Dyslipidemia Flashcards Preview

Pharm I Fall 2016 NUNM Jensen > Dyslipidemia > Flashcards

Flashcards in Dyslipidemia Deck (34)
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1

What is the MOA for statins?

They inhibit HMG-CoA reductase, a vital step in cholesterol synthesis. The liver then increases cholesterol uptake by increasing the number of LDL receptors

2

Statin: indications?

First-line therapy for primary and secondary prevention of ASCVD
Familial hypercholesterolemia

3

Statin: contraindications?

Active liver disease, pregnancy (cat. X), breast feeding

4

Statin: side effects?

Myopathy, increase in liver enzymes, nausea, ha

5

Statin: onset?

Varies, peak effect in a few weeks

6

Statin: interactions?

Red yeast rice (redundant), Niacin, alcohol, grapefruit, st. john's wort, sweet orange

7

Ezetimibe: MOA?

Prevents absorption of dietary and biliary cholesterol

8

Ezetimibe: indications?

Adjunctive therapy in homozygous familial hypercholesterolemia and primary hyperlipidemia
Typically used when statin intolerant

9

Ezetimibe: contraindications?

Pregnancy (cat. C) or breast feeding

10

Ezetimibe: side effects?

Increase in liver enzymes

11

Ezetimibe: metabolism?

~30% undergoes glucuronide conjugation in the SI and liver

12

Ezetimibe: interactions

It would lower effectiveness of green tea, O3FA, sitostanol and beta-sitosterol

13

Fibrates: MOA?

Lower production and increased clearance of VLDL
Increased HDL production
Lowers TG

14

Fibrates: indications?

Hypercholesterolemia or mixed dyslipidemia as adjunct therapy or monotherapy in pts who can't tolerate statins
Hypertriglyceridemia first-line pharmacotherapy

15

Fibrates: contraindications?

Active liver disease, severe renal impairment or ESRD and pre-existing GB disease, and breast feeding

16

Fibrates: side effects?

Dyspepsia, gallstones, myopathy (increased risk with statins)

17

Fibrates: interactions?

Red yeast rice, niacin, alcohol

18

Gemfibrozil increases risk for what side effect when used with statin therapy? and how can we assess severity of this effect?

Myopathy
CK

19

Niacin: MOA?

Unclear, but..it increases lipoprotein lipase activity, enhancing removal of triglycerides from plasma.
Reduces TG synthesis
Increases HDL-C levels

20

Niacin: indications?

Hypercholesterolemia or mixed dyslipidemia as adjunct therapy for pts who do not tolerate fibrates or O3FA, or as monotherapy for pts who do not tolerate statins, BAS, or fibrates
Hypertriglyceridemia second-line pharmacotherapy

21

Niacin: contraindications?

Active liver disease, gout, peptic ulcer disease

22

Niacin: side effects?

Hepatotoxicity, hyperglycemia, hyperuricemia, upper GI distress, flushing itching

23

Niacin: interactions?

Red yeast rice, alcohol

24

Niacin causes flushing, the extended release form has less flushing as a side effect. However, it is not used very often because of an increased risk for what major side effect?

Hepatotoxicity > Acute necrosis

25

Omega-3 fatty acids: MOA?

Inhibits the release of FA from adipose tissue.
Inhibits beta oxidation of hepatic FA.
Inhibits FA synthesis
Increases VLDL clearance
Lowers TG and increases HDL

26

Omega-3 fatty acids: indications?

Hypertriglyceridemia second-line pharmacotherapy

27

Omega-3 fatty acids: contraindications?

Hypersensitivity to fish oil

28

Omega-3 fatty acids: side effects?

Eructation, nausea, dyspepsia, taste changes, and may increase bleeding time.

29

Bile Acid Sequestrants (BAS): MOA?

Resins bind bile acid in the intestine. This reduces enterohepatic recycling.
Increases hepatic conversion of cholesterol to bile acid. Up regulates LDL receptors on the liver

30

Bile Acid Sequestrants (BAS): indications?

Hypercholesterolemia for high risk patient who are statin-intolerant or are on maximal tolerated doses of statins

31

Bile Acid Sequestrants (BAS): contraindications?

TG > 300 mg/dL
complete biliary obstruction

32

Bile Acid Sequestrants (BAS): side effects?

Constipation, abdominal discomfort, intestinal gas, dyspepsia, heartburn, diarrhea

33

BAS and ezetimibe both work in the intestine to lower absorption of cholesterol. What change occurs in the liver to lower LDL?

Increase in LDL receptors

34

Bile Acid Sequestrants (BAS): interactions?

Niacin absorption may be hindered