Prophylaxis Of Atherosclerotic Cardiovascular Disease Flashcards
What risks are associated with prescribing statins?
Myopathy and rhabdomyolysis
How do statins affect muscle?
They can injure muscle tissue. Muscle inflammation is associated with elevation of creatine kinase (CK), an enzyme released from the injured muscle.
What are signs of myopathy? What lab should be collected to facilitate diagnosis?
Muscle aches, tenderness or weakness which may be diffuse or localized. CK level should be obtained
Which statin pose the highest risk for rhabdomyolysis?
Rosuvastatin (Crestor)
How do statins affect the liver? What serum level indicates liver injury?
Statins can cause hepatotoxicity. Monitor LFTs before and after starting the drug.
Increased transaminase levels indicate liver injury.
What drugs can raise levels of lovastatin and simvastatin?
Drugs that inhibit CYP3A4: macrolide antibiotics (erythromycin, azithromycin), azole antifungal drugs, HIV protease inhibitors, amiodarone, and cyclosporine.
How do statins affect pregnancy?
They cause fetal malformation and should NOT be used during pregnancy.
Stoping the statin for 9 months will not cause a harmful or dramatic rise in cholesterol levels.
How are Asians and white subjects affected by rosuvastatin?
With normal dosage, there has been twice the blood levels shown in Asians. Start with a very low dose and monitor closely.
What drugs are the most effective in lowering triglyceride levels and raising HDL levels?
Fibrates and fibric acid derivatives
When __________ is combined with a statin, it helps reduce the LDL cholesterol more than the statin alone.
Ezetimibe
What is a bile acid sequestrant and how does it affect LDL cholesterol?
They are insoluble in water, cannot be absorbed from the GI tract, and are not broken down by digestive enzymes. They pass through the intestine and are excreted in the feces. They reduce LDL cholesterol.
Constipation is the main complaint.
How is the type and intensity of the statin determined?
Using the risk level of CAD
