Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
40 Cards in this Set
- Front
- Back
|
Types of Dyslipidemia |
Primary (Familial)
Secondary (Acquired) |
|
|
Friedewald Equation --- Calculate LDL
|
LDL = TC - HDL - (TG/5)
Can't use if TG > 400 mg/dL |
|
|
New (ATP IV, 2014) guideline differences
|
Four statin benefit groups
Nonstatin therapies are not recommended unless statins are not tolerated Treating to specific LDL goals is no longer advised |
|
|
4 Statin benefit groups
|
* Atherosclerotic CV disease (ACS, MI, stable or unstable angina, coronary or arterial revascularization), stroke, TIA, peripheral arterial disease
* LDL >/= 190 mg/dL * DM + 40-75 y/o with LDL 70-189 mg/dL * 40-75 y/o and LDL 70-189 mg/dL and 10 yr risk >/= 7.5% |
|
|
Dyslipidemia Lifestyle Changes
|
* Low fat diet; 5-6% of calories from saturated fat; reduce % of calories from trans fat
* Aerobic physical activity 3-4x/wk; 40 minutes of moderate to vigorous intensity * Maintain healthy weight * Avoid tobacco |
|
|
Atorvastatin
|
Lipitor
HMG-CoA reductase inhibitor 10-80 mg QD Equivalent dose --- 10 mg |
|
|
Simvastatin
|
Zocor
HMG-CoA reductase inhibitor 10-40 mg QHS Equivalent dose --- 20 mg |
|
|
Vytorin
|
Simvastatin + Ezetimibe
|
|
|
Rosuvastatin
|
Crestor
HMG-CoA reductase inhibitor 5-40 mg QD Equivalent dose --- 5 mg |
|
|
Pravastatin
|
Pravachol
HMG-CoA reductase inhibitor 10-80 mg QD Equivalent dose --- 40 mg |
|
|
Lovastatin
|
Mevacor, Altoprev
HMG-CoA reductase inhibitor 20-80 mg * Mevacor (IR) - taken w/ evening meal * Altoprev (ER) - taken QHS Equivalent dose --- 40 mg |
|
|
Statins
|
***DOC for elevated LDL***
Inhibit enzyme HMG-CoA reductase preventing conversion of HMG-Coa to mevalonate (rate-limiting step in cholesterol synthesis) |
|
|
Statin Contraindications
|
Active liver disease
Pregnancy (Category X)*** Breastfeeding Pitavastatin is contraindicated w/ cyclosporine Warning --- Myopathy, risk of rhabdomyolysis |
|
|
Statin Adverse Effects
|
Myalgias, arthralgias, myopathy, rhabdomyolysis
Diarrhea Cognitive impairment (reversible) Hyperglycemia Increased LFTs |
|
|
Statin Interactions
|
Comcomitant lipid-lowering therapies
3A4 substrates --- sim, lova, atorvastatin Cyclosporine --- rosuvastatin, pravastatin, fluvastatin |
|
|
Don't exceed simvastatin 10 mg/d with:
|
Verapamil, diltiazem, dronedarone
|
|
|
Don't exceed simvastatin 20 mg/d with:
|
Amiodarone, amlodipine, ranolazine
|
|
|
Don't exceed lovastatin 20 mg/d with:
|
Danazol, diltiazem, dronedarone, verapamil
|
|
|
Don't exceed lovastatin 40 mg/d with:
|
Amiodarone
|
|
|
Don't exceed atorvastatin 20 mg/d with:
|
Clarithromycin, itraconazole, lopinavir + ritonvacir, darunavir + ritonavir, fosamprenavir + ritonavir
|
|
|
Don't exceed atorvastatin 40 mg/d with:
|
Nelfinavir, boceprevir
|
|
|
Ezetimibe
|
Zetia
Inhibits cholesterol absorption in small intestine 10 mg QD |
|
|
Ezetimibe Info
|
Contra in moderate to severe hepatic impairment
