Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Naplex
Dyslipidemia - Clinical pearls
| Question | Answer |
|---|---|
| Drugs that increase LDL and TG | - Diuretics (eg, furosemide) - Immunosuppressants (eg, cyclosporine, tacrolimus) - Protease inhibitors (eg, atazanavir, darunavir) - Atypical antipsychotics (eg, quetiapine, olanzapine) - Systemic steroids (eg, methylprednisolone) |
| Lipid emulsions that increase TG | - IV fat emulsions - Propofol (Diprivan) - Clevidipine |
| Select High or Moderate-Intensity Statin, if present w Clinical ASCVD | High intensive statin |
| Select High or Moderate-Intensity Statin, if present w LDL ≥ 190 mg/dL | High intensive statin |
| Select High or Moderate-Intensity Statin, if present w 10-year ASCVD risk ≥ 20% | High intensive statin |
| Select High or Moderate-Intensity Statin, if present w DM plus multiple traditional risk factors (h/x of HTN, smoking and obesity) | High intensive statin |
| Select High or Moderate-Intensity Statin, if present w DM only | Moderate intensive statin |
| Select High or Moderate-Intensity Statin, if present w 10-year ASCVD risk 7.5-19.9% | Moderate intensive statin |
| STATIN EQUIVALENT DOSES P - R- A-S- L-P-F : 2 - 5 - 10 - 20 - 40 - 40 - 80 | Pitavastatin 2 Rosuvastatin 5 Atorvastatin 10 Simvastatin 20 Lovastatin 40 Pravastatin 40 Fluvastatin. 80 |
| Next step if AST or ALT > 3 times upper limit of normal (jaundice, abdominal pain) if pt is on statin | Stop statin |
| What cause Muscle Damage • Myopathy → rhabdomyolysis • increase CPK, renal failure | • gemfibrozil + statin • DDIs (eg, CYP3A4 inhibitors) • Simvastatin 80 mg |
| True or false: statin is safe for pregnancy, breastfeeding | False |
| What Statin SHOULD NOT be used with strong CYP3A4 inhibitors (Grapefruit, protease inhibitors, azole antifungals, cyclosporine, cobicistat, macrolides (except azithromycin) | simvastatin or lovastatin, (?) Atorvastatin |
| Max daily dose of SIMVASTATIN when concurrent use w Amiodarone | • Simvastatin 20 mg/day |
| Max daily dose of LOVASTATIN if concurrent use w Amiodarone | • Lovastatin 40 mg/day |
| Max daily dose of SIMVASTATIN when concurrent use w NON-DHP CCBS (Diltiazem or verapamil ) | • Simvastatin 10 mg/day |
| Max daily dose of LOVASTATIN when concurrent use w non-DHP CCBS (Diltiazem or verapamil ) | • Lovastatin 20 mg/day |
| What Statin w fewer drug interactions | rosuvastatin & pravastatin |
| Ezetimibe decreases LDL by about | 20% |
| Ezetimibe causes | Hepatotoxicity |
| PCSK9 inhibitors decrease LDL by about | 60% |
| PCSK9 inhibitors administration route | SC, Q2W / Q1M |
| Vascepa (icosapent ethyl) is for what type of patients | add on for pt w controlled LDL, but ELEVATEDDD TG |
| Vascepa (icosapent ethyl) can be replaced by alternative Omega-3 products like fish oil | no evidence data |
| Niacin SEs | - Flushing and pruritus, HypERglycemia & hypERuricemia - Vomiting, Diarrhea - Hepatotoxicity |
| managing Flushing and pruritus caused by niacin | - Aspirin or ibuprofen 30 to 60 min before taking niacin - Avoiding spicy foods or hot beverages |
| Niacin ER vs IR or SR product | -Less flushing / hepatotoxicity (E less than I / S) |
| Lomitapide (JUXTAPID) Box warning | - Hepatotoxicity - It treats homozygous familial hypercholesterolemia (HoFH) |
| Welchol (colesevelam) SEs | - Constipation, gas and bloating - Treart T2D & high cholesterol - For TG > 500 mg/dL, - Hx of pancreatitis (inflammation of the pancreas) due to high TG - Hx of intestinal blockage. |
| Lopid (Gemfibrozil) is contraindicated in patients w | gallbladder disease |
| Lovaza (omega-3 ethyl esters) is for | High TG. But Fish oils (except Vascepa / icosapent ethyl) may increase LDL |
| Lopid (Gemfibrozil) is for | High TG, but if TG very high, they end up increasing LDL.!!! |
| Lovastatin contraindicated with (G "LOVE" PACMAN) | Grapefruit, Protease inhibitors, Azole antifungals, Cyclosporine, cobicistat, Macrolides (except azithromycin) |
| Niacin > 1 gram per day in combination with statin, causes | Rhabdomyolysis |
| List of Bile acid sequestrants (3Cs) | - Colesevelam (Welchol) - Cholestyramine (Questran) - Colestipol (COLESTID: micronized) |
