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26 Cards in this Set

  • Front
  • Back
Which statins are lipophilic?
Which statins are hydrophilic (sometimes more tolerable in terms of muscle aches)
Rank in terms of potency
simvastatin, atorvastatin, rosuvastatin, pravastatin
#1 rosuvastatin (but can't use 80mg dose)
#2 atorvastatin (can use 80)
#3 simvastatin
#4 pravastatin
Which two statins are not metabolized by the CYP system?
Which statins have some 3A4 interactions?
Atorvastatin (but minimal, also goes down 2D6 pathway)
Which statin may result in increased levels in Asian pts?
Rosuvastatin (Crestor)
When and why should statins be dosed?
At night because this is when cholesterol synthesis occurs (but if long half life - such as atorvastatin, and rosuvastatin - doesn't really matter)
What are the safest statins to use if pt has liver disease?
pravastatin or rosuvastatin (low dose)
How do fibrates work?
They activate the transcription factor for PPAR-alpha (which regulates the genes that control lipid metabolism)
Fibrates lower ______ and raise ______
triglycerides, HDL
What are the cytochrome interactions of gemfibrozil?
inhibit 2C9 and 2C19
(main players: fluconazole and PPIs and use with caution with other statins - choose fenofibrate instead)
What are the most common side effects with fibrates?
N/V and dyspepsia

(also reversible hepatotoxicity, cholelithiasis, and myositis)
Which cholesterol drug improves all plasma lipoproteins/lipids by a little bit?
niacin (nicotinic acid)
Which two formulations of niacin should not be used?
immediate release and sustained-release

(choose controlled release Niaspan)
How can flushing side effect of niacin be managed?
1. take at night
2. take aspirin 45 min before
3. take with small meal to slow absorption
4. stick with same dose for 4-6 weeks before increasing
Which cholesterol med has histamine-related pruritis as a side effect (similar to vanco)?
niacin (may go away after a few doses)
Niacin may aggravate condition of which two populations of patients?
1. Diabetic pts
2. Gout pts
How does ezetemibe work?
inhibits absorption of dietary AND biliary cholesterol in the small intestine by blocking transport at brush border
What is the most common side effect of ezetemibe?
Which lipids are affected by ezetemibe?
LDL (dec by 18%)
Which bile acid sequestrant is probably best tolerated?
How do bile acid sequestrants work?
they bind bile acids in the intestinal lumen which increases cholesterol clearance from the blood to replace the lost bile.
Fish oils mainly affect which lipid?
How do fish oils work?
reduce hepatic triglyceride production and increasing triglyceride clearance
Which two lipid drugs are absolutely contraindicated in pg?
What of the following drugs should be used first if TG > 500? niacin, fish oil, or fibrates
fibrates, then fish oil. but if TG 200-500 start with niacin b/c will get HDL up and LDL down.