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Cardiology 2 > Pharm - dyslipidemia > Flashcards

Pharm - dyslipidemia Flashcards

1
Q

What are 3 risk assessment tools that can be used to assess the risk for cardiovascular dz?

A
  • Framingham
  • ASCVD risk instrument
  • National lipid association risk stratification
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2
Q

major cardiovascular risk factors

A
  • age: male 45 or higher, female 55 or higher
  • family hx of early CHD (<55 in male first degree, <65 if female first degree relative)
  • current cig smoking
  • high BP (> or equal to 140/90, or on BP meds)
  • low HDL (<40 in men, <50 in women)
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3
Q

What 3 national organizations have published guidelines for the treatment of dyslipidemias?

A
  • national cholesterol education program(NCEP)
  • american college of cardiology (ACC) / american heart association (AHA)
  • national lipid association (NLA)
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4
Q

What 4 groups of people have demonstrated benefit of treating dyslipidemias?

A
  • pts w/ CHD, w/ or w/o hyperlipidemia
  • men w/ hyperlipidemia but no known CHD
  • men w/ HTN multiple cardiac risk factors but w/o hyperlipidemia
  • men and women w/ avg total and LDL levels and no known CHD
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5
Q

HMG-CoA reductase inhibitors, aka statins, MoA

A
  • statins inhibits HMG-CoA reductase
  • this enzyme catalyzes the rate-limiting step of cholesterol synthesis so the liver can’t make cholesterol
  • the liver therefore upregulates LDL receptors, and decreases production of VLDL, IDL, and LDL
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6
Q

What is the lipid lowering effect of statins on LDL?

A

decreased by 20-55%

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7
Q

What is the lipid lowering effect of statins on HDL?

A

increased by 2-10%

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8
Q

What is the lipid lowering effect of statins on triglycerides?

A

lowered 14-40%

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9
Q

What is the expected LDL lowering of a low intensity statin?

A

lowered by about <30%

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10
Q

What is the expected LDL lowering of a moderate intensity statin?

A

lowered by 30-50%

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11
Q

What is the expected LDL lowering of a high intensity statin?

A

lowered by about 50%

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12
Q

low intensity statin and dose

A

-Simvastatin: 10mg

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13
Q

moderate intensity statins and doses

A
  • Atorvastatin: 10-20mg

- Rosuvastatin: 5-10mg

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14
Q

high intensity statins and doses

A
  • atorvastatin: 40-80mg

- rosuvastatin: 20 mg

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15
Q

clinical endpoints demonstrated by statins

A
  • most studied drugs for dyslipidemia
  • they reduce all-cause mortality, cardiovascular mortality, stroke, angina, and need for revascularization procedures
  • also clear benefit in pts w/ DM
  • benefits are directly associated w/ percent LDL reduction
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16
Q

contraindications to statins

A
  • active liver dz
  • pregnancy or lactation (class X)
  • use low dose in transplant pts
  • contraindicated with use of certain drugs
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17
Q

drug interactions with simvastatin, in which they are completely contraindicated to prescribe

A
  • strong CYP3A4 drugs (statins are red flag drugs)
  • erythromycin, clarithromycin
  • gemfibrozil
  • azoles
  • HIV protease inhibitors
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18
Q

other drug interactions with simvastatin

A
  • amiodarone, amlodipine

- grapefruit juice

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19
Q

what is the prescribing recommendation for drug interactions with simvastatin that aren’t completely contraindicated?

A
  • with amiodarone/amlodipine, limit simvastatin to 20 mg

- avoid grapefruit juice

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20
Q

interacting drugs with rosuvastatin

A

-gemfibrozil

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21
Q

prescribing recommendation for drug interactions with rosuvastatin

A

-if using with gemfibrozil, limit rosuvastatin dose to 10 mg daily

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22
Q

drug interactions w/ atorvastatin

A

-clarithromycin

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23
Q

prescribing recommendation for atorvastatin/clarithromycin drug interaction

A

-limit atorvastatin to 20 mg daily

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24
Q

adverse effects of statins

A
  • myopathy
  • myalgia
  • liver enzyme elevation
  • rhabdomyolysis
  • cognitive decline
  • DM
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25
Q

patient risk factors for developing rhabdomyolysis secondary to a statin

A
  • renal insufficiency
  • age > 65
  • concurrent admin of gemfibrozil, niacin or a drug that interacts w/ a statin resulting in statin accumulation
26
Q

monitoring parameters for efficacy of statin therapy

A
  • lipid profile 6 wks following initiation

- lipid profile eval 2-3 times per year once goals have been met

27
Q

monitoring parameters for safety of statin therapy

A
  • liver function tests - baseline and then as clinically indicated
  • CPK: baseline (optional) and repeat w/ myalgia
28
Q

What is the best time of day to take a statin?

