Exam 1 - Dyslipidemia Drugs

Question 1

Atorvastatin

Answer 1

Lipitor
HMG CoA Reductase Inhibitor

Question 2

Rosuvastatin

Answer 2

Crestor
HMG CoA Reductase Inhibitor

Question 3

Simvastatin

Answer 3

Zocor
HMG CoA Reductase Inhibitor

Question 4

Lovastatin

Answer 4

Mevacor
HMG CoA Reductase Inhibitor

Question 5

Pravastatin

Answer 5

Pravachol
HMG CoA Reductase Inhibitor

Question 6

Fluvastatin

Answer 6

Lescol
HMG CoA Reductase Inhibitor

Question 7

Pitavastatin

Answer 7

Livalo
HMG CoA Reductase Inhibitor

Question 8

What is the MOA of HMG CoA Reductase Inhibitors?

Answer 8

Reduces hepatic cholesterol synthesis and lowers intracellular cholesterol

Question 9

Which statins must be taken in the evening due to short half lives?

Answer 9

1.) Lovastatin
2.) Fluvastatin
3.) Simvastatin

Question 10

What enzyme metabolizes all the statins beside rosuvastatin?

Answer 10

CYP3A4

Question 11

What enzyme metabolizes rosuvastatin? Does this have more or less drug interactions?

Answer 11

CYP2D6
Less Drug Interactions :)

Question 12

What is the rule of 6?

Answer 12

For each doubling of a statin dose (i.e. simvastatin 10mg to 20mg), anticipate about 6% additional LDL-C reduction

Question 13

Which statins are most effective at reducing triglycerides?

Answer 13

Atorvastatin and Rosuvastatin (think high intensity)

Question 14

Which statins are high intensity?

Answer 14

Atorvastatin and Rosuvastatin

Question 15

What are contraindications for statins (HMG CoA Reductase Inhibitors)?

Answer 15

1.) Pregnancy and Lactation
2.) Active Liver Disease

Question 16

What are the adverse effects of statins? KNOW THESE

Answer 16

1.) Myalgias (muscle pain)
2.) Rhabdomyolysis (breaking down of the muscle, pee is usually cola color)
3.) Increased blood glucose and A1C levels
4.) CNS effects

Question 17

What is the dosing for Rosuvastatin (moderate and high intensity)?

Answer 17

Moderate Intensity: 5-10mg daily
High Intensity: 20-40mg daily

Question 18

What are some drug interactions with Crestor?

Answer 18

1.) Gemfibrizol (Lopid)
2.) HIV Protease Inhibitors
3.) Cyclosporine

Question 19

What are some drug interactions with Lipitor?

Answer 19

1.) Cyclosporine
2.) Gemfibrizol (avoid)
3.) Fenofibrate (use with caution)
4.) Itraconazole
5.) Niacin (doses more than 1g)

Question 20

Can a patient be newly started on Simvastatin 80mg?

Answer 20

No, FDA states this increases the risk of muscle toxicity. Patients already on this dose can stay on it (if they’ve been on it at least 12 months).

Question 21

Pravastatin and Rosuvastatin are both hydrophilic which means…

Answer 21

less muscle pain

Question 22

What is the statin equivalency? (this will be a test question)

Answer 22

Pitavastatin 2mg
Rosuvastatin 5mg
Atorvastatin 10mg
Simvastatin 20mg
Lovastatin 40mg
Pravastatin 40mg
Fluvastatin 80mg

Remember: Pharmacists Rock At Saving Lives and Preventing Flu

Question 23

What is the dosing for Lipitor?

Answer 23

High Intensity: 40-80mg daily
Moderate Intensity: 10-20mg daily

Question 24

Ezetimibe

Answer 24

Zetia
Cholesterol Absorption Inhibitor

Question 25

Adverse Effects of Zetia

Answer 25

1.) GI Complaints (like diarrhea) - most common 2.) Arthralgias 3.) URTIs 4.) Mild increase in serum transaminases when used with statins BUT generally well tolerated

Question 26

Zetia is most commonly used as adjunct therapy with...

Answer 26

Statins

Question 27

If a patient cannot tolerate a stain, they'll likely take..

