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pharm statins Flashcards

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1
Q

omega 3 polyunsaturated fatty acids drug names

A

Lovaza (omega 3 ethyl esters)

Viscepa (icosapent ethyl) metabolized to EPA

fatty fish/supplements

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2
Q

omega 3 fatty acids moa

A

inhibit VLDL synthesis, and TG synthesis

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3
Q

in lowering cholesterol omega 3 increases what cholesterol (HDL, LDL, TG)

A

increase HDL, LDL and lower TG

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4
Q

adverse drug reaction of omega 3

A

nausea
abdominal pain.
atrial fibrillation.
fishy aftertaste.
bleeding.

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5
Q

pts with condition of ______ contraindication for omega 3 fatty acids

A

atrial fibrillation

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6
Q

drug interactions with omega 3 fatty acids

A

anticoagulant/antiplatelets

increase bleeding risk

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7
Q

additional lab monitoring for omega 3

A

ekg, if pt experiencing palpitation, or in pt with a fib

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8
Q

nicotinic acid moa

A

inhibitor of lipolysis of adipose tissue (doesn’t allow breakdown)suppress lipolysis

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9
Q

cholesterol lowering of nicotinic acid

A

increase HDL
decrease LDL, decrease TG

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10
Q

drug name for nicotinic acid

A

niacin ER

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11
Q

nicotinic acid route of administration

A

oral

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12
Q

adverse events of nicotinic acid

A

intense cutaneous rash
- increase in uric acid
- sensation of warmth
hepatotoxicity

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13
Q

for nicotinic acid (cutaneous rash how do u want to decrease the risk of cutaneous rash)

A

give an aspirin prior to and slow titration

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14
Q

lab monitoring for nicotinic acid

A

liver function tests
uric acid (baseline and then q6)
creatinine kinase

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15
Q

fibrate class includes what

A

fenofibrate
gemfibrozil

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16
Q

mechanism of action for fibrates

A

activate peroxisome proliferated activated receptor (PPARS) regulars of lipid metabolism which decrease TG and increase HDL

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17
Q

do not use gemfibrozil with a _____

A

statin

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18
Q

fibrates do not use with preexisting ______

A

gallbladder disease

also do not use in hepatic disease

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19
Q

adverse effect of fibrates

A

gallstones
myopathy/rhabdomyolysis, weakness

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20
Q

drug-drug interaction of fibrate

A

warfarin, and statin

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21
Q

lab monitoring with fibrates

A

liver function
creatine kinase
serum creatine

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22
Q

bile sequestrants include which drug

A

cholestyramine
colestipol
coleselvam

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23
Q

bile sequestrate moa

A

anion exchange bind to bile acids and excrete through feces, decrease bile acid concentration

