Pharm - Dislipidemia

Question 1

What is the optimal level of LDL?

Answer 1

Less than 100

Question 2

What number should triglycerides be under?

Answer 2

Under 150

Question 3

Is it helpful to share the Total Cholesterol number with a patient?

Answer 3

Not really. LDLs, TGs and HDLs are more helpful.

Question 4

What would be a high HDL number?

Answer 4

Greater than or equal to 60

Question 5

High triglycerides: what is the number and what is the patient at risk of?

Answer 5

Risk for pancreatitis. Greater than 1000 mg/dl.

Question 6

What is of higher importance, triglycerides over 1000mg/dl or high LDL levels?

Answer 6

High triglycerides

Question 7

How do statins work?

Answer 7

Inhibit HMG-CoA. Limits the rate of cholesterol synthesis in the liver.

Question 8

What are the benefits of statins?

Answer 8

Decrease LDL

Stabilize plaques in arteries (so they don’t break off), this also decreases inflammation.

Reduces mortality/morbidity (stroke, MI, etc)

Question 9

What are the highest intensity statins?

Answer 9

Atorvastatin
Rosuvastatin
(Greater than 50% reduction of cholesterol on average)

Question 10

What advice should we give to patients taking statins?

Answer 10

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).

Question 11

What is myalgia?

Answer 11

Muscle pain, soreness, weakness

Question 12

What is myositis?

Answer 12

Myalgia plus elevated CK

Question 13

MOA of ezetimibe?

Answer 13

Inhibits ABSORPTION of dietary cholesterol absorption.

Question 14

Is Ezetimibe used as a monotherapy?

Answer 14

No. It’s used in combination with a statin. Make sure pt is taking a statin before starting Ezetimibe therapy.

Question 15

What are the contraindications for statins?

Answer 15

Not for pregnancy, not for liver disease.

Question 16

Niacin MOA?

Answer 16

Inhibits production of VLDL by the liver.

Question 17

What’s the best formulation of Niacin?

Answer 17

The extended release version: Niaspan.

This is least-likely to lead to “flushing” (hot flashes).

Question 18

What risk is high dose of OTC niacin associated with?

Answer 18

Hepatotoxicity (over 2000mg/day).

Question 19

Adverse effects of Niacin?

Answer 19

Flushing (can take 325mg aspirin 30min prior to dose)

Increased LFTs

Hyperuricemia (avoid in pts with gout)

Hyperglycemia

Question 20

What nursing interventions for Niacin?

Answer 20

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.

Question 21

Bile Acid Sequestrants MOA

Answer 21

Bind to cholesterol in the GI tract

Question 22

How often do we use Bile Acid Sequestrants?

Answer 22

Rarely. Not a first line agent. Sometimes used as an add-on.

Question 23

Adverse effects of Bile Acid Sequestrants?

Answer 23

GI distress, flatulance

Decreased absorption of other drugs

Question 24

Nursing interventions for Bile Acid Sequestrants?

Answer 24

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

Question 25

What do Fibrates do? MOA?

Answer 25

Lower TGs (go-to medication).

MOA: induces lipolysis and clearance of TGs.

Question 26

A/Es of Fibrates?

Answer 26

GI effects

Gallstones

Increased myopathy if used with Statins (try to avoid this).
(Fenofibrate is okay. Gemfibrozil not).

DDIs: check INR if used with warfarin

Question 27

MOA of Omega-3 fatty acids?

Answer 27

Inhibits hepatic synthesis of TGs.

(Not an LDL focus).

Question 28

Are Omega-3’s effective?

Answer 28

Maybe, if the pt has a history of CV disease.

No evidence as a primary intervention.
Diet change is a better intervention.

Question 29

What is Lovaza? Why is it better than OTC?

Answer 29

Prescription for Lovaza means that you don’t have to take as many OTC fish oil supplements.

Question 30

What can you tell a patient if they’re experiencing fishy burps from Omega-3s?

Answer 30

Can freeze the pills beforehand.

Question 31

If you’re going to use Fish oil supplements, what should you look for on the bottle?

Answer 31

“USP” seal

Indicates it’s been tested independently for the contents of the product.

Question 32

PCSK9 inhibitors MOA?

Answer 32

PCSK9 is a Protein that binds to and degrades the LDL receptors that eliminate the LDL from the bloodstream.

PCSK9 inhibitors prevent this from happening, so that LDL can be cleared.

Question 33

What’s unique about the administration of PCSK9?

Answer 33

Injections: not an oral product.

Profiled pen, cartridge or syringe.

Question 34

What’s a big downside of PCSK9 inhibitors?

Answer 34

They’re super expensive: $14k per year.

Question 35

What allergy should we be aware of with Evolocumab?

Answer 35

Latex.

Needle cover contains dry rubber

Question 36

When should you be taking Statin medications?

Answer 36

Take in the evening or at bedtime.