Statin Lowering Agents Flashcards
What are the 5 aspects of care in the treatment approach to dyslipidemia?
1) Initiate therapeutic lifestyle changes
2) treat any secondary causes
3) Treat LDL
4) Consider specific treatment for hypertriglyceridemia (>200)
5) Consider TX of HDL if <40
What are the 3 primary therapeutic lifestyle changes recommended for the treatment of dyslipidemia?
1) Reduce cholesterol-raising foods
2) LDL lowering options (plant stanols/sterols, fiber
3) Diet and exercise
In a cholesterol-lowering diet for dyslipidemia, what is the max percentage of total calories that should come from saturated fats?
7%
What is the dosage for plant stanols/sterols for reducing LDL?
2g/day
What is the dosage for viscous fiver for reducing LDL?
10-25g/dy
What are the underlying causes of dyslipidemia? (5)
1) DM2
2) Hypothyroidism
3) Obstructive liver disease
4) CKD (nephrotic syndrome)
5) Medications
What medications can cause an increase LDL? (8)
1) Anabolic steroids
2) Cyclosporine
3) Glucocorticoids
4) O3FA (slightly)
5) Isotretinoin
6) Protease Inhibitors (for HIV)
7) Thiazides
8) TZD (slightly)
What medications can increase TG? (10)
1) Antipsychotics
2) BB
3) Cyclosporine
4) Estrogen (oral)
5) Glucocorticoids
6) Isotretinoin
7) Protease inhibitors (for HIV)
8) Thiazides
9) Tamoxifen (SERM)
10) Raloxifene (SERM)
What are the primary drug classes used in treating high LDL? (7)
1) HMG-CoA reductase inhibitors (Statins)
2) PCSK9
3) Bile acid sequestrants
4) Selective cholesterol absorption inhibitors
5) Niacin
6) Fibrates
7) Fish oil
What percentage do statins decrease LDL?
20-60%
What percentage does PCSK9 decrease LDL?
64%
What percentage do bile acid sequestrants decrease LDL?
20-35%
What class of drugs used to help decrease LDL can raise TG by 5-20%
Bile acid sequestrants
What percentage do selective cholesterol absorption inhibitors decrease LDL?
18-25%
What percentage does Niacin (Niaspan) decrease LDL?
20%
What percentage do fibrates decrease
LDL?
10%
**May also raise by 10%
What effect does fish oil ( O3FA) have on LDL?
Increase by 46%
How should tx of hypertriglyceridemia (<200) be approached?
Attaining non-HDL goal?
What HDL level warrants consideration of treatment?
> 40
What is the dose range for Lovastatin (Mevacor)?
How does dosing affect LDL and HDL levels?
40-80 mg
Can decrease LDL by up to 40% on max dose and can increase HDL by 8.6%
Does Lovastatin (Mevacor) cross BBB?
Yes
What is the dose range for Simvastatin (Zocor)
How does dosing affect LDL and HDL levels?
20-40mg
Can decrease LDL by up to 47% and can increase HDL by 12%
Does Simvastatin (Zocor) cross BBB?
Yes
What is the dose range for Atorvastatin (Lipitor)?
How does dosing affect LDL and HDL levels?
10-80 mg
Can decrease LDL by up to 60% and can increase HDL by 6%.
Is Atorvastatin (Lipitor) short-or long-acting?
LONG-Acting
What is the dose range for Rosuvastatin (Crestor)?
How does dosing affect LDL and HDL?
5-40 Mg
Can decrease LDL by up to 60%+ and can increase HDL by 14%
Is Rosuvastatin (Crestor) short or long-acting?
Long-acting?
What is the conversion sequence for statins?
Rosuvastatin 5mg=Atorvastatin 10mg=Simvastatin 20mg=Lovastatin 40mg
What Coenzyme does statin therapy reduce?
CoQ10, consider supplementation
What’s the MOA for statins?
Inhibit HMG CoA reductase
Reduction in HMG CoA decreases intracellular cholesterol production, upregulation of LDL receptors in liver, and enhanced clearance of LDL out of circulation
What time of day should statins be taken? Why?
Short-acting taken at night, long-acting doesn’t matter when taken
Short-acting best taken at night because that’s when cholesterol synthesis most active (2-4 AM)
Side Effects of Statins? (4)
Elevated liver enzymes
Muscle issues (esp those with HIV)
CNS/cognitive effects (r/t lipophilic BBB crossing
Risk for development of DM
What are the 45primary muscle issues that can occur with Statin treatment?
Myalgia Myopathy Myositis Myonecrosis Rhabdo
How is myalgia r/t statin use manifested?
flu-like symptoms with normal CK
How is myopathy r/t statin use manifested?
muscle weakness or CK elevation
How is myositis r/t statin use manifested?
muscle inflammation
How is myonecrosis r/t statin use manifested?
CK elevation
How is Rhabdo r/t stain use manifested?
Myonecrosis + Myoglobinuria or ARK/AKI
YES OR NO
Do statins induce liver failure, transplant, or death in the general population?
Yes
YES OR NO
Should liver enzymes be monitored with long-term use?
NO
YES OR NO
Are statins contraindicated in chronic liver disease, cirrhosis, NASH or liver transplant?
NO
YES OR NO
Do statins need to have dose adjustments in HIV< HCV treatment?
Yes
What are the risk factors for statin-induced myopathy? (5)
>60 years Female CKF Hypothyroidism Meds (drug interactions)