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24
Q

bile sequestrates adverse event

A

constipation, flatulence,

powders can lead to teeth staining

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25
contraindication of bile acid sequestrates
patients with TG greater than (>400) biliary obstruction
26
bile acid sequestrate drug interactions include
digoxin and warfarin, take other drugs 1-2 hours before, or 4-6 hours after bile acid resin
27
which bile acid sequestrate is best tolerated
coleselvalam
28
are bile acid sequestrates absorbed ?
not absorbed,. insoluble
29
ezetimibe moa
inhibit the absorption of dietary and biliary cholesterol, at brush border of small intestine leads to decreased delivery of cholesterol to the liver
30
ezetimibe adverse effect
well tolerated diarrhea
31
metabolic pathway for ezetimibe is ______
glucoronic acid conjugation (usually is cyp)
32
moa of PCSK9 inhibitor
monoclonal antibody which inhibits binding of PCSK9 to LDL.
33
PCSK9 inhibitor route
subcutaneous injection
34
PCSK9 inhibitors given how frequent
every two weeks
35
adverse reactions of PCSK9
Allergic reaction and also injection site reaction
36
why are PCSK9 not given as frequently
they are very expensive
37
ACL inhibitor drug names
bempedoic acid (nexletol)
38
bempedoic acid route
oral
39
ACL inhibitors frequency is ____ daily
once
40
what is MOA of ACL inhibitor (bempedoic acid)
inhibits adenosine triphosphate (ATP)-----> (ACL) another step in cholesterol biosynthesis two steps up from statin moa
41
adverse reaction of ACL inhibitors
hyperuricemia abdominal pain anemia
42
precaution with ACL inhibitor
caution in pt with history of tendon rupture avoid with simvastatin and pravastatin (40+) due to myopathy risk caution in elderly and caution with gout
43
lab monitoring with ACL inhibitor
uric acid serum creatinine liver function (AST/ALT)
44
angiopoietin like 3 inhibitor drug name
evinacumab-dgnb
45
angiopoietin like 3 inhibitor route of administration Evinacumab- dgnb
intravenous (1 hour)
46
angiopoietin like 3 inhibitor moa
monoclonal antibodies which inhibits angiopoietin-like 3
47
adverse reaction of angiopoietin like 3 inhibitor
nasopharyngitis influenza like illness nausea dizziness
48
angiopoieitin like 3 inhibitor clinical pearl (evinacumab)
very expensive only for familial hyperlipidemia administered by a healthcare professional only
49
small interfering RNA drug names
inclisirin
50
small interfering RNA route
subcutaneous injection
51
small interfering RNA moa
small interfering RNA molecule which catalyzes the breakdown of mRNA which code for PCSK9
52
small interfering RNA adverse drug reactions include
injection site reaction (common) UTI diarrhea bronchitis
53
small interfering RNA drug class clinical pearls
very expensive administered by a healthcare professional
54
statins moa
inhibit 3 hmg-coa reductase inhibit the conversion oF HMG COA reductase to mevalonate
55
which statin does not have some sort of dosing consideration in renal disease ?
atorvastatin
56
metabolism of statins includes extensive ______ extraction by the liver
first pass
57
statins avoid in _______
pregnancy
58
adverse reaction of statins
dizziness 'headache abdominal pain ----- then dose at night if experiencing side effect myopathy, new onset of diabetes
59
drug interactions of statins
warfarin (monitor INR frequently after dose)
60
lab monitoring with statin
Fasting lipid panel liver function test creatinine kinase Serum creatinine A1C consider TSH (hypothyroid predisposes to myopathy)
61
Pravachol statin metabolism is not through cyp 450 but is through ________
sulfation
62
atorvastatin dosing (high intensity)
40-80 mg
63
rosuvastatin dosing (high intensity)
20-40 mg
64
low intensity statin
lovastatin (20 mg) pravastatin (10-20 mg)
65
what factors predispose a patient to adverse events from a statin
many comorbitities - diabetes - renal or hepatic dysfunction history of prior statin associated muscle disorders HIGH dose drug interactions including - fibrates (fenofibrate, gemfibrizol) -azole anti fungal - macrolide - grapefruit - cyclosporine - verampiril Bempedoic, Simvastatin and pravastatin only pt factors untreated hypothyroidism asian over 80 small body alcohol abuse female drug use (cocaine, methamphetamine)
66
counseling point #1 for statins to tell patients what is the goal of statin?
goal of medication primarily is to reduce risk of heart disease and to reduce risk of a heart attack
67
counseling #2 for statin if pt is experiencing dizziness, stomach upset, then pt should take the medication ______
if dizziness, headache, or stomach upset is experienced while using statin then the patient should take the medication. at night
68
counseling point #3 for statins. if you (patient) experience unexplained myalgia, and notice a change in the urine to dark brown ________ and go to ER immediently
stop taking medication
69
baseline monitoring for statin everyone
fasting lipid panel fasting blood glucose (A1C) to monitor for diabetes mellitus creatinine kinase, ALT TSH
70
what pt risk factor is most associated with an adverse event for statin penicillin verapamil amlodipine
verapamil
71
what pt risk factor is most associated with an adverse event for statin? history of Cancer untreated hypothyroid cigarette smoking TB
untreated hypothyroid
72
are females or males more likely to experience adverse event from a statin?
females are most likely to experience an adverse event
73
are white/ black or asians more likely to experience an adverse event while taking a statin
asians are most likely to experience an adverse event
74
efficacy of statin is seen with checking _____ panel in ___ weeks
full lipid panel in 6-8 weeks
75
if ldl is less than ___ it is reasonable to reduce intensity of the _____
40 statin
76
after first initiation of statin or when switching to another statin, what to check?
a1c creatinine kinase ALT (liver enzyme) symptoms of any myopathies, (muscle disorder) any myalgia?
77
what initially do u want to assess before u place patient on a statin?
assess for diabetes assess for risk of diabetes (A1c) assess for any risks associated with statins, other drug interactions (WARFARIN)
78
with statins only ____ is absorbed
30-85%
79
pravastatin has least _____ interactions due to low protein binding and due to ________
drug interactions low binding and due to sulfation mechanisms
80
With bempedoic acid which statins generally will u want to avoid
Simvastatin and pravastatin
81
Which statin med is based on weight
Angiopoietin like 3 inhibitors (evinacumab)
82
Hypertriglyceridemia best statin lowering meds
Can do fibrates (gemfibrozil, and fenofibrate( Omega 3
83
If pt not meeting lipid targets what can be done
Rule out non adherence Ensure it was a fasting lipid panel Repeat lipid panel after 6-8 weeks
84
If pt not meeting target what statin do u want to use
Highest potency statin Rosuvastatin Atorvastatin
85
Goal for hypertriglyceridemia is to
Lower risk of pancreatitis
86
If for hypertriglyceridemia pt has diabetes, or triglycerides are still greater than 150 despite statin want to use what med
Vascepa
87
Treatment of hypertriglyceridemia
Look for second causes Lifestyle, weight loss, alcohol reduction, Pharmacological therapy involves First use a statin Then use vascepa or ezetimibe if despite statin triglycerides are greater than >150, diabetes, or cvd If >500 tg then add on fenofibrate
88
Pt not meeting lipid target what to do first
Ensure it was a fasting lipid Rule out nonadherence Consider second cause Use highest rosuvastatin and or atorvastain
89
If Rhabdomyolysis confirmed restart statin
NO
90
Hold statin for _____ weeks if ck >3 times upper limit or weakness and what do u want to assess
2-4 Secondary cause Hypothyroid, alcohol, drug interaction
91
If after 2-4 weeks symptoms resolve and ck resolves what to do? If symptoms do resolve try to extend the dosing ___what med
Statin rechallenge same or low dose Frequency Rosuvastatin, 5 mg 2-3 times weekly Atorvastatin, 20 mg every other

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