Risk of rhabdomyolysis w/ statin use Pregnancy category C SE - URTIs, diarrhea, arthralgias, sinusitis |
|
|
Colesevelam
|
Welchol
Bile Acid Sequestrant 3.75 grams (6 tablets or 1 packet QD OR 3 tablets BID) Take w/ meal and liquid Also used in DM Type 2 (lowers A1C ~0.5%) |
|
|
Bile Acid Sequestrants
|
Binds bile acids in the intestine forming a complex that is excreted in the feces
Cholestyramine, colesevelam, colestipol |
|
|
Bile Acid Sequestrants Contraindications and Adverse Effects
|
Cholestyramine - contra in complete biliary obstruction
Colesevelam - contra in bowel obstruction, TG > 500, hx of hypertriglyceridemia-induced pancreatitis SE - constipation, abdominal pain, cramping, gas, bloating, hypertriglyceridemia |
|
|
Bile Acid Sequestrants Interactions
|
Cholestyramine and colestipol --- separate all other drugs by 1-4 hrs before or 4-6 hrs after
Colesevelam --- take cyclosporine, BC pills, levothyroxine, olmesartan, phenytoin, sulfonylureas, tetracyclines 4 hours prior to colesevelam |
|
|
Fenofibrate
|
TriCor, Trilipix
Fibrate |
|
|
Gemfibrozil
|
Lopid
Fibrate 600 mg BID, 30 minutes before breakfast and dinner |
|
|
Fibrates MOA
|
PPAR-alpha activators
Decrease TGs and increase HDL ***Risk of increasing LDLs when reducing high TGs |
|
|
Fibrate Info
|
Contra -- severe liver or renal disease, gallbladder disease, breastfeeding
SE - increased LFTs, abdominal pain, rhabdomyolysis Avoid w/ statin d/t rhabdomyolysis (Trilipex is only fibrate indicated for use w/ statin) Gemfibrozil - contra w/ repaglinide |
|
|
Extended Release Niacin
|
Niaspan
500 mg QHS x 4 weeks, can increase every 4 weeks for max dose of 2 grams/d Take w/ food |
|
|
Niacin Info
|
AKA nicotinic acid, vitamin B3
Decreases rate of hepatic synthesis of VLDL (decreasing TGs) and LDL Contra in active liver disease, active PUD, arterial bleeding Caution in unstable angina or acute MI, hepatotoxicity |
|
|
Niacin Adverse Effects
|
Flushing, itching
N/V/D/GI distress Hyperglycemia Hyperuricemia Increased cough Hepatotoxicity Orthostatic hypotension Hypophosphatemia |
|
|
Niacin Interactions
|
Hepatotoxic drugs
Take niacin 4-6 hrs after bile acid sequestrants |
|
|
Omega-3 Acid Ethyl Esters
|
Lovaza
Fish oils 2 capsules QD, can increase to 4 capsules QD SE - distorted sense of taste Can prolong bleeding time (monitor INR if on warfarin) |
|
|
Fish Oil Info
|
Adjunct to diet in pts w/ TG > 500 mg/dL
SE - burping, dyspepsia Ex. Omega-3 acid ethyl esters, icosapent ethyl |
|
|
Lomitapide MOA
|
Binds to and inhibits microsomal TG transfer protein (MTP) --- reduces production of chylomicrons and VLDL, thus reducing LDL
|
|
|
Lomitapide Info
|
Juxtapid
BLACK BOX - hepatotoxicity Contra - pregnancy, 3A4 inhibitors, moderate or severe hepatic impairment, active liver disease SE - GI issues, increased LFTs, chest and back pain PREGNANCY CATEGORY X ***** |
|
|
Mipomersen
|
Kynamro
Inhibitor of apo B-100 synthesis (main component of LDL) BLACK BOX - hepatotoxicity Contra in liver disease |
