Pharm III Lipids

Question 1

HMG-CoA Enzyme reductase Inhibtors (Statins)

Answer 1

Blocks HMG-CoA Reductase–> Intracellular depletion of cholesterol–> Inc. binding of LDL by Rec.; Dec.LDL

DOC for H-LDL and CHD risk; CI- PREGO X; Myalgia, Myopathy, Rhabdo, HepToxic; Baseline, 6wk, 12 wk LFT

Question 2

HMG-CoA Enzyme Reductase Inh. Drug Interactions

Answer 2

Fibric Acid derivatives; Gemfibrozil (No Combo Statin)
Prego X; NO CHF Pts;; Hemodialysis

Niacin–> Inc. risk of severe myopathy, rhabdo, hepatoxicity; Grapefruit Inh CYPSA4; Red yeast rice Inc. Myopathy and Rhabdo; Cytochrome p450

Question 3

Statins (HMG-CoA Reductase Inh.) with no renal insufficiency

Answer 3

Atorvastatin

Pitavastatin

Question 4

High Intensity Statin class that lowers LDL by approx 50%

Answer 4

Atorvastatin 40-80mg

Rosuvastatin 20-40 mg

Question 5

Moderate intensity statin class that lowers LDL by 30-<50%

Answer 5

• Pitavastatin (HD) -Pravastatin (HD)
• Lovastatin (HD) - Fluvasttatin (HD)
• Rosuvastatin (LD) -Atorvastatin (LD) -Simvastatin

Question 6

Low intensity statin class that lowers LDL by 30%

Answer 6

• Pravastatin -Pitavastatin
• Lovastatin -Fluvastatin
• Simvastatin

Question 7

Initiation of Statin Therapy in Pt w/ Clinical ASCVD

Answer 7

• Fasting Lipid panel -ALT
• CK -2ndary Statin safety consider

<75 W/O CI= HI >75 W/ CI=Mod. I

Question 8

Initiation of statin W/No Clinical ASCVD

Answer 8

-Add A1C Pts w/o ASCVD –> No Diabetes 40-75

Question 9

Fibric Acid Derivatives (Fibrates)

Answer 9

Stimulate Lipoprotein Lipase Activity–>Red.Lipogenesis
Raises LDL and Lowers TG by30-55%, Inc. HDL 18-22%

Use: Dec hypertiglyeridemias, include HIV protease tx
PREGO C; No monitor; No Statin Combo (Gemfibrozil)–> Rhabdo, Myopathy, GI S/S
Inc. Warfarin effects; CI-Severe renal or hepatic disease

Question 10

Fibric Acid Derivatives (Agents)

Answer 10

• Gemfibrizol (w/food) -Fenofibrate

- Fenofibric Acid

Question 11

Nicotinic Acid (Niacin)

Answer 11

Inhibits the hepatic synthesis of VLDL by inh. Lipolysis in adipose tissue–> Dec. Free FA–>Dec. LDL

Lower LDL 15-26%
Lower TG 20-50%
Raises HDL 20-50%
Reduces Major coronary events

Question 12

Niacin (Nicotinic Acid)

Answer 12

Use;Combo w Resin or HMG-CoA Red inh. to normalize LDLw/ Family Hx of hypercholestererolemia/triglecerimia

AE: PREGO C ; Flushing, Warmth, Upper GI distress, Inc Hepatic Transaminase; Hepatoxic, Hyperglycemia/ Hyperurecemia/Gout; Req. LFTs c 6-12 wks

Question 13

Bile Acid Sequestrants (Bile Acid Binding)

Answer 13

Anion exchange resins bind Neg. charge bile acids/salt
Small intestine–> Dec LDL from Inc. Bile Produce

AE: GI Distress/constipation/Bloating;Dec. Tolerance 40%
Dec. Vit. ADEK and Other Rxs Admin 1-2 hrs bef or4-6 aft
CI: >400 TG –> VLDL Synth from TG

Question 14

Bile Acid Sequestrants (Bile Acid Binding)

Answer 14

• Colistepol (Prego B) -Cholestyramine

- Colesevelam (Prego B) Fewer GI AE;

Question 15

Ezetimibe

Answer 15

Selective Cholesterol intest. Absorption Inhibitor of cholesterol; nhibits cholesterol reabsorpt in bile

Lowers-LDL 18-20% HDL- Raises Lower TG-7-17%
Adjunct to Statin >25% add Dec. LDL; Prego C
Take Bile sequestrans 2 hrs before or 4-6 hrs after Rx

Question 16

PCSK9 Inhibitor

Answer 16

Human Monoclonal Ab inh. enzyme from binding LDL Receptors; stops degredation of LDL rec. Inc LDL bind

Highly Effective Lower LDL; Adjunt to statin or statin not Tolerated w/ ASCVD or Fam Hx; AE- Flu, Inject site rx Nasopharyngitis

Question 17

PCSK9 Enzyme Inhibitor

Answer 17

• Alirocumab (D$672)

- Evolocumab (D $1410) Once a month or c 2 wks

Question 18

Omega-3 Fatty Acid

Answer 18

Lovaza - Burp fishy taste, dyspepsia; inh platelet aggreg
Pregnancy C; Fish Allergy

Icosapent Ethyl (EPA) -Diet Adjunct TG reducer >500

Question 19

High Intensity statin

Answer 19

• Secondary ASCVD prevention in <75 Pts; LDL<190 or H
• DM Pts 40-75 Y/O 70-189 and 10yr Risk of >7.5% or H
• Adult 40-75 Y/O 70-189 and 10yr Risk of >7.5% or H

Question 20

Moderate Intensity Statin

Answer 20

• Secondary ASCVD prevention in <75 Pts; HI no tolerate
• Primary DM DM Pts 40-75 Y/O 70-189 and 10yr Risk<7.5
• Adult 40-75 Y/O 70-189 and 10yr Risk of >7.5% or H

Question 21

Low Intensity statin

Answer 21

Pts who cannot tolerate high or moderate Statins

Question 22

Non-Statin

Answer 22

Tryglicerides 500mg or higher (Omega 3, Niacin, Fenofibrate)

Cannot tolerate, High risk diabetes, pregnant or don’t achieve goal

Question 23

4 Major Statin Benefit groups

Answer 23

• Pt wi clinical ASCVD
• Pts w/ Primary Elevation of LDL > =190 (Very High)
• Pts 40-75 y/o W DM
• Pts W/ASCVD/DM 40-75 y/o LDL 70-189 10 yr >7.5 ASCVD risk