

  • hs-CRP – is high sensitivity (more sensitive for CVD)
  • Low < 1; intermediate 1 – 3; high >3
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6
Q

Emerging Risk Factors

A 
C-Reactive Protein (CRP)
Lipoprotein(a)
Apolipoprotein-B
Coronary Artery Calcium
Ankle Brachial Index (ABI)
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7
Q

Lifestyle Modifications

A

Physical activity
-Engage in aerobic physical activity; 3-4 sessions per week; lasting ~ 40 minutes per session, involving moderate-to vigorous physical activity

Avoidance of tobacco products

Maintenance of a healthy weight

Adhering to a heart healthy diet

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8
Q

B&G:

Lovastatin

Lovastatin ER

Pravastatin

Simvastatin

Fluvastatin

Atorvastatin

Rosuvastatin

Pitavastatin

A

Mevacor

Altoprev

Pravachol

Zocor, FloLipid

Lescol

Lipitor

Crestor

Livalo

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9
Q

Lovastatin (Mevacor®), Lovastatin ER (Altoprev®) dosing:

A

10, 20, 40 mg oral tablet; 20, 40, 60 mg ER oral tablet

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10
Q

Pravastatin (Pravachol®) dosing:

A

10, 20, 40, 80 mg oral tablet

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11
Q

Simvastatin (Zocor®, FloLipid®) dosing:

A

5, 10, 20, 40, 80 mg oral tablet

Oral suspension (FloLipid 20 mg/5 ml, 40 mg/5 ml)

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12
Q

Fluvastatin (Lescol®) dosing:

A

20, 40 mg oral capsule, 80 mg ER tablet

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13
Q

Atorvastatin (Lipitor®) dosing:

A

10, 20, 40, 80 mg oral tablet

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14
Q

Rosuvastatin (Crestor®) dosing:

A

5, 10, 20, 40 mg oral tablet

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15
Q

Pitavastatin (Livalo®)

A

1 , 2, 4 mg oral tablet (no generic)

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16
Q

Statin Equivalent Doses

A

Pharmacists Rock At Saving Lives and Preventing Fatty deposits

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17
Q

You should check ______________ at baseline in pt w. hepatic injuries

A

alanine aminotransferase (ALT) at baseline

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18
Q

How do you check for symptoms of hepatotoxicity?

A
  • Unusual fatigue
  • Loss of appetite
  • Abdominal pain
  • Dark colored urine
  • Yellowing of skin or sclera
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19
Q

Statin-induced myopathy should be ___________ and in large adjacent muscle groups

A

SYMMETRICAL

  • Usually in legs, back, or arms
  • Usually occurs within 6 weeks of initiation but can happen at anytime
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20
Q

TorF: Coenzyme Q10 may provide benefit of mild myalgias

A

True

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21
Q

TorF: Pts should avoid gemfibrozil and statin combinations

A

True

Gemfibrozil(LOPID) with statins increase the risk for myopathy.

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22
Q

What should you do if a patient is experiencing severe unexplained muscle symptoms or fatigue during statin therapy??

A
  • Promptly discontinue the statin
  • Evaluate CK and creatinine
  • Check urinalysis for myoglobinuria
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23
Q

Common Statin Drug Interactions

A
  • G – Grapefruit
  • P – Protease inhibitors
  • A – Azole Antifungals
  • C – Cyclosporine, Cobistat
  • M – Macrolides (except azithromycin)
  • A – Amiodarone
  • N – Non-DHP CCBs
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24
Q

TorF: Statins should be discontinued in patients with diabetes until adverse effects are realized.

A

False. Statin use should not be discontinued in patients with
diabetes, including newly diagnosed individuals due to no greater risk of MI, stroke or ASCVD without a statin.

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25
Q

What FDA approved antidiabetic medications are used in the prevention of cardiovascular diseases?

A

• GLP-1 receptor agonist “The TIDES”

  • liraglutide (Victoza®)
  • dulaglutide(Trulicity®)
  • semaglutide (Ozempic®)

• Sodium glucose cotransporter 2 inhibitor
– empagliflozin(Jardiance®)
-canagliflozin (Invokana®)

26
Q

When starting a statin, what labs should you check?

A

8-12h NPO FLP

ALT

A1C if diabetes status is unknown

Creatinine kinase when indicated

Pregnancy

27
Q

Repeat lipid measurements ________ weeks after statin therapy or dose changes

A

4-12 weeks

28
Q

Define responses to lifestyle with statin therapy by PERCENTAGE REDUCTIONS in LDL-C compared with baseline

A
  • High intensity ≥50%

* Low intensity 30 to < 50%

29
Q

How do you counsel on statins?

A
  • Take this medicine at the same time every day, preferably at night (lovastatin with evening meal)
  • Do not consume excessive quantities of grapefruit products
  • Do not miss any doctor or lab appointment

• Report signs/symptoms of myopathy or rhabdomyolysis
(muscle pain, tenderness, weakness, fever)

  • May cause diarrhea, UTIs, extremity pain, nasopharyngitis, arthralgia, dyspepsia, or nausea
  • Report signs and symptoms of liver injury (jaundice, dark urine, upper abdominal discomfort, anorexia, fatigue)
  • Avoid excessive quantities of alcohol to reduce risk of hepatotoxicity
30
Q

What groups of people should absolutely be started on a statin?

