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Pharm Exam I > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

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1
Q

MOA of Omega 3’s

A

Unknown

dec. hepatic circulation vs. dec. TG synthesis

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2
Q

ADE Omega 3’s

A

FISHY BURP
indigestion
altered taste

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3
Q

Omega 3’s Lab effects:

A

Dec. TG by 60%

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4
Q

Cholesterol Absorption Inhibitors

drug name

A

Ezetimibe

Zetia, Vytorin (from the ppt)

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5
Q

MOA Cholesterol Absorption Inhibitors

ezetimibe, zetia, vytorin

A

dec. intestinal absorption of DIETARY and BILIARY cholesterol

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6
Q

ADE Chol. Absorption Inhibitors

A

Diarrhea, upset stomach, musculoskeletal, sinusitis and infections

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7
Q

Metabolism of Ezetimibe, Zetia, Vytorin

A

Glucuronidation active metabolite

NOT CYP450- advantage

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8
Q

Lovaza
Supplements
Fatty Fish
Drug class?

A

Omega 3 Fatty Acids

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9
Q

Fibrates Drug names

A

Gemfibrozil
Fenofibrate

Lofibra, Lipoforr, Trilipix, Tricor (from ppt)

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10
Q

MOA Fibrates

A

Activate PPAR-a, which modulates metabolism and catabolism of lipids
(RNA/DNA transcription)

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11
Q

ADE Fibrates

A

Abd. pain, nausea, inc SCr, inc transaminases, Myopathy

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12
Q

Metabolism Pathway of Fibrates

A

Hepatic metabolism, renal excretion (conjugated)

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13
Q

Fibrates place in therapy

A

2nd line for pts who can’t take Statins

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14
Q

Nicotinic Acid class

A

Nicotinic Acid
Niacinamide
Niacin
Niaspan (from ppt)

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15
Q

MOA Nicotinic Acid

A

? in adipose tissue, dec. TG synthesis

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16
Q

ADE Nicotinic Acid

A

FLUSHING

n/v, inc. transaminases, myopathy

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17
Q

How to dec. the flushing of nicotinic acid?

A

Take aspirin (325 mg) 30 min prior to nicotinic acid

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18
Q

Metabolism of Nicotinic acid

A

Hepatic Conjugation

renal excretion

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19
Q

Classes that use hepatic metabolism and renal excretion?

A

Fibrates and Nicotinic Acid

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20
Q

Bile Acid Sequestrants

drugs

A 
Cholestyramine (powder- mix in 8 oz H20)
Colestipol (p, tablet)
Colesevelam (p,t)
Colestid
Questran
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21
Q

MOA Bile Acid Sequestrants

A

Anion exchange resins in GI tract that bind to bile acids

helps to excrete in feces

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22
Q

ADE Bile Acid Sequestrants

A 
Abd Pain
constipation
flatulance
n/v
**GI Effects**
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23
Q

