Pharm - Dislipidemia Flashcards
What is the optimal level of LDL?
Less than 100
What number should triglycerides be under?
Under 150
Is it helpful to share the Total Cholesterol number with a patient?
Not really. LDLs, TGs and HDLs are more helpful.
What would be a high HDL number?
Greater than or equal to 60
High triglycerides: what is the number and what is the patient at risk of?
Risk for pancreatitis. Greater than 1000 mg/dl.
What is of higher importance, triglycerides over 1000mg/dl or high LDL levels?
High triglycerides
How do statins work?
Inhibit HMG-CoA. Limits the rate of cholesterol synthesis in the liver.
What are the benefits of statins?
Decrease LDL
Stabilize plaques in arteries (so they don’t break off), this also decreases inflammation.
Reduces mortality/morbidity (stroke, MI, etc)
What are the highest intensity statins?
Atorvastatin
Rosuvastatin
(Greater than 50% reduction of cholesterol on average)
What advice should we give to patients taking statins?
Take at night (except for atorvastatin and rosuvastatin, which can be taken at any time).
Avoid grapefruit juice
Monitor Liver function and CK
Don’t use in pregnancy (babies need cholesterol for development) or if there’s active liver disease.
Might have mild GI upset or dydpepsia.
Muscle-related adverse effects can be severe (myalgia, myositis, rhabdomyolysis - very rare but very severe).
What is myalgia?
Muscle pain, soreness, weakness
What is myositis?
Myalgia plus elevated CK
MOA of ezetimibe?
Inhibits ABSORPTION of dietary cholesterol absorption.
Is Ezetimibe used as a monotherapy?
No. It’s used in combination with a statin. Make sure pt is taking a statin before starting Ezetimibe therapy.
What are the contraindications for statins?
Not for pregnancy, not for liver disease.
Niacin MOA?
Inhibits production of VLDL by the liver.
What’s the best formulation of Niacin?
The extended release version: Niaspan.
This is least-likely to lead to “flushing” (hot flashes).
What risk is high dose of OTC niacin associated with?
Hepatotoxicity (over 2000mg/day).
Adverse effects of Niacin?
Flushing (can take 325mg aspirin 30min prior to dose)
Increased LFTs
Hyperuricemia (avoid in pts with gout)
Hyperglycemia
What nursing interventions for Niacin?
Make sure that doses are low to start and then titrated upwards slowly… like 4-8 weeks (500mg/day)
Take with food
Take at night to avoid flushing.
Bile Acid Sequestrants MOA
Bind to cholesterol in the GI tract
How often do we use Bile Acid Sequestrants?
Rarely. Not a first line agent. Sometimes used as an add-on.
Adverse effects of Bile Acid Sequestrants?
GI distress, flatulance
Decreased absorption of other drugs
Nursing interventions for Bile Acid Sequestrants?
Might need fat-soluble vitamin increase (reduced absorption occurs).
ORAL CONTRACEPTIVES might be reduced. Could get pregnant.
4 hour separation after taking bile Acid Sequestrants to avoid.
Terrible taste. Take with juice if dissolvable, or in tablets instead of powder.
Slow titration to avoid GI issues
