To Review Ch 38- Statins Flashcards
(22 cards)
Which statins can be taken any time of the day?
Crestor, Lipitor, Livalo, Lescol XL and Pravachol
Simvastatin is taken in the evening.
Lovastatin IR is taken in the evening while lovastatin ER is taken at bedtime.
Fluvastatin (Lescol) is taken with evening meal.
High Intensity statins
Low Intensity Statins
(No longer treating to LDL goal)
H: Atorvastatin (Lipitor) 40-80
Rosuvastatin (Crestor) 20-40
L: S 10
A x
L 20
P 1
F 20-40
R x
P 10-20
Which agents will help to lower triglycerides?
- Fibrates (but can increase LDL when TG are high)> Fenofibrate (Antara, Fenoglide, Fibricor, Lipofen, Lofibra, Tricor, Triglide, Trilipix)
Gemfibrozil (Lopid) only fibrate BID 600mg, 30mins before bkft and dinner
Niacin (Niacor, Niaspan, Slo-Niacin)- should be taken 4-6hrs separate from bile acids (can dec. absorption) Fish Oils (Lovaza, Vascepa, Epanova, Omtryg)
Statins and Ezetimibe- not so much
Colesevelam (Welchol) is contraindicated in TG>500
Bile acids can increase TG; cause constipation (maintain adequate fluid intake and take a multivitamin at another time of day)
Bind to and inhibit microsomal triglyceride transfer protein (MTP) in the endoplasmic reticulum
Lomitapide (Juxtapid) for familial Hypercholesterolemia (HoFH)
hepatotoxic
preg X
REMS
Inhibit apo B-100 synthesi
Mipomersen (Kynamro)
hepatotoxic
preg B
REMS
Advicor
Lovastatin (Mevacor) + Niacin (Niacor)
Increased risk of hepatotoxicity
Caduet
Atorvastatin/Amlodipine
LIPTRUZET
Ezetimibe/Atorvastatin
Vytorin
Ezetimibe/simvastatin
Simcor
Niacin/simvastatin
Which formulation of niacin has the highest risk for liver damage?
Slo-Niacin has the highest risk of hepatotoxicity
IR (Niacor) has more flushing/itching = Hot beverages and spicy food should be avoided to decrease flushing
CR - SR (Slo-Niacin) have less flushing but more hepatotoxicity
Niaspan has less flushing and less hepatotoxicity (take QHS after low fat snack)
SE of Lovaza Omega 3 ethyl ester
Well tolerated but can cause dyspepsia, burping, taste pervesions
can increase LDL, 4 caps daily or 2 BID (1g each, total 4g)
Fish oils increase risk of bleeding
Conditions are the fenofibrate agents contraindicated?
- Gallbladder disease
- Severe liver disease
- Nursing mothers
- Severe kidney disease Crcl
drugs could raise lipoprotein levels
beta blockers cyclosporine amiodarone glucocorticoids steroids tacrolimus protease inhibitors atypical antipsychotics
Niacin and gout
Niacin can raise uric acid levels and should be used with caution in patients with gout.
Myalept
Metreleptin (Myalept) is indicated in leptin deficiency with congenital or acquired generalized lipodystrophy
Statins taken with meal
Lovastatin IR (Mevacor) Fluvastatin IR (Lescol)
Factors for ASCVD Risk
Gender Age Race TC HDL SBP HTN Tx Diabetes Dx Smoking status
NOT LDL
cholesterol-lowering drug classes require liver enzyme monitoring at baseline due to a risk of hepatotoxicity?
Niacins, statin, and the fibrates
could possibly cause liver damage and liver enzymes should be monitored.
In recent years it has been recognized that statins do not cause liver damage worse than placebo in most patients, but the guidelines state to check at baseline and consider if the statin could be contributory if the liver is damaged and no other cause can be identified.
Niacin SEs
Flushing pruritus N/V diarrhea GI distress hyperglycemia hyperuricemia (gout) cough hepatotoxicity orthostatic hypotension hypophosphatemia
Niacin CIs
Active liver disease
Active PUD
Arterial bleeding
Arterial hemorrhage
This patient should not be started on ??? due to liver impairment
a statin, ezetimibe, or a fibrate