A

Clinical ASCVD

Severe Hypercholesterolemia

Diabetes mellitus

Primary Prevention

31
Q

Severe Hypercholesterolemia is defined as between age 20-75 with LDL-C of _________

A

GREATER THAN or equal to ≥190 mg/dL

32
Q

What are secondary causes of INCREASED LDL-C?

A
  • Hypothyroidism
  • Nephrotic syndrome
  • Alcoholism
  • Smoking
  • Diabetes
  • Obstructive liver disease
33
Q

Which drugs cause an increase in LDL-C?

A

Protease inhibitors

  • Steroids
  • Thiazide diuretics
  • Immunosuppressants (cyclosporine, tacrolimus)
  • Fibrates
  • SGLT2 inhibitors
  • Progestins
  • Isotretinoin (retinols)
34
Q

THESE pts who have diabetes should absolutely be placed on a statin therapy:

A

Between the ages of 40-75 with LDL greater than 70 mg/dL

OR

If between ages 20-39, with diabetes-specific risk enhancers such as

  • Long duration (≥10 years for type 2; ≥20 years for type 1)
  • Albuminuria ≥30 mcg albumin/mg creatinine
  • eGFR <60 ml/min/1.73 m2
  • Retinopathy
  • Neuropathy
  • Ankle Brachial Index <0.9 (measures blood flow to the arteries of the legs)
35
Q

Risk-Enhancing Factors

A

• Family history of premature ASCVD
• Persistently elevated LDL-C levels ≥160 mg/dL
• Chronic kidney disease
• History of preeclampsia or premature menopause
• Chronic inflammatory disorders (rheumatoid arthritis, psoriasis, chronic HIV)
• High risk ethnic groups (South Asian ancestry)
• Persistent elevations of triglycerides ≥175 mg/dL
- Metabolic syndrome

36
Q

When statin therapy is not enough, and the patient triglyceride level is greater than 500 mg/dL what medication or pharmacological therapy should you use?

A

Use omega-3 fatty acids or fenofibrate

37
Q

When is it appropriate to use non-statin therapy?

A
  • Patients who cannot tolerate statins (statin intolerance) or can only tolerate less than recommended statin intensity
  • Patients who do not achieve the expected statin response and are high risk for ASCVD

• Triglycerides >500 mg/dL
-Use omega-3 fatty acids or fenofibrate

38
Q

Bile acid sequestrants may be used in ezetimbe-intolerant

patients with TG _________

A

TG ≤ 300 mg/dL

Normal: less than 150mg/dL

39
Q

Vytorin generic & dosing

A

Ezetimibe and simvastatin 10/10, 10/20, 10/40, 10/80mg

40
Q

Praluent

A

Alirocumab

41
Q

Praluent is indicated for

A
  • Familial hypercholesterolemia (in combination with a statin)
  • Primary hypercholesterolemia with atherosclerotic cardiovascular disease (in combination with a statin)
42
Q

Repatha generic and indication

A

Evolocumab,

  • Familial hypercholesterolemia (in combination with other lipid lowering therapies)
  • Familial hypercholesterolemia (in combination with a statin)
  • Primary hypercholesterolemia with atherosclerotic cardiovascular disease (in combination with a statin)
43
Q

Welchol

A

Colesevelam

44
Q

Questran

A

Cholestyramine

45
Q

Colestid

A

Colestipol

46
Q

Bile acid sequestrants MOA

A

binds to bile acids in the gut and excretes them into the feces

47
Q

TorF: BAS lower A1c but increase TGs

A

True

48
Q

TorF: BAS have been proven to decrease LDL and ASCVD to the same level as statins

A

False. NOT TO THE SAME EXTENT

49
Q

When are BAS contraindicated?

A

Contraindicated for fasting TG ≥300 mg/dL

50
Q

Fibrates MOA

A

Peroxisome proliferator receptor alpha (PPARα) activator

51
Q

Icosapent Ethyl

A

Vascepa

52
Q

Omega-3 Acid Ethyl esters

A

Lovaza

53
Q

Nexletol & MOA

A

Bempedoic acid

  • Adenosine triphosphate-citrate lyase (ACL) inhibitor, inhibits cholesterol synthesis in the liver
  • ACL - An enzyme upstream of HMG-CoA reductase in the cholesterol biosynthesis pathway
54
Q

Inclisiran

A

Leqvio

MOA – small interfering RNA therapy – directs catalytic breakdown of mRNA for PCSK9

55
Q

Advicor

A

Lovastatin and Niacin

Lovastatin and Niacin (Advicor ®): 20/500, 20/750, 20/1000, 40/1000 mg

56
Q

Niacin

A

Decreases the rate of hepatic synthesis of VLDL and LDL

No evidence of reduced coronary events

Contraindicated in peptic ulcer disease

57
Q

Nexlizet

A

Zetia and Nexletol

58
Q

Psyllium

A

Psyllium (Metamucil)

  • Temporarily aids in LDL reduction
  • 10 – 15 gm/day
  • Can use in conjunction with bile acid sequestrants to ease constipation
59
Q

Juxtapid

A

Lomitapide

60
Q

Evkeeza

A

Evinacumab

Angiopoietin-like protein 3 (ANGPTL3) inhibitor (ANGPTL3 regulates lipid metabolism)

Approved for the treatment of Homozygous Familial Hypercholesterolemia (orphan drug) in 12+

61
Q

Fetal risk is minimal with _________ and ____________

A

Fetal risk is minimal with bile-acid sequestrants and omega-3 fatty acids

Fetal risk cannot be ruled out with niacin, fenofibrate and gemfibrozil

Spring 22 PT HTN (4 decks)

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