Week 7: Antilipidemics Flashcards
1
Q
HMG CoA Reductase Inhibitors - “statins” (Atorvastatin/Rosuvastatin) MOA
A
- block synthesis of cholesterol in the liver by competitively inhibiting the HMG CoA reductase activity - best at lowering LDL
2
Q
HMG CoA Reductase Inhibitors - drug interactions
A
- CYP 3A4 inhibitors - “azoles” - increase statin concentration
- CYP 3A4 inducers - “rifampin” - decrease statin concentrations
Pravastatin - not affected by grapefruit juice
3
Q
HMG CoA reductase inhibitors cautions/ contraindications
A
- Pregnancy Category X - not safe in pregnancy
- Avoid in active liver disease
- Avoid grapefruit juice with simvastatin, lovastatin and atorvastatin - can increase toxicity
4
Q
HMG CoA reductase inhibitors ADRs
A
- myalgias/myopathies –> increased CPK - rhabdo/metabolic acidosis
- headache
- fatigue
5
Q
Statin Monitoring
A
- check lipid levels 4 to 6 weeks after starting therapy and then every 3 to 4 months until control is established
- LDL levels guide dose increases
- LFTs before starting therapy and then 3 to 6 months later only is suspected issues or underlying hepatic disease
6
Q
Niacin MOA
A
- uncertain but appears to reduce VLDL synthesis - best at increasing HDL
7
Q
Niacin cautions/ contraindications
A
- avoid w/ hx of gout
- avoid w/ hepatic dysfunction
- avoid in uncontrolled diabetes
- avoid w/ active peptic ulcers
8
Q
Niacin ADRs
A
- pruritis, flushing, hepatotoxicity
9
Q
Niacin Pt education
A
- take anti-inflammatory strength NSAID 30 minutes prior to dose to decrease ADRs
10
Q
Fibrates (Gemfibrozil/Fenofibrate) MOA
A
- Increased plasma and hepatic lipoprotein lipase (LPL) activity - inhibition of cholesterol and triglyceride synthesis - inhibition of lipolysis in adipose tissue - decreased production of VLDL
- *best at decreasing triglyceride levels**
11
Q
Fibrates ADRs
A
dyspepsia, abdominal pain - cholelithiasis
12
Q
Fibrates cautions/ contraindications
A
- avoid in liver or renal disease
- avoid in pre-existing gallbladder disease
- avoid in pregnancy and lactation
13
Q
Bile Acid Sequestrants (Cholestyramine/Questran) MOA
A
- indirectly blocks absorption of cholesterol by forming a nonabsorbable complex with bile acids in the intestine - increase the number of LDL receptors on the cell membrane for greater uptake in the liver and less in the bloodstream
- *can increase triglycerides**
14
Q
Bile Acid sequestrants ADRs
A
flatulence, bloating, abdominal pain, constipation
15
Q
Bile Acid sequestrants cautions/ contraindications
A
- avoid in pts w/ elevated triglycerides >300
- safe in pregnancy and lactation
- must take other medications and vitamins either 1 hour before or 4 hours after this medication
