Lipid agents (statins, zetia, BASs, niacin, fibric acids) Flashcards

Terms Definitions
bile acid sequestrants
What lipid therapy can INCREASE TG?
statins (then niacin)
What lipid therapy has the greatest effect on LDL?
niacin and fibric acids
What lipid therapy has the greatest effect on TGs?
niacin
What lipid therapy has the greatest effect on HDL?
block HMG-CoA reductase in the liver (reduces plasma cholesterol)
How do statins reduce LDL?
atorvastatin, lovastatin, simvastatin
Which statins use CYP3A4?
rosuvastatin, atorvastatin, pitavastatin (can give any time of day)
Which statins have a longer halflife and what does this mean?
pravastatin, rosuvastatin (less side effects)
Which statins are hydrophilic and what does this mean?
take any time of day
Counseling info with atorvastatin (LIPITOR)
more DDIs, take at bedtime with snack
Counseling info with lovastatin (MEVACOR)
least effective in lowering LDL, take at bedtime
Counseling info with fluvastatin (LESCOL)
newest agent, least research
Counseling info with pitavastatin (LIVALO)
take at bedtime on empty stomach, most research, few DDIs, less CK issues (i.e. myalgia)
Counseling info with pravastatin (PRAVACHOL)
most potent, can take any time of day
Counseling info with rosuvastatin (CRESTOR)
take at bedtime, some research
Counseling info with simvastatin (ZOCOR)
yes (no CYP3A4 DDI)
Can pravastatin be taken with warfarin?
no (CYP3A4 DDI)
Can simvastatin be taken with warfarin?
no (CYP3A4 DDI)
Can lovastatin be taken with erythromycin?
no (CYP3A4 DDI)
Can atorvastatin be taken with nefazadone?
yes (no CYP 3A4 DDI)
Can rosuvastatin be taken with verapamil?
yes (no CYP3A4 DDI)
Can pitavastatin be taken with clarithromycin?
fluvastatin (increase fluvastatin conc.)
Cimetidine is known to affect which statin in particular?
pregnancy or active liver disease (caution in renal failure b/c of CK/rhabdomyolysis)
Don't use statins in ____
liver function, CPK, creatinine (if suspected rhabdomyolysis)
Which labs should be monitored on patients on statins?
muscle pain and 3x to 10x levels of CK (compared to usual normal limit)
Myopathy is defined as what?
muscle pain with 10x ULN or elevated SCr (or need for IV hydration)
Rhabdomyolysis is defined as what?
muscle pain or weakness and slight increase in CK
Myalgia is defined as what?
lowers CRP (CRP is an inflammatory marker)
What effect does statin therapy have on CRP?
additional 6% decrease in LDL (adding ezetibime might be more effective)
What is the effect of doubling a statin dose?
additional 17% decrease in LDL (more effective than doubling the dose)
What is the effect of adding ezetimibe to statin therapy?
fibrates (need to reduce ezetimibe dose to 5mg daily)
Ezetimibe (ZETIA) interacts with what other lipid medication?
inhibits intestinal absorption of cholesterol (increases clearance from blood)
How does zetia work?
constipation
What is the main side effect of ezetimibe?
GI disorders
What is the main side effect of bile acid sequestrants?
colestipol (COLESTID), cholestyramine(QUESTRAN), colesevelam (WELCHOL)
Name 3 BASs
20-25% (should use as adjunct only)
Bile acid sequestrants offer a ___% reduction in LDL
cholestyramine (QUESTRAN)
This BAS is a gritty powder that causes poor compliance
colestipol (COLESTID)
This BAS requires many tablets to be taken (up to 16) which causes poor compliance. The powder version is also gritty
colesevelam (WELCHOL)
This BAS requires fewer tablets to be taken than other BASs
before meals (if BID - breakfast and supper; if QD - largest meal of day)
When should BASs be taken?
resins (warfarin, thyroid, digoxin, Antibiotics - take BAS 1hr before or 4-6hrs after)
What DDIs are involved with BASs?
increase fluids, stool softeners
What can be done to decrease BAS side effects?
niacin (leads to inhibition of VLDL secretion from liver)
Inhibits the metabolism of adipose tissue to free fatty acids
FALSE (start low, go slow, side effects can hurt)
TRUE/FALSE - high doses of niacin are required from the beginning in order to increase HDL and lower TGs
rash, GI, flushing (poor compliance associated), hepatotoxicity (rare but severe), hyperglycemia (diabetes), hyperuricemia (gout), PUD
What are the side effects of niacin?
0.5-1g TID (very large doses are used)
What is the typical dose of niacin?
500mg QHS (increased to 2g QHS - provide ↓ LDL, ↓↓↓ TG, ↑↑↑ HDL)
Niaspan (niacin ER) QD should be started at what dose?
with food, no hot beverages, take with ASA or IBU to avoid flushing, report muscle pain or tenderness
What are important counseling points for niacin?
diabetes, gout, PUD (also arrhythmias, liver disease, asthma)
Caution use of niacin in what patients?
lipids, uric acid, glucose, LFTs (liver function tests)
What should be monitored in patients on niacin?
block secretion of VLDL from liver (a little different than niacin)
How do fibrates work?
gemfibrozil (LOPID), fenofibrate (TRICOR), clofibrate (ATROMID-S)
Name the fibrates
causes gall stones
Why is clofibrate NOT recommended?
(gemfibrozil) 600mg BID
Common dose of LOPID?
(fenofibrate) 67-201mg QD
Common dose of TRICOR?
GI (nausea, vomiting, constipation) most common, liver damage, cholelithiasis (AKA gallstones)
Side effects of gemfibrozil?
LFTs and CK
What should be monitored when taking fenofibrate?
reduction of TGs (some increase in HDL - brand names are LOVAZA and OMACOR)
What is fish oil mainly used for?
decrease LDL, increase HDL, INCREASE TGs (CV risk, benefits and risks)
Estrogens effects on lipids?
BAS with statin, BAS with niacin, ezetimibe with statin (statins with fenofibrate)
Recommneded combos are what?
yes (monitor LFTs closely - good for TG lowering)
Can niacin and gemfibrozil be used together?
niacin
Best agent to increase HDL
niacin
Caution in diabetes and gout
niacin, fibric acid, fish oil
Good agent to treat triglycerides
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