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19 Cards in this Set
- Front
- Back
Statins MOA and effects
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-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 |
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Risks of Statins
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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) |
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Contraindications for Statins
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1. Significant liver disease ie. cirrhosis
2. History of rhabdomyolysis or myopathy 3. Certain drugs 4. Pregnancy |
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When do you administer Statins?
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Nighttime because cholesterol peaks in early morning
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Adverse effects of Statins
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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 |
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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) |
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Considerations for Bile Acid Resins
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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 |
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Bile Acid Resins --drug interactions
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-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) |
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Contraindications for Bile Acid Resins
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Triglycerides > 400 mg/dL
Familial/Genetic High Cholesterol (ApoE) |
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Niacin Effect and Types
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-decreases LDL
-lowers TG -Raises HDL Types: - (Crystalline) Nicotinic Acid -Extended release (Niaspan)-most used -Sustained released-not commonly used |
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Common Side Effects of Niacin
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Flushing
Itching Headache** pt make want to take aspirin before dose Hepatotoxcity and GI intolerance-esp. SR Hyperglycemia, Hyperuricemia (gout risk) |
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Niacin Monitoring
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-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 |
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Fibric Acids Effects and Types
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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) |
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Contraindications for Fibric Acids
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-severe renal or hepatic disease
-gall bladder disease (can cause gall stones) |
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Things to remember about Fibric Acids
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-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) |
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Adverse effects of Fibric Acids
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-GI intolerance
-Cholesthiasis (gall stones) -Myopathies- especially when combined with statins |
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Cholesterol Inhibitor (Ezetimibe) Effects and Considerations
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lowers LDL, lowers TG, slight increase in HDL
did not really do well in clinical trials in showing decreased cardiovascular events (artheroslerosis) very expensive! |
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Adverse effects of Cholesterol Inhibitor (Ezetimibe)
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-Moderate to severe hepatic disease
-Increased risk of gallstones (definitely don't combine with Fibrates which also have a risk of gallstones) |
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Omega 3's
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Lovaza
Decrease TG No change in LDL or HDL May cause GI upset Tight glucose control in diabetics to improve TG |