CAD and HTN Flashcards
Non-HDL Calculation
TC - HDL
Lipid panels
taken after 9-12 hour fast
Friedewald equation
LDL = TC - HDL - TG/5
When can you NOT use the Friedewald equation
when TG > 400 mg/dL
normal non-HDL
< 130
normal LDL
< 100
normal HDL for men and women
< 40 (men) & < 50 (women)
normal TG
< 150
drugs that increase LDL and TG
- Diuretics
- Efavirenz
- Steroids
- Immunosuppressants
- Atypical antipsychotics
- Protease inhibitors
retinoids
drugs that increase LDL only
- Fish oils (except vascepa)
- Anabolic steroids
- Fibrates
- Progestins
SGLT2 inhibitors
drugs that increase TG only
- IV lipid emulsions
- Propofol
- Bile acid sequestrants
- Estrogen
- Tamoxifen
- Clevidipine
betablockers
conditions that raise LDL and/or TG
Obesity, poor diet, hypothyroidism, alcoholism, smoking, diabetes, renal/liver disease, nephrotic syndrome
Pregnancy, PCOS, anorexia
when is ASCVD not needed to be calculated
patients with clinical ASCVD, diabetes, or LDL > 190
Red yeast rice
naturally occurring, HMG-CoA reductase inhibitor
Which statin should be given for secondary prevention in those with clinical ASCVD
high intensity (if patient > 75 and LDL is 70-189 mg/dL can consider moderate)
Which statin should be given for primary prevention in those with primary elevation of LDL > 190 mg/dL
high intensity
Which statin should be given for primary prevention in those with diabetes and are 40-75 years with LDL between 70-189 & multiple ASCVD risk factors
high intensity
Which statin should be given for primary prevention in those with diabetes and are 40-75 years with LDL between 70-189 with regardless of 10 year ASCVD risk
moderate intensity
Which statin should be given for primary prevention in those 40-75 years with LDL between 70-189 & have 10-year ASVCD risk > 20%
high intensity
Which statin should be given for primary prevention in those 40-75 years with LDL between 70-189 & have 10 year ASCVD risk 7.5-19.9% + risk enhancing factors
moderate intensity
high intensity statins
atorvastatin 40-80 & rosuvastatin 20-40
Equivalent statin doses: Pharmacists Rock At Saving Lives and Preventing Fatty deposits
*pitavastatin 2 mg
*Rosuvastatin 5 mg
*atorvastatin 10 mg
*simvastatin 20 mg
*lovastatin 40 mg
*pravastatin 40 mg
*fluvastatin 80 mg
managing myalgias with statins: reduce the risk
avoid drug interactions, including OTC products; do not use simvastatin 80 mg/day; do not use gemfibrozil + statin
managing myalgias with statins: managing myalgias
*hold statin, check CPK, investigate other possible causes
*after 2-4 weeks: re-challenge with the same statin or decrease dose.
*if myalgias return, discontinue statin. Once muscle symptoms resolve, use a low dose of a different statin and gradually increase dose
MMR
myalgias, myopathy, myositis, rhabdomyolysis
amlodipine and atorvastatin, lovastatin, simvastatin
can increase concentration (max 20 mg/day)
Statin drug interactions: G PACMAN
grapefruit, protease inhibitors, azole antifungals, cyclosporine & cobicistat, macrolides (not azithromycin), amiodarone, Non-DHP CCBs
Grapefruit, protease inhibitors, azole antifungals, cyclosporine, cobicistat, macrolides (except azithromycin)
do not use with simvastatin or lovastatin
max daily dose of simvastatin and lovastatin with amiodarone
20 mg & 40 mg
max daily dose of simvastatin and lovastatin with non-DHP CCB
10 mg & 20 mg
PCSK9 & PCSK9 inhibitors
increases LDL receptor degradation
block the ability of PCSK9 to bind to the LDL receptor