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26 Cards in this Set
- Front
- Back
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Which statins are lipophilic?
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Atorvastatin
Simvastatin Lovastatin Fluvastatin |
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Which statins are hydrophilic (sometimes more tolerable in terms of muscle aches)
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rosuvastatin
pravastatin |
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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 |
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Which two statins are not metabolized by the CYP system?
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pravastatin
rosuvastatin |
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Which statins have some 3A4 interactions?
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Simvastatin
Lovastatin Atorvastatin (but minimal, also goes down 2D6 pathway) |
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Which statin may result in increased levels in Asian pts?
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Rosuvastatin (Crestor)
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When and why should statins be dosed?
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At night because this is when cholesterol synthesis occurs (but if long half life - such as atorvastatin, and rosuvastatin - doesn't really matter)
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What are the safest statins to use if pt has liver disease?
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pravastatin or rosuvastatin (low dose)
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How do fibrates work?
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They activate the transcription factor for PPAR-alpha (which regulates the genes that control lipid metabolism)
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Fibrates lower ______ and raise ______
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triglycerides, HDL
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What are the cytochrome interactions of gemfibrozil?
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inhibit 2C9 and 2C19
(main players: fluconazole and PPIs and use with caution with other statins - choose fenofibrate instead) |
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What are the most common side effects with fibrates?
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N/V and dyspepsia
(also reversible hepatotoxicity, cholelithiasis, and myositis) |
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Which cholesterol drug improves all plasma lipoproteins/lipids by a little bit?
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niacin (nicotinic acid)
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Which two formulations of niacin should not be used?
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immediate release and sustained-release
(choose controlled release Niaspan) |
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How can flushing side effect of niacin be managed?
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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 |
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Which cholesterol med has histamine-related pruritis as a side effect (similar to vanco)?
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niacin (may go away after a few doses)
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Niacin may aggravate condition of which two populations of patients?
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1. Diabetic pts
2. Gout pts |
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How does ezetemibe work?
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inhibits absorption of dietary AND biliary cholesterol in the small intestine by blocking transport at brush border
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What is the most common side effect of ezetemibe?
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flatulence
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Which lipids are affected by ezetemibe?
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LDL (dec by 18%)
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Which bile acid sequestrant is probably best tolerated?
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colestipol
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How do bile acid sequestrants work?
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they bind bile acids in the intestinal lumen which increases cholesterol clearance from the blood to replace the lost bile.
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Fish oils mainly affect which lipid?
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triglycerides
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How do fish oils work?
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reduce hepatic triglyceride production and increasing triglyceride clearance
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Which two lipid drugs are absolutely contraindicated in pg?
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statins
fibrates |
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What of the following drugs should be used first if TG > 500? niacin, fish oil, or fibrates
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fibrates, then fish oil. but if TG 200-500 start with niacin b/c will get HDL up and LDL down.
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