Dyslipidemia Flashcards Preview

Fall 2014 - Pharm Cardio > Dyslipidemia > Flashcards

Flashcards in Dyslipidemia Deck (33):
1

What is the non-pharmacologic therapy for dyslipidemia?

lifestyle modifications: healthy diet, weight loss, exercise, stop smoking

2

What are the pharmacologic options for dyslipidemia?

-statins
-fibric acids
-bile acid resins
-nicotinic acid
-2-azetidione

3

What is another name for the statin drug class?

-HMG CoA Reductase Inhibitors

4

What it the statin MOA?

-inhibit HMG CoA reductase, which is an enzyme in cholesterol production
-statins reduce, but don't completely block, cholesterol synthesis
-increase LDL catabolism
-also have anti-inflammatory activity (decrease CRP)

5

Adverse Effects of Statins

-hepatic toxicity
-myopathy (myalgia, myositis, rhabdomyolysis)
-neuropathy
-small increased risk of DM at high doses
-non-serious and reversible cognitive side effects (memory loss, confusion)

6

Statin CI

-pregnancy (cat X) and lactation
-active or chronic liver dz
-concomitant use of CSA (cyclosporin A), gemfibrozil, niacin

7

Drug Interactions of Statins

-reports of myopathy when administered with CSA, gemfibrozil, clofibrate, niacin, azole antifungals, erythromycin, nefazodone, protease inhibitors
-may potentiate oral anticoagulants
-increased effect/toxicity of levothyroxine (thyroid med)

8

What kind of dose-response relationship do statins have?

-non-linear: substantial reduction in LDL at starting doses; each doubling of dose reduces LDL 6% more

9

When is dosing of statins most effective?

evening dosing usually yields greater effects on LDLs

10

Which statins have the most drug interactions?

lovastatin and simvastatin

11

MOA of Bile Acid Resins

-increase LDL catabolism
-decrease cholesterol absorption

12

AEs of Bile Acid Resins

-GI SXS MOST COMMON

13

Bile Acid Resins CI

-monotherapy for TGs > 500 MG/DL
-familial dysbetalipoproteinemia
-hx of severe constipation

14

Bile Acid Resins Drug Interactions

-binds with many coadministered acidic drugs (eg warfarin, NSAIDs, beta blockers)
-take 1 hour before or 4 hours after

15

Fibric Acid MOA

-increase VLDL clearance
-decreased VLDL synthesis

16

Fibric Acid AE

-GI complaints most common
-can increase bile lithogenicity

17

Fibric Acid CI

-hepatic or severe renal dysfunction
-pre-existing gallbladder dz

18

Nicotinic Acid/Niacin MOA

-decrease LDL and VLDL synthesis

19

Nicotinic Acid/Niacin AE

-flushing most common
-may cause glucose intolerance and increase uric acid levels
-hepatotoxicity

20

Nicotinic Acid/Niacin CI

-liver disease
-type 2 DM
-hout
-hyperuricemia

21

Ezetimibe MOA

blocks cholesterol absorption

22

Ezetimibe AE

-may cause fatigue, abd pain, diarrhea, arthralgia, back pain

23

Ezetimibe CI

-combination with statins in active liver dz or pts with persistent LFT elevations

24

Which dyslipidemia class is best at reducing LDL?

statins

25

Which dyslipidemia class is best at reducing TG?

fibric acids and nicotinic acid/niacin

26

Which dyslipidemia class is best at increasing HDL?

niacin/nicotinic acid

27

Which dyslipidemia class actually causes an increase in TG?

bile acid resins

28

MOA of Plant Stenol Esters

-decrease cholesterol absorption, TC, and LDL

29

What labs must be monitored for statin therapy?

-baseline ALT
-ALT as clinically indicated thereafter
-CK prn myositis

30

What labs must be monitored for fibric acid therapy?

-baseline ALT and alk phos
-ALT and alk phos 6-12 wks x2, then q12 mo thereafter
-fasting lipid profile 6-12 wks after dose change, q12mo
-CK prn myositis

31

What labs must be monitored for bile acid resin therapy?

-fasting lipid profile 6-12 wks after stable dose then q12mo

32

What labs must be monitored for nicotinic acid therapy?

-baseline ALT and alk phos,
-ALT and alk phos 6-12 wks, q12mo
-after stable dose achieved x2 mos, fasting lipid profile, uric acid and glucose
-fasting lipid profile q12 mo thereafter
-CK prn myositis

33

ACC/AHA Statin Benefit Groups

-pts with clinical ASCVD
-pts with LDL >190
-pts 40-75 yo with DM and LDL 70-189 (but no clinical ASCVD)
-pts w/o clinical ASCVD or DM with LDL 70-189 with 10 year risk of ASCVD >7.5%