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19 Cards in this Set

  • Front
  • Back
Statins MOA and effects
-HMG CoA inhibitors
-used to lower cholesterol
-blocks cholesterol synthesis
-lowers LDL
-raises HDL
-+/-TG
-MOST potent/first line
-decreases cardiovascular events, inflammation, need for PCI and CABG
Risks of Statins
Metabolized: SYP3A4- lots of drug interactions!
Atorvastatin and Rosuvastatin are the most potent but have renal risk (Pravastatin is used when renal issues are a concern)
Contraindications for Statins
1. Significant liver disease ie. cirrhosis
2. History of rhabdomyolysis or myopathy
3. Certain drugs
4. Pregnancy
When do you administer Statins?
Nighttime because cholesterol peaks in early morning
Adverse effects of Statins
1. Headache
*2. Myalgia
3. Fatigue
4. GI Upset
*5. Elevated liver enzymes (LFT's_
-rare
-concern/contraindicated only when levels are 3X the normal
*6. Myopathy: nurse check creatine kinase level, 10X normal is a conern
-also signs of muscle weakness/pain
7. rhabdomyolysis
-rare
Bile Acid Resins
-Role and Types
Conversion of cholesterol to bile acids
+lowers LDL
unfortunately raise TG
+/- raises HDL

Types:
1. Cholestyramine (Questran)
2. Colestipol (Colestid)
3. Colesevelam (Welchol)
Considerations for Bile Acid Resins
1. Given multiple times a day and this can be a concern for drug interactions
2. They increase triglycerides
3. Second line defense for pt's ineligible for statins due to pregnancy or due to hx of liver disease, myopathy, rhabdomyolysis
4. Not really any systemic toxicity
5. Cause bloating, constipation, and gas- gradually increase dose
6. Colesevelam (Welchol) is better tolerated
Bile Acid Resins --drug interactions
-They decrease absorption of other drugs and vitamins
-bind to negatively charged drugs
-when administering, must separate from other drugs (give other drugs 1 hour before or at lest 4 hours after bile resin)
Contraindications for Bile Acid Resins
Triglycerides > 400 mg/dL
Familial/Genetic High Cholesterol (ApoE)
Niacin Effect and Types
-decreases LDL
-lowers TG
-Raises HDL

Types:
- (Crystalline) Nicotinic Acid
-Extended release (Niaspan)-most used
-Sustained released-not commonly used
Common Side Effects of Niacin
Flushing
Itching
Headache** pt make want to take aspirin before dose
Hepatotoxcity and GI intolerance-esp. SR
Hyperglycemia, Hyperuricemia (gout risk)
Niacin Monitoring
-LFT's
-Blood glucose
Watch closely diabetics and pt's with gout and patient's with peptic ulcer's

obtain blood glucose level prior to administering to a diabetic
Fibric Acids Effects and Types
do not lower LDL's but help raise HDL's and lower TG productions *actually may raise LDL's!
1. Gemfibrozil (Lopid)
2. Fenofibrate (Tricor)
Contraindications for Fibric Acids
-severe renal or hepatic disease
-gall bladder disease (can cause gall stones)
Things to remember about Fibric Acids
-add on Treatment for raising HDL and lowering TG not LDL
-increase risk of myopathy when used in combination with statins (Trilipix is the only one approved for concomitant use with a statin)
Adverse effects of Fibric Acids
-GI intolerance
-Cholesthiasis (gall stones)
-Myopathies- especially when combined with statins
Cholesterol Inhibitor (Ezetimibe) Effects and Considerations
lowers LDL, lowers TG, slight increase in HDL

did not really do well in clinical trials in showing decreased cardiovascular events (artheroslerosis)

very expensive!
Adverse effects of Cholesterol Inhibitor (Ezetimibe)
-Moderate to severe hepatic disease
-Increased risk of gallstones (definitely don't combine with Fibrates which also have a risk of gallstones)
Omega 3's
Lovaza

Decrease TG
No change in LDL or HDL

May cause GI upset

Tight glucose control in diabetics to improve TG