RX PREP DYSLIPIDEMIA

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created 2 months ago by vodaosu88
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1

What are key drugs that increase

  • LDL and TGs?
  1. Immunosuppressants (e.g. cyclosporine, tacrolimus)
  2. Protease inhibitors (e.g. darunavir, ritonavir)
  3. 2nd gen antipsychotics (e.g. quetiapine, olanzapine)
  4. Glucocorticoids and anabolic steroids
  5. Isotretinoin
2

What are Lipid emulsions that increase TG’s

  • LDL and TGs?
  • Propofol (Diprivan)
  • Clevidipine (rare, acute use)
  • IV fat emulsion
3

What are some conditions that can cause dyslipidemia?

  • Obesity
  • hypothyroidism
  • pregnancy
  • nephrotic syndrome
4

What's the Friedewald equation? Must know

  • LDL = TC - HDL - (TG/5)
5

What populations should receive

  • High-intensity statins?
  1. Clinical ASCVD
  2. LDL >190 mg/dL
  3. 10-year ASCVD risk >20% (an ASCVD risk of >20% is essentially equivalent to having a clinical ASCVD!)
  4. Diabetes at high risk
6

What populations should receive

  • Moderate-intensity statins?
  1. Any patients with diabetes
  2. 10-year ASCVD risk 7.5-19%
7

Exam tips for dyslipidemia?

  • Generally, recognize if a patient needs a statin! If doses are included, only one answer can be correct (moderate or high-intensity)
  • If patient is already on a statin, the dose may need to be titrated or add-on treatment may be needed
8

What are some statin equivalent doses?

  • Remember: Pharmacists Rock At Saving Lives and Preventing Fatty-deposits
  • Pitavastatin 2 mg
  • ROsuvastatin 5 mg
  • Atorvastatin 10 mg
  • Simvastatin 20 mg
  • Lovsastatin 40 mg
  • Pravastatin 40 mg
  • Fluvastatin 80 mg
9

What are high intensity statin?

  • Atorvastatin 40-80
  • Rosuvastatin 20-40
10

What statin should be taken in the evening?

  • simvastatin, lovastatin (IR with evening meal)
11

What are some AEs with statin?

  • Myopathy → rhabdomyolysis:
  • Increased CPK
  • renal failure
12

What put patients at risk for muscle damage?

  • Simvastatin 80 mg daily
  • Statin + gemfibrozil
  • Statin + niacin >1 g
  • CYP3A4 drug interactions!
13

How to manage hepatoxicity with statin?

  • Stop statin if AST or ALT >3x ULN
14

How to reduce the risk of myalgias with statin?

  • Avoid drug interactions, including OTC products:
  • Do not use sinvastatin 80 mg/day
  • Do not use gemfibrozil + statin
15

How to manage myalgias?

  • After 2-4 weeks: rechallenge with same statin at same or decreased dose. Most patients who did not tolerate a statin will tolerate it when re-challenged, or will tolerate a different statin.
  • If myalgias return, discontinue statin. Once muscle symptoms resolve, use a low dose of a different statin; gradually increase dose
16

Name 2 statins that require cap dose?

  • Simvastatin (Zocor)
  • Lovastatin (Mevacor, Altoprev)
17

Max dose of simvastatin with

  • verapamil, diltiazem, dronedarone

Must know

  • Max 10 mg/day simvastatin
18

Max dose of simvastatin with

  • amlodipine, amiodarone, lomitapide, ranolazine

Must know

  • Max 20 mg/day simvastatin
19

Max dose of simvastatin with

  • ticagrelor
  • Max 40 mg/day simvastatin
20

Max dose of lovastatin with

  • danazol, diltiazem, dronedarone, verapamil, amlodipine, amiodarone, ticagrelor

MUST KNOW

  • Max 20-40 mg/day lovastatin
21

What are DDI with statins?

Strong CYP3A4 inhibitors - avoid with simvastatin and lovastatin:

  • Itraconazole, keto/posaconazole, voriconazole, erythromycin, clarithromycin
  • HIV PIs
  • Cobicistat-containing regimens
  • Nefazodone
  • Check book ~page 448? For this list!
22

When to use some add-on treatments?

  • Additional cholesterol-lowering drug options for those receiving a statin (at maximized dose) but still at high risk of ASCVD
23

What are some add-on treatments?

    • Ezetimibe (Zetia)
    • PCSK9i
  • Due to high cost of PCSK9 inhibitors, use ezetimibe first
24

When to use ICOSAPENT ETHYL (VASCEPA)?

  • Maximally-tolerated statin, to reduce CV risk, when:
    • TG >150 mg/dL AND
    • ASCVD or diabetes + CVD risk factors
25

What are the AEs of Niacin?

  • flushing and pruritus
26

What are the AEs of Colesevelam?

  • constipation, gas and bloating
27

What are the AEs of Lopid?

  • gallbladder disease
28

What are the AEs of Lovaza?

  • burping and taste perversion
29

What are the AEs of Lomitapide?

  • hepatotoxicity (also seen in niacin and lopid)