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Flashcards in Dyslipidemia Deck (55):
1

Classification of cholesterol levels
non-HDL
LDL
HDL
Triglycerides

non-HDL: <130
LDL: <100
HDL: <40 men; <50 women
Triglycerides: <150

2

High intensity statins

Atorvastatin 40-80mg daily
Rosuvastatin 20-40mg daily

3

Moderate intensity statins

Atorvastatin 10-20mg daily
Rosuvastatin 5-10mg daily
Lovastatin 40mg daily
Simvastatin 20-40mg daily
Pravastatin 40-80mg daily

4

Low intensity statins

Lovastatin 20mg daily
Simvastatin 10mg daily
Pravastatin 10-20mg daily

5

Praluent

alirocumab
PCSK9 inhibitors
FDA approved for treatment of familial hypercholesterolemia

6

Repatha

evolocumab
PCSK9 inhibitors
FDA approved for treatment of familial hypercholesterolemia

7

PCSK9 inhibitors MOA

Block the protein that binds LDL receptors in the liver, increases the amount of receptors, which increase LDL degradation and decrease LDL levels by ~60%

8

Route of administration for PCSK9 inhibitors

SC
Praluent Q2 weeks
Repatha Q2 weeks/monthly

9

Myalept

metreleptin
Recombinant human leptin analog

Used to treat leptin deficiency
REMS program for use

10

MOA of statins

HMG-CoA reductase inhibitor which prevents the conversion of HMG-CoA to mevalonate, which is the rate limiting step in cholesterol synthesis.

11

Lipitor

atorvastatin

12

Caduet

atorvastatin + amlodipine

13

Liptruzet

atorvastatin + ezetimibe

14

Lescol

fluvastatin

15

Mevacor
Altoprev

lovastatin

16

Livalo

pitavastatin

17

Pravachol

pravastatin

18

Crestor

rosuvastatin

19

Zocor

simvastatin

20

Vytorin

simvastatin + ezetimibe

21

Warnings of statin use

Skeletal muscle effects: myopathy, rhabdomyolysis
Diabetes, increased A1C and fasting blood glucose.

22

Side effects of statin use

Myalgias, arthralgias, myopathy

23

Monitoring of statin use

LFTs at baseline and clinically after as indicated. Obtain lipid panel 4-12 weeks after initiation.

24

Special counseling points for lovastatin

Take in the evening with food

25

Contraindications to statin use

Active liver disease, pregnancy, breastfeeding

26

Statin drug interactions

Increased risk of myopathies when used with fibrates, avoid with gemfibrozil,

27

Statins that are contraindicated with 3A4 inhibitors

simvastatin and lovastatin

28

Zetia

ezetimibe

29

Vytorin

ezetimibe + simvastatin

30

Ezetimibe MOA

Inhibits absorption of cholesterol at the brush border of the small intestine

31

Bile acid sequestrants MOA

Bind bile acids in the intestine, forming a complex that is excreted in the feces. Non-systemic action results in partial removal of bile acids from enterohepatic circulation and prevents their reabsorption.

32

Questran
Prevalite

cholestyramine
4 gram powder packet

33

Welchol

colesevelam
Tablets or granule packets
Give with a meal and a liquid

34

Colestid

colestipol
Tablets, 5 gram packet and granules

35

Side effects of BAS

Constipation
abdominal pain
cramping
gas
bloating
increased TGs

36

How to space drugs with cholestyramine and colestipol.

Take all other drugs at least 1-4 hours before or 4-6 hours after BAS.

37

Fibrates MOA

Peroxisome proliferator receptor alpha activators (PPAR-alpha), which upregulate the expression of apolipoprotein C2 and apolipoprotein A1.

38

Lipid effects of fibrates

Can decrease TGs but can increase LDL when TGs are high.

39

Tricor
Lofibra
Trilipix

fenofibrate, fenofribic acid

40

Lopid

gemfibrozil

41

Side effects of niacin

flushing, pruritis, NVD, hyperglycemia, hyperuricemia

42

Monitoring of niacin

Check LFTs at baseline and every 6-12 weeks for 1st year.

43

Warning of niacin use

Can cause hepatotoxicity
Decreased risk with extended release Niaspan

44

Niacin drug interactions

Monitor for other concurrent drugs that are potentially hepatotoxic.
Take niacin 4-6 hours after bile acid sequestrants.

45

What is fish oil used for?

Indicated as an adjunct to diet in patients with TGs >500 mg/dL.

46

Vascepa

icosapent ethyl

47

Epanova

omega-3-carboxylic acids

48

Omtryg

omega-3acid ethyl esters A

49

Lovaza

omega-3 acid ethyl esters

50

Side effects of fish oil

Eructation (burping), dyspepsia

51

Lipid effects of fish oil

Decreases TG
Can increase LDL but no increase seen with Vascepa.

52

Fish oil drug interactions

May prolong bleeding time
Monitor INR

53

MOA of PCSK9 inhibitors

Monoclonal antibodies that bind to proprotein convertase subtilisin kexin type 9 (PCSK9).

PCSK9 binds to LDL receptors on hepatocyte surfaces to promote LDLR degradation. LDLR is the primary receptor that clears circulating LDL.

Blocking PCSK9 leads to lower LDL levels.

54

Juxtapid

lomitapide

contraindicated in pregnancy

55

Kynamro

mipomersen


SC administration

contraindicated in active liver disease