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lipid-modifying pt2
pharm exam 2
| Question | Answer |
|---|---|
| Omega-3 Fatty Acids examples | Omega-3-acid ethyl esters (Lovaza®) Icosapent ethyl (Vascepa®) non-prescription fish oil preparation |
| How do Omega-3 Fatty Acids work? | ↓ VLDL synthesis from liver |
| Omega-3 Fatty Acids have a potent? | triglyceride-lowering effect (indicated for TRG > 500 mg/dL) |
| Omega-3 Fatty Acids adverse effects | GI: belching, dyspepsia, altered taste Rash Arthralgia |
| PCSK9 | Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) |
| PCSK9 is a serine protease expressed? | in liver, kidney, intestines |
| PCSK9 regulates? | plasma LDL-C levels by binding to the LDL-receptor |
| PCSK9 targets? | LDL-receptor for degradation |
| PCSK9 inhibitors | Alirocumab (Praluent®) Evolocumab (Repatha®) |
| When are PCKSK9 inhibitors used? | for patients who need a "boost" for LDL lowering or can't take statins because of side effects |
| How do PCKSK9 inhibitors work? | by inhibiting PCKSK9, the LDL receptors can't keep pulling LDLs out of blood |
| How are PCKSK9 inhibitors given? | subcutaneously by monthly or bi-monthly self-injection |
| effect of PCKSK9 | Potent LDL lowering effect |
| Who are PCKSK9 inhibitors indicated for? | patients with familial hypercholesterolemia or those with clinical ASCVD, especially if not achieving LDL goal despite statin |
| Small Interfering RNA (siRNA) examples | Inclisiran (Leqvio®) |
| How does Inclisiran work? | "reverse engineers" PCKSK9 to cause cell to produce a copy that doesn't work |
| how is inclisiran given? | subcutaneously every 3 to 6 months by a clinician (must be supervised) |
| effect of inclisiran? | Potent LDL lowering effect |
| Who is inclisiran indicated for? | patients with familial hypercholesterolemia or those with clinical ASCVD, especially if not achieving LDL goal despite statin |
| ACL Inhibitor (Adenosine triphosphate-citrate lyase) examples | Bempedoic acid (Nexletol®) Bempedoic acid / ezetimibe (Nexlizet®) |
| where does bempedoic acid work? | in the liver, one step before statins |
| what does bempedoic acid do? | LDL lowering |
| how is bempedoic acid given? | oral, once daily |
| bempedoic acid adverse effects | Hyperuricemia Tendon rupture/injury |
| Cholesterol Measurement for Adults aged 20 yrs or older and not on lipid-lowering therapy | Measure fasting or non-fasting lipid profile to document baseline LDL |
| Cholesterol Measurement for Adults aged 20 yrs or older and not on lipid-lowering therapy if triglycerides are >400mg/dL in nonfasting state | repeat lipid profile in fasting state |
| foundation of ASCVD risk education | healthy lifestyle |
| healthy lifestlye | reduces risk at all ages, primary intervention for metabolic syndrome |
| metabolic syndrome | 3 of following (increased waist circumference, triglycerides > 175 mg/dL, elevated BP, elevated glucose, low HDL (< 40 mg/dL in men; < 50 mg/dL in women) |
| use high intensity statins to lower LDL by >/= 50% for these (secondary prevention) | Clinical ASCVD Consider for diabetes mellitus (DM), especially with multiple risk factors, aged 50 to 75 yrs 10-yr ASCVD risk ≥ 20% LDL ≥ 190 mg/dL (primary prevention) |
| Use moderate-intensity statin to lower LDL by ≥ 30% for these patients (primary prevention) | 40 to 75 yrs with DM and LDL ≥ 70 mg/dL 40 to 75 yrs without DM and LDL ≥ 70 mg/dL, and 10-yr ASCVD risk ≥ 7.5% based on risk discussion Patient is indicated for high-intensity statin, but experiences adverse effects |
| For patients > 75 yrs of age with clinical ASCVD (secondary prevention): | Moderate or high-intensity statin may be used after evaluation for potential ASCVD risk reduction, adverse effects, drug interactions, patient frailty, and patient preferences |
| statin use for patients > 75 yrs of age with clinical ASCVD (secondary prevention) | Moderate or high-intensity statin may be used after evaluation for potential ASCVD risk reduction, adverse effects, drug interactions, patient frailty, and patient preferences |
| if patient has Goals: ≥ 50% LDL reduction & LDL < 55 and is on High-intensity statin or maximally tolerated and the goals are unmet what are Non-Statin Therapies for Very High-Risk | Consider ezetimibe and/or PCSK9 inhibitor May consider bempedoic acid or inclisiran |
| very high risk patients | Multiple major ASCVD events (acute coronary syndrome within 12 months, history of MI, ischemic stroke, or symptomatic peripheral arterial disease) or 1 major ASCVD event and multiple high-risk conditions |
| Therapies for Hypertriglyceridemia | Increase statin intensity Consider fibrates, prescription omega-3 fatty acids to lower risk of pancreatitis |
| what should you rule out before treating hypertrigylceridemia? | Rule out secondary causes, optimize lifestyle, low-fat diet, alcohol abstinence, glycemic control |
| hypertriglyceridemai | >500 |
Created by:
camrynfoster