Answer 27

Ezetimibe

Question 28

Evolocumab

Answer 28

Repatha PCSK9 Inhibitors

Question 29

Alirocumab

Answer 29

Praluent PCSK9 Inhibitors

Question 30

Adverse effects of PCSK9 inhibitors

Answer 30

1.) Injection-site Reactions 2.) Allergic/hypersensitivity reactions 3.) URTIs

Question 31

What is the dosing for PCSK9 inhibitors?

Answer 31

Subcutaneous injections administered biweekly or once monthly

Question 32

How do you store PCSK9 inhibitors?

Answer 32

Store unopened in the refrigerator (2-8 C) and may be kept at room temperature for 30 days

Question 33

Major adverse effect of repatha

Answer 33

Back pain

Question 34

Major adverse effect of praluent

Answer 34

Increased LFTs (liver enzymes)

Question 35

Bempedoic Acid

Answer 35

Nexletol ACL inhibitor

Question 36

When would you add on Bempedoic Acid?

Answer 36

Added on after ezetimibe and/or PCSK9

Question 37

Evinacumab

Answer 37

Evkeez ANGPTL3 inhibitor

Question 38

What is special about Evkeez?

Answer 38

Once monthly IV

Question 39

Inclisiran

Answer 39

Leqvio siRNA agent that inhibits translation of the PCSK9

Question 40

How early should you pull your injectable medication out of the fridge before injecting?

Answer 40

30 minutes before injection (reduces side effects like irritation)

Question 41

What injection sites are SUBQ friendly?

Answer 41

1.) Stomach 2.) Upper Arm 3.) Front of Thigh

Question 42

What class of medications is first line for pregnant women with dyslipidemia?

Answer 42

Bile Acid Sequestrants (BSA) due to it not being systemically absorbed and local to the gut)

Question 43

Cholestyramine

Answer 43

Questran Bile Acid Sequestrant

Question 44

Colesevelam

Answer 44

Welchol Bile Acid Sequestrant

Question 45

Colestipol

Answer 45

Colestid Bile Acid Sequestrant

Question 46

Adverse effects of bile acid sequestrants

Answer 46

1.) constipation 2.) cramping 3.) abdominal pain 4.) bloating 5.) gas 6) INCREASE IN TRIGLYCERIDES

Question 47

How much does LDL need reduced for low intensity?

Answer 47

Less than 30% from baseline

Question 48

How much does LDL need reduced for moderate intensity?

Answer 48

30 to 49%

Question 49

How much does LDL need reduced for high intensity?

Answer 49

50% or more

Question 50

Which is more concerning: elevated LDL or elevated triglycerides?

Answer 50

LDL

Question 51

Triglycerides are more relative to..

Answer 51

diet

Question 52

High triglycerides is linked to

Answer 52

Pacreatitis

Question 53

Fibrates are primarily used for

Answer 53

lowering triglycerides and VLDL

Question 54

Fibrates may increase..

Answer 54

LDL

Question 55

Gemfibrizol

Answer 55

Lopid Fibrate

Question 56

Fenofibrate

Answer 56

Tricor Fibrate

Question 57

Fenofibric Acid

Answer 57

Trilipix Fibrate (active form of fenofibrate)

Question 58

*****Contraindications for fibrates

Answer 58

1.) GALLBLADDER DISEASE 2.) CrCL less than 30 3.) Severe liver disease

Question 59

Adverse effects of fibrates

Answer 59

1.) Formation of gallstones 2.) Arthralgias/myalgias 3.) GI complaints 4.) Transient elevations in transaminase levels

Question 60

Gemfibrizol and Statins when used together can cause..

Answer 60

muscle issues including rhabdomyolysis

Question 61

Gemfibrizol when used with warfarin increases your risk for..

Answer 61

bleeding

Question 62

Omega 3 Ethyl Esters

Answer 62

Lovaza Fish Oil

Question 63

Icosapent Ethyl

Answer 63

Vascepa Fish Oil

Question 64

Adverse Effect of fish oils

Answer 64

burping, dyspepsia, taste perversion

Question 65

Fish Oils and warfarin cause an increase risk of...

Answer 65

bleeding

Question 66

Niacin

Answer 66

Niaspan (ER) or Vitamin B3

Question 67

Niacin Adverse Effects

Answer 67

1.) Hepatotoxicity 2.) Flushing/Itching ***** 3.) GI Upset 4.) Hyperuricemia (gout) 5.) Increase Blood Glucose

Question 68

Reduce flushing by..

Answer 68

Avoiding spicy foods, take with food, take aspirin 325mg prior to dose