Dyslipidemia Flashcards
(70 cards)
statin MOA
HMG-CoA reductase inhibitor = rate-limiting step in cholesterol synthesis
reduces formation of cholesterol
reduces ASCVD risk
ezetimibe MOA
blocks cholesterol absorption
colesevelam MOA
bile acid sequestrant
blocks enterohepatic circulation
HDL benefit
lowers ASCVD risk
hypertriglyceridemia risk
pancreatitis if >500
drugs that increase LDL and TG
diuretics
efavirenz
steroids
immunosuppressants (cyclosporine, tacrolimus)
atypical antipsychotics
protease inhibitors
drugs that inc LDL only
fish oils (except vascepa)
drugs that inc TG only
IV lipid emulsions
propofol
bile acid sequestrant
conditions that inc hyperlipidemia
obesity
poor diet
hypothyroidism
alcoholism
smoking
diabetes
renal disease
liver disease
nephrotic syndrome
pregnancy
polycystic ovarian syndrome
anorexia
Friedewald equation
LDL = TC - HDL - (TG/5)
do not use when TG >400
inputs into ASCVD risk calculator
TC
HDL
SBP
antihypertensive use
diabetes status
smoking status
ASCVD risk-enhancing factors
very high LDL
FH of premature ASCVD
metabolic syndrome
chronic kidney disease
preeclampsia or premature menopause
chronic inflammatory disorders (esp. if 10-yr ASCVD risk 7.5-19.9%; if CAC 100 or more = start statin
high CRP
high CAC score
abnormal ankle brachial index
non-drug treatment
BMI 18.5-24.9
veggies, fruits, whole grains, high fiber, fish
limit saturated fat, trans fat, cholesterol
aerobic 3-4 times/week
natural products
red yeast rice - has naturally occurring HMG-CoA reductase inhibitors
OTIC fish oils - lower TG
drug treatment
DOC: statin: high non-HDL and LDL
ezetimibe and PCSK9 inhibitors over other non-statin drugs
Liver damage from cholesterol lowering drugs
niacin
fibrates
potentially statins
do not use if AST or ALT is >3 times ULN
high-intensity statin indications
clinical ASCVD (ACS, MI, stable/unstable angina, coronary or other revascularization), stroke, TIA, PAD of atherosclerotic origin
LDL 190 or more
DM age 40-75 with LDL 70-189 and multiple ASCVD risk factors
40-75 with LDL 70-189 and 10-yr ASCVD risk 20% or more
moderate-intensity statin indications
DM age 40-75 with LDL 70-189 without multiple ASCVD risk factors
age 40-75 with LDL 70-189 and 10-yr ASCVD risk 7.5-19.9% and risk-enhancing factors
statin equivalent doses
Pharmacists Rock At Saving Lives and Preventing Fat
Pitava: 2 mg
Rosuva: 5 mg
Atorva: 10 mg
Simva: 20 mg
Lova: 40 mg
Prava: 40 mg
Fluva: 80 mg
statin side effects
muscle damage: symmetrical; usu within 6 weeks
myalgia: sore/tender
myopathy: weak w or wo CPK inc
myositis: muscle inflammation
rhabdo: symptoms + very high CPK (>10,000) + myoglobinuria (can lead to renal failure)
managing myalgia
reduce risk:
avoid DI
don’t use simvastatin 80 mg
do not use gemfibrozil + statin
manage:
hold statin, check CPK, investigate other causes
re-challenge in 2-4 weeks with same at same or lower dose
if myalgias return, dc statin; once resolve, use low dose of different statin and gradually inc
statin CI
pregnancy
breastfeeding
liver disease
CYP3A4 inhibitors (with simvastatin and lovastatin)
statin warnings
muscle damage: inc CPK; higher risk with high dose, advanced age, niacin, gemfibrozil, CYP3A4 inhibitors
diabetes: inc A1C/FBG
statin monitoring
lipid panel 1-3 mo after starting; then annually
if myalgia: check CPK
if little/no urine: check SCr/BUN
if abd pain/jaundice: LFTs for hepatotoxicity
