Ch 48: Dyslipidemia Flashcards

1
Q

Friedewald Equation

A

LDL = TC - HDL - (TG/5). Do not use if TG >400 mg/dL.

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2
Q

Red Yeast Rice

A

natural HMG-CoA reductase inhibitor. Do not recommend d/t inconsistencies in manufacturing.

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3
Q

OTC Fish Oils on Cholesterol

A

lower TG. sometimes lower LDL.

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4
Q

Non-HDL Classification and Goals

A

<130 desirable. 130-159 above desirable. 160-189 borderline high. 190-219 high. >220 very high.

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5
Q

LDL Classification and Goals

A

<100 desirable. 100-129 above desirable. 130-159 borderline high. 160-189 high. >190 very high.

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6
Q

HDL Classification and Goals

A

<40 men low. <50 women low.

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7
Q

TG Classification and Goals

A

<150 normal. 150-199 borderline high. 200-499 high. >500 very high.

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8
Q

Statin Benefit Groups

A

1) clinical ASCVD, 2) LDL >190. 3) Diabetes, 40-75 YO, LDL 70-189. 4) 10-yr ASCVD risk >7.5%, 40-75 YO, LDL 70-189. (repeat ASCVD risk q4-6yrs for low risk pts)

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9
Q

Clinical ASCVD

A

coronary heart disease (ACS, s/p MI, stable or unstable angina, coronary or other arterial revascularization), stroke, TIA, peripheral arterial disease thought to be of atherosclerotic origin

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10
Q

Metreleptin

A

Myalept. Recombinant human leptin analog. Adjunct to diet for leptin deficiency with lipodystrophy. Warnings: development of leptin abs, lymphoma risk. REMS drug, restricted use.

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11
Q

AST/ALT considerations

A

monitor LFTs with cholesterol lowering therapies. Normal range is 10-40 for each. DC drug if LFTS >3x ULN

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12
Q

rhabdomyolysis

A

muscle sx + CPK > 10,000 (normal 22-198) + muscle protein in urine (myoglobinuria) –> acute renal failure

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13
Q

Statins to take specifically at night (brand + generic)

A

Lescol (Fluvastatin) IR. Altoprev (Lovastatin ER) and Mevacor (Lovastatin IR). Take Mevacor with food.

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14
Q

Asian considerations

A

Rosuvastatin exposures are 2x higher in Asian patients. consider 5 mg starting dose.

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15
Q

Statin DDIs

A

Avoid GPACMAN (CYP 3a4 inhibitors) with simvastatin and lovastatin (Mevacor/Altoprev) d/t contraindication. Others have max dose with DDIs. Avoid gemfibrozil.

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16
Q

Ezetimibe MOA, brand, DDIs

A

inhibits cholesterol absorption in GI. Zetia. separate from bile acid sequestrants. avoid with gemfibrozil d/t cholelithiasis.

17
Q

Statin MOA, contraindications

A

inhibit HMG-Coa reductase, preventing the conversion of HMG-CoA to mevalonate (rate limiting step for cholesterol synthesis). active liver disease, preg, lactation.

18
Q

Vytorin

A

simvastatin + ezetimibe

19
Q

Liptruzet

A

atorvastatin + ezetimibe

20
Q

Bile Acid Sequestrants: Names (brand + generic), ADRs, lipid effects

A

cholestyramine (Questran), Colesevelam (Welchol) with meal and liquid, less DDIs. Colestipol (Colistid). ADRs: constipation (dose reduce), abd pain, cramping, gas, inc TGs (by ~5%). dec LDL 10-30%. inc HDL 3-5%.

21
Q

Fibrates: Names (brand + generic), ADRs unique, lipid effects, MOA (class)

A

fenofibrate - take fenoglide, lofibra (cap not tab), lipofen with food. gemfibrozil (lopid) before food. ADRs: dyspepsia. dec TG 20-50%, inc HDL 15%, dec LDL 5-20%. may inc LDL when TG is high. peroxisome proliferator receptor alpha activators. many DDIs with lopid.

22
Q

Niacin: MOA, warning, ADRs, lipid effects

A

dec hepatic synthesis of VLDL (dec TG) and LDL. aka vit b3. warning: hep tox. ADRs: flushing, pruritis, NVD, hyperglycemia, hyperuricemia (gout), cough. IR (niacor) more flushing/itching, ER more hep tox. niaspan less tox all around, most costly. IR /ER not interchangeable. reduce flushing with asa 325 mg or ibu 200 mg 30-60 min before dose. dec LDL 5-25%. inc HDL 15-35%. dec TG 20-50%.

23
Q

Fish oils: indication, brand + generic, warning, lipid effects

A

adjunct to diet with TG >500. omega-3-FA (lovaza). may prolong bleeding time. inc LDL up to 44%. Vascepa (icosapent ethyl) does not inc LDL.

24
Q

PCSK9 Inhibitors: MOA, name (brand + generic), lipid effects

A

proprotein convertase subtilisin kexin type 9 inhibitors. PCSK9 binds LDLR to degrade it. When inhibited LDLR conc inc and degrades more LDL. Alirocumab (Praluent) and Evolocumab (Repatha, Pushtronex) SC - inj site rxns. dec LDL 60%. dec nonHDL 35%. dec TC 36%.

25
Q

when to consider PCSK9 inhibitors

A

1) 2ndary ppx for pts on max tolerated statin +/- zetia with LDL >70 or nonHDL >100. 2) very high risk pts who are intolerant to statins and not at goal despite use of other lipid agents. 3) pts with FH (hetero both, homo repatha) and LDL pre-tx of >190 depending on age, on-treatment lipids, and other risk factors.

26
Q

Lomitapide: brand, BBW, contraindications, warnings, DDIs

A

Juxtapid cap. BBW: hep tox. REMS, medguide. contraindicated in preg. VD and embyro fetal tox for warnings. DDIs: GPACMAN, dose adjust for weak inhibitors

27
Q

Mipomersen: brand, BBW, contraindications.

A

kynamro. prefilled syringe, SC. BBW: hep tox, medguide, REMS. contraindication: active liver disease.

28
Q

Caduet

A

atorvastatin + amlodipine

29
Q

Liptruzet

A

atorvastatin + ezetimibe