A

in the evening as that is when the most cholesterol is produced

29
Q

lipid lowering effects of niacin on LDL

A

decrease 5-25%

30
Q

lipid lowering effects of niacin on HDL

A

increase of 15-35%

31
Q

lipid lowering effects of niacin on TGs

A

decrease 20-50%

32
Q

contraindications of niacin

A
  • liver dz
  • severe gout
  • active peptic ulcer
  • arterial bleeding
33
Q

drug interactions of niacin

A
  • statins: this is a caution

- antihyperglycemic agents (DM meds)

34
Q

monitoring parameters for efficacy of niacin

A

-fasting lipids q 4-6 weeks during dose titration then q 4-6 mos

35
Q

monitoring parameters for safety of niacin

A
  • LFTs at baseline, q 6-12 weeks X 1yr, then periodically
  • blood glucose in DM
  • CPK baseline and w/ muscle sx if on statin
  • uric acid
36
Q

lipid lowering effects of fibric acid derivatives (aka fibrates) on LDL

A
  • variable
  • in many pts: decrease of 5-20%
  • usually LDL increases in pts w/ very high TGs
37
Q

lipid lowering effects of fibric acid derivatives on HDL

A

-increase 10-35%

38
Q

lipid lowering effects of fibric acid derivatives on TGs

A

decrease 20-50%

39
Q

contraindications of fibric acid derivatives

A
  • pre-existing gallbladder dz
  • hepatic dysfunction
  • severe renal impairment
40
Q

drug interactinos of fibrates

A
  • statins - avoid gemfibrozil in combo w/ statins, fenofibrate can be used if needed.
  • exetimibe - cholelithiasis risk
41
Q

monitoring parameters for efficacy in fibric acid therapy

A
  • these drugs take 3 mos to see full effect

- fasting lipids q 4-6 mos

42
Q

monitoring parameters for safety in fibric acid therapy

A

-LFTs at baseline then periodically

43
Q

MoA of ezetimibe

A
  • cholesterol absorption inhibitor
  • inhibits cholesterol absorption at the brush border of the small intestine from bile and dietary intake
  • results in reduced hepatic cholesterol stores and increases cholesterol clearance in the blood
44
Q

lipid lowering effects of ezetimibe on LDL

A

-decrease of 20%

45
Q

lipid lowering effects of exetimibe on HDL and TGs

A
  • negligible
  • HDL increased 0-5%
  • TG decreased 5-11%
46
Q

MoA of bile acid sequestrants (BAS)

A
  • bile acids are normally reabsorbed in the jejunum and ileum then return to cholesterol cycle
  • BASs are resins that complex w/ the bile acids preventing reabsorption
  • liver recognizes the reduction and increases hepatic uptake and catabolism of LDL
47
Q

lipid lowering effects of BAS on LDL

A

-15-30% (modest at best)

48
Q

lipid lowering effects of BAS on HDL

A

3-5%

49
Q

lipid lowering effects of BAS on TG

A

-they actually can increase the TGs 0-10%

50
Q

contraindications to using BASs

A
  • bowel obstruction
  • complete biliary obstruction
  • hypersensitivity
51
Q

precautions to using BASs

A
  • malabsorptions disorders
  • chronic constipation
  • TGs > 200 mg/dL
52
Q

drug interactions with BASs

A
  • they bind many drugs (too many to list) and impair absorption to varying degrees
  • most clinically relevent to drugs w/ narrow therapeutic window (warfarin)
  • separate the doses of BASs from other drugs (1 hr before or 4-6 hrs after)
53
Q

ADRs of BASs

A
  • contipiation/flatulence/bloating
  • steatorrhea
  • increased TG concentration
  • malabsorption of fat soluble vitamins
54
Q

long-chain omega-3 FAs

A
  • EPA
  • DHA
  • essential
  • sources: anchovy, halibut, herring, kipper, mackerel, mullet, salmon, sardine, sturgeon, trout, tuna
55
Q

ADRs of omega-3 FAs

A

fishy aftertaste - fishy burp

-use enteric coated or refrigerate capsules

56
Q

lipid lowering effects of fish oil on LDL

A

-can see an increase by 40% when TGs >500

57
Q

lipid lowering effects of fish oil on TGs

A

-20-50% (similar to fibrates)

58
Q

The AHA recommends eating how much fatty fish?

A

-two servings per week

59
Q

dosing of fish oil for hypertriglyceridemia

A

2.0 - 4.0 gm of DHA plus EPA daily

60
Q

dosing of fish oil for very high triglycerides

A

Lovaza 4 gm daily or 2.0 gm BID

61
Q

NLA recommendations for LDL goals

A

<70 or 100 mg/dL

62
Q

NLA recommendations for non-HDL goals

A

<130 or 100 mg/dl

Cardiology 2 (13 decks)

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