Place in therapy for bile acid sequestrants

A

2nd line for selected pts

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24
Q

Statin drugs

A 
fluvastatin
pravastatin
lovastatin
simvastatin
atrovastatin
rosuvastatin
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25
MOA statins
inhibit HMG- CoA reductase | at rate limiting step in chol. synthesis, block step, block pathway
26
ADE statins
dizzy, h/a, abd pain | nausea, inc. transaminases, myopathy
27
Bile Acid Sequestrants DI
interfere with many drugs so take 1-2 hours AFTER other meds or other meds 4-6 hours AFTER resin
28
Statin effects
``` plaque stability angiogenesis vascular cytoprotection anti-oxidant immunomodulary anti-inflammatory anti-thrombic endothelial fxn ```
29
Order statins in low to high potency
Fluva, Prava, Lova, Simva, Atorva, Rosuva
30
Which statins are lipophilic?
Fluva, Lova, Simva, Atorva so they're good concern w/myopathy
31
Which statins are not lipophilic?
Prava, Rosuva
32
Which statin is not metabolized through the CYP450 pathway? | How it is metabolized?
Pravastatin by sulfation
33
Long half life statins?
Atorva, Rousuva
34
Dose which statins at night?
The lower doses: | Fluva, prava, lova, simva!
35
Which statin has an inactive metabolite?
Pravastatin
36
High intensity statins lower LDL by
>50% again: atorva, rosuva
37
Moderate Intensity Statins lower LDL by
30-50%
38
Low Intensity lower LDL by
39
Old way of Tx
- set LDL goal - Tx to target - use whatever works until LDL
40
New way of Tx
Follow the high quality evidence from RCTs
41
Lifestyle Modifications: Diet Exercise
Always: veggie, fruit, whole grains Sometimes: low fat dairy, poultry, fish, legumes, nontropical oil, nuts Rarely: sweets, sweet beverage, red meat Exercise: 3-4x/wk, 40 min, mod to vigorous intensity
42
Diet elevated LDL
weight gain saturated/trans fat anorexia
43
Diet elevated TG
** Excess ETOH | Wt. gain, low-fat diet, refined carbs
44
Drugs that elevate LDL
**steroids, diuretics, cyclosporine, amiordarone
45
Drugs that elevate TG
**Glucocorticoids **Protease inhibitors **anabolic steroids **sirolimus thiazide diuretics, estrogen, bile acid sequestrant, ralozifene, tamoxifen, beta blockers
46
Disease that elevate LDL
Nephrotic Syndrome | Biliary Obstruction
47
Disease that inc. TG
Nephrotic syndrome chronic renal failure lipodystrophies
48
Altered metabolism elevate LDL
hypothyroidism obesity pregnancy
49
altered metabolism to elevate TG
hypothyroidism obesity pregnancy poor controlled DM- consider stabilize DM before TG
50
comorbidities- renal/hepatic dysfxn hx of statin intolerance or muscle disorder unexplained ALT elevation > 3x ULN age over 75 years
Factors predisposing individuals to adverse events | excluding DI
51
Drug interactions that increase statin concentrations | aka inc risk of ADE
``` nicotinic acid, fibrates cyclosporine, azole antifungals macrolids, protease inhibitors verapamil, amiodarone grapefruit juice, alcohol ```
52
baseline labs to check
``` fasting lipid panel (for statin intensity) alanine aminotransferase (ALT) creatine kinase (CK) fasting blood glucose/ A1c for DM ```
53
drugs to check for classes other than statins
uric acid (niacin) triglycerides (bile acid sequestrants bc they inc TG) serum Cr/ GFR (fibrates)
54
ACVD 10 year risk score is specific to what 4 categories?
Male and female | White and AA populations
55
what factors are used in the pooled cohort other than gender and race?
Age, SBP, smoking, DM, HDL, total cholesterol, meds for BP
56
asses ASCVD risk factors every:
4-6 yrs in adults 20-79 yo w/o hx of ascvd
57
estimate 10 yr risk every 4-6 years in pts
40-79 yo w/o hx of ascvd
58
what are the 3 statin benefit risk groups
1. LDL >= 190, age 21+ 2. DM + Age 40-75 yo 3. ASCVD >= 7.5% and age 40-75yo
59
Dizziness points
less noticeable if take pill at night lessens with time SE not harmful if tolerable
60
STOP taking statins if:
There is a change in urine color to dark brown! this is rare and shows renal failure
61
How long on statin before benefit?
2-5 years! but it decreases LDL in 6-8 wks
62
if LDL is less than _____, it is reasonable to reduce the intensity.
40 mg/dl
63
monitor LFT's
w/in first 3 months if elevated usually resolves with d/c ALT/AST elevation = normal
64
monitor symptoms of myopathies
CK labs severe if CK is 10x normal- if yes it will progress to rhabdomyolitis and kidney failure mc with DI to inc statin conc.
65
What is an alternative to statin for Men at risk for ASCVD?
1st Colestipol before meal | 2nd Gemfibrozil
66
What is a statin alternative for a HIGH risk MALE?
1st Cholestyramine
67
Male or female with T2DM, w/ or w/out renal impairment. | Alternative to statin?
Micronized fenofibrate
68
Male or female with established ASCVD. | Alternative to statins?
Gemfibrozil | Colestipol
69
What is important to remember about the pooled cohort equation?
Only designed for naive pts.
70
How do you tell if your pt on lipid lowering meds can benefit from a higher intensity?
-titrate up as tolerated by pt use opposite method if you think the intensity can be lowered and consider removing the non statin if pt is on more than one drug
71
TG over 1000 mg/dL | now what?
PREVENT PANCREATITIS. more than prevent ASCVD. 1st Line = FIBRATES 2nd Line= niacin and omega 3 lifestyle mod: d/c etoh, d/c meds that inc TG, tx uncontrolled DM
72
Pt has clinical ASCVD they need _____ intensity
HIGH intensity | A-grade recommendation
73
Pt has LDL >= 190 and over 21 yrs old | they need a ______ intensity statin
HIGH!! | B-grade recommendation
74
Pt has DM and is 40-75 yo | They need a ______ intensity
MODERATE intensity A- grade (if same pt ASCVD risk >7.5%-- HIGH intensity)
75
ASCVD >= 7.5% and Age 40-75 yo
MODERATE or HIGH intensity A-grade assess the other risks!
76
What can you use if the ASCVD risk assessment is unclear?
Family history hs-CRP >= 2 mg/ml CAC score >= 300 ABI
77
What factors have uncertainty for the ASCVD risk calculation?
``` ApoB CKD Albuminurea Cardiorespiratory fitness Carotid intima media thickness (CIMT) ```

Pharm Exam I (3 decks)

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