Exam 6 - Drugs for Hyperlipidemia Flashcards Preview

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Flashcards in Exam 6 - Drugs for Hyperlipidemia Deck (42):
1

LDL and non-HDL goal for a person of lower risk: 0-1 risk factors

LDL goal: <160
non-HDL goal: 190

2

What is the only way to raise your HDL?

exercise; has no effect on LDL but increases HDL by 4-22%

3

Statins: MOA

HMG-CoA Reductase inhibitors

4

Do not use 80 mg dose

Simvastatin

5

As a group, what are statins the drug of choice for?

LDL reduction

6

Metabolized by 3A4

Atorvastatin
Lovastatin
Simvastatin

7

Metabolized by 2C9

Rosuvastatin

8

Statin adverse effects

- Elevation in liver enzymes
- Myopathy (myalgia, myositis, rhabdomyolysis)
- cognitive dysfunction (age>50)
- elevated blood glucose/diabetes

9

Complaints of muscle pain or weakness w/o elevation in creatine kinase (CK), marker for muscle damage

Myalgia

10

Complaints of muscle aches/pains w/ mildly elevated CK levels (<10 times the ULN)

Myositis

11

Complaints of muscle pain w/ presence of dark urine and a CK level > 10 times the ULN

Rhabdomyolysis

12

Drug interactions of Statins: potentiate the risk of myopathy/rhabdomyolysis

- Amidarone
- Azole antifungal agents
- Macrolide antibiotics
- Verapamil

13

Cholestyramine

Bile acid sequestrant

14

Colesevelam (Welchol)

Bile acid sequestrant

15

Cholestyramine and Colesevalam/Wilchol are both indicated for

Hypercholesteremia

16

Indicated for diarrhea and pruritis associated w/ partial biliary obstruction.

Cholestyramine

17

Indicated to improve glycemic control in adults w/ Type II diabetes mellitus

Colesevelam (Welchol)

18

interrupts the enterohepatic circulation of bile acids which depletes cholesterol content of hepatic cells

Bile acid sequestrants MOA

19

Bile acid sequestrant: adverse effects

- constipation
- abdominal pain
- bloating
- dyspepsia (indigestion)
- flatulence
- INCREASES TG (TG>400 mg/dL contraindicated)

20

Bile acid sequestrant: drug ineractions
What do these drugs decrease the absorption of?

- warfarin
- levothyroxine
- digoxin
- thiazide diuretics

21

When should other medications be taken when taken bile acid sequestrants?

other medications should be taken at least 1 hour before or 4 hours after the bile sequestrant

22

Inhibits intestinal absorption of dietary and biliary cholesterol at the brush border of the small intestine

Ezetimibe

23

Ezetemibe: adverse effects

- GI: diarrhea, abdominal pain
- increase in ATL

24

Gemfibrozil

Fibrate

25

Fenofibrate

Fibrate

26

Fibrates: adverse effects

- abdominal pain, INCREASE IN GALLSTONES
- MYALGIA, MYOPATHY
- increase in serum creatinine

27

Activates peroxisome proliferator activator - alpha (PRAR-alpha) which enhances catabolism (by LIPOPROTEIN LIPASE) of triglycerides and decrease hepatic synthesis of VLDL particles and increases HDL levels

Fibrates MOA

28

Fibrates contraindications

- severe hepatic disease
- SEVERE RENAL DISEASE (DO NOT USE FENOFIBRATE)
- PREEXSITING GALLBLADDER DISEASE

29

Gemfibrozil drug interaction

- CONTRAINDICATED: INCREASES REPAGLINIDE LEVELS (HYPERGLYCEMIA)
- increases statin levels (muscle toxicity)

30

Fenofibrate drug interaction

has minimal impact on statin levels

31

Enhance lipoprotein lipase

Niacin MOA

32

Niacin adverse effects

- GI (nausea, exacerbation of peptic ulcers)
- flushing, pruritus
- liver dysfunction (liver enzyme abnormalities)
- glucose intolerance (hyperglycemia)
- hyperuricemia/gout
- peptic ulcer disease

33

Niacin contradindications

- significant hepatic dysfunction
- active peptic ulcer disease
- gout

34

Indicated to treat hypertriglyceridemia > 500 mg/dL

Omega-3-acid ethyl esters

35

Indicated for high TG (> or equal to 500 mg/dL)

Icosapent ethyl

36

Icosapent ethyl

may prolong bleeding time

37

What should you monitor when giving Icosapent ethyl?

LFT (patients w/ hepatic impairment), lipids

38

Moderate risk: 2+ riskfactors
(10-year risk < 10%)

LDL goal: < 130
non-HDL goal: <160

39

High risk: CHD or CHDrisk equivalents
(10-year risk >20)

LDL goal: <160

40

Moderate high risk: 2+ risk equivalents
(10-year risk 10%-20%)

LDL goal: <160

41

Use caution in patients w/ known hypersensitivity to fish and/or shellfish

Icosapent ethyl

42

What do omega-3 ethyl esters contain that icosapent ethyl doesn't? And what does it cause?

- contains DHA
- causes an increase in LDL