Dyslipidemia Flashcards
(20 cards)
what are the ways we can lower cholesterol
with drugs
- decrease formation: statins (and somewhat niacin)
- block absorption: zetia
- blocking enterohepatic recirculation of bile salts: bile acid sequestrents
- increased lipoprotein lipase activity -> catabolism of VLDL particles -> decease TG: fibrates
which choelsterol is the “good choesterol” and why is it called that
HDL - takes cholesterol from blood and delivers it to liver for removal
if LDL is not provided, how can you calculate it?
total cholesterol - HDL - (TG / 5)
result will be falsely low if TG is > 400
cholesterol level goals
- non-HDL: < 130
- LDL: < 100 (is considered very high if > 190)
- HDL: >40 in men, >50 in women
- TG: < 150 (very very bad if > 500, like can cause acute pacreatitis bad)
ASCVD risk is calculated with what
- pt sex, age, and race
- smoking status
- cholesterol levels and whether or not pt on sstatin
- BP and whether or not pt on med
- DM hx and asa use
key drugs that increase LDL and TG
both
- diuretics
- efavirenz:
- immunosuppressants (cyclosporine, tacrolimus)
- atypical APs
- protease inhibitors
- LDL only: fibrates, fish oils (excluding Vascepa)
- TG only: IV lipid, propofil, clevidipine, bile acid sequestrants
non drug treatment for dyslipidemia
- maintain a normal BMI: eat veggies, fruits, whole grains and high fibers
- healthy proteins
- limit saturated fat and trans fat
- aerobic activity 3-4 times a week
- no smoking
what pateints qualify for a high intensity statin
- anyone who is using it for secondary prevention
- baseline** LDL >190**
- diabetics age 40-75: (with multiple ASCVD risk factors) OR (with an LDL between 70 and 189 with a 10 year ASCVD risk > 20%)
what patient qualfies for moderate intensity statin
diabetics age 40-75 who didn’t qualify for high intensity
what are the statin intensity break down
- high: atorvastatin 40-80 and rosuvastatin 20-40
- low: simvastatin 10, pravastatin 10-20, lovastatin 20, fluvastatin 20-40
everything else is moderate - pitavastatins is only moderate
equivalence breakdown: pharmacists rock at saving lives and preventing fatty deposits
- pitavastatin: 2
- rosuvastatin: 5
- atoravastatin: 10
- simvastatin: 20
- lovastatin: 40
- pravastatin: 40
- fluvastatin: 80
what to do if pt develops myalgia while on statin
- hold statin, check CPK (you’d expect it to be like >10,000 in rhabdo), investigate other causes
- 2-4 weeks later, re-challenge with same statin at same or lower dose
- if re-challenge fails, dc statin. wait for symptom resolution and then retry a low dose of a different statin
- if pt fails to tolerate staitn after at least 2 attempts, give up
contraindicatins to statisn
- breastfeeding
- liver disease
- simvastatin and lvoastatin shouldn’t be used with CYp3A4 inhibitors
- pitavastatin shouldn’t be used with cyclosporine
statin DDIs
the following have interactions with simvastatin and lovastsatin (G- PACMAN)
- grapefruit
- protease inhibitors
- azole antifungals
- cyclosporine (rosuvastatin also DDI, cap rosuvstatin is 5mg/day)
- cobicistat (atorvastatin also DDI, cap lipitor at 20mg/day)
- macrolides - no DDI with zithro though
- amiodarone - can technically take with a max dose of simvastatin 20 or lovastatin 40
- non-DHP CCBs - can technically take with a max dose of simvastatin 10 or lovastatin 20
- pitavastatin: cyclosporine
whcih statins have adminstration considerations (either wth food or time)
- fluvastatin: take in PM
- lovastatin: take with dinner
- simvastatin: take in PM on an empty stomach
ezetimibe safety considerations
- avoid in mod-severe hepatic impairement
- can also cause myalgia
statins vs. zetia vs. PCSK9 mAb vs. bile acid sequestrants vs. fibrates vs. niacin vs. fish oil
exepcted cholesterol change
- statins: lower LDL, raise HDL, lower TG
- zetia: mostly lowers LDL
- PCSK9 mAb: lowers LDL, TG and non-HDL
- bile acid sequestrants: somewhat lower LDL (can actually increase TG)
- fibrates: lower TG (but if TG is super high, can actually increase LDL)
- niacin: increase HDL, lower TG
- fish oils: decrease TG but can increase LDL
what mAbs are available to treat dyslipidemia
- alirocumab (praluent)
- evolocumab (repatha)
PCSK9 mAb
what should you know about bile acid sequestrants
- they bind to bile acids and excrete in the feces
- can decrease absorption of fat-soluble viamines (ADEK) - may need MVI
- include: colesevelam, cholestyramine, cholestipol
- colesevelam can nlower BG, needs to be taken with a meal and is safe in preggers
- cholestyramine: if used for a prolonged period of time can discolor teeeth and eventually lead to decay
- cholestyramien AND colestipol: have DDI, take all other drugs 1-4 hrs before or 4-6 hrs after
safety considerations for fibrates
- CI in severe liver disease or gall bladder disease
- myopathy - risk increased with coadmin of statin or zetia
- gemfibrozil has dyspepsia
can icnrease effects of SUs and warfarin
niacin saftey considerations
- needs to be titrated slowly and taken with food
- can cause: rhabdo, heptatox
- can increase BG and uric acid (worsen gout)
- may cause flusing or pruitis - can take with asa or ibuprofen to reduce
- take 4-6 hrs after bile acid sequestrants
ER has less flusing and hepatotox