| Bile acid sequestrants MoA | Binds bile acids in the intestines, preventing their reabsorption & stimulating hepatic conversion of cholesterol into bile acids |
| Colestyramine SEs | Tooth discoloration, enamel erosion, dental decay |
| Drugs that increase LDL only (2Fs) | - Fibrates (eg, fenofibrate, gemfibrozil) - Fish oils (except icosapent ethyl) |
| Drugs that increase TGs only | - Bile acid sequestrants (eg, colesevelam) - IV lipid emulsions, Clevidipine, Propofol, Parenteral nutrition (lipids) |
| LDL formula | LDL= TC - HDL-1/5 TG |
| Drugs treat high TG | - Fibrates - Niacin - Fish oils (fish oil increase LDL, except Icosapent ethyl / Vascepa) |
| LDL goal of < 55 mg/dL | clinical ASCVD + very high risk (Multiple ASCVD events or one ASCVD event & multiple high-risk conditions such as DM, smoking, age ≥ 65 years) |
| LDL goal of < 70 mg/dL | clinical ASCVD (not very high risk), clinical ASCVD + LDL ≥ 190 mg/dL, DM + ≥ 1 risk factor, or ASCVD risk score ≥ 20% |
| LDL goal of < 100 mg/dL | no clinical ASCVD w or w/o LDL ≥ 190 mg/dL |
| 1st line add-on treatment to statin | (After maximized statin) ezetimibe and/or PCSK9 mAb |
| 2nd line add-on treatment to statin | bempedoic (NEXLETOL) acid & inclisiran |
| True or Wrong if Statin is safe for pregnancy and breastfeeding | WRONG |
| Statin-associated safety issues | - Hepatotoxicity (elevate AST & ALT vs baseline) - Muscle toxicity (eg, myalgia, rhabdomyolysis) - New-onset DM |
| TRUE or FALSE if stop taking statin once having new onset of DM | WRONG, continue statin therapy (benefits outweigh risks) |
| statin-associated muscle symptoms | • Myalgia: muscle pain & tenderness • Myopathy: muscle weakness w or w/o elevated CPK • Rhabdomyolysis (muscle breakdown): symptoms + very high CPK (> 10,000 IU/L) + protein in the urine |
| Lipid effects of statin | decease LDL : ++ increase HDL : + decrease TG : + |
| Lipid effects of Ezetimibe | decease LDL : + increase HDL : non decrease TG : + |
| Lipid effects of PCSK9 | Same as statin decease LDL : ++ increase HDL : + decrease TG : + |
| Lipid effects of Inclisiran (LEQVIO) | decease LDL : ++ increase HDL : non decrease TG : + |
| Lipid effects of Bempedoic acid (NEXLETOL) | decease LDL : + increase HDL : non decrease TG : non |
| Lipid effects of Bile acid sequestrants | same ezetimide decease LDL : + increase HDL : non decrease TG : + |
| Lipid effects of Fibrates | decease LDL : + increase HDL : + decrease TG : ++ |
| Lipid effects of Niacin | decease LDL : + increase HDL : ++ decrease TG : ++ |
| Fish oil on Lipid effects | decease LDL : non, but INCRAESE (except Vascepa) increase HDL : + decrease TG : ++ |
| inclisiran (LEQVIO) duplicate therapy with | PCSK9 inhibitors |
| what statin should be administered in the evening / bedtime | Short acting statin: simvastatin, lovastatin, fluvastatin immediate-release |
| What statin has DDI w Symtuza (darunavir/cobicistat/emtricitabine/TAF) | Simvastatin, lovastatin |
| What statin has DDI w fungal azole | Simvastatin, lovastatin |
| When to repeat lipid panel as a f/u assessment | in 4-12 weeks |
| When to repeat lipid panel as a f/u assessment, if LDL at goal | in 3-12 months |
| Gengraf (cyclosporine modified) effects on lipid panel? | increase both LDL & TGs |
| Diuretics (eg, chlorthalidone, furosemide) effects on lipid panel | increase both LDL & TGs |
| Efavirenz effects on lipid panel | increase both LDL & TGs |
| Protease inhibitors (eg, darunavir) effects on lipid panel | increase both LDL & TGs |
| Second-generation antipsychotics (eg, olanzapine, quetiapine) effects on lipid panel | increase both LDL & TGs |
| Diuretics (eg, chlorthalidone, furosemide) effects on lipid panel | increase both LDL & TGs |
| What Bile acid sequestrant is approved for diabetes mellitus | WelChol (Colesevelam) |
| what add-on treatment if pt is on Rosuvastatin 40 mg PO daily, LDL over 115 and LDL goal < 55 | Select PCSK9 (not ezetimibe as reduce only 20%) |
| what med can increase uric acid levels, which could precipitate a gout flare in pt w a h/o gout. | Niacin |
| What lipid-lowering drugs are administered by injection? | Inclisiran and PCSK9 |
| Which lipid-lowering therapy is LEAST likely to worsen pt's liver function? | Bile acid sequestrants (eg, colesevelam) |
| Dyspepsia (Chứng khó tiêu) is a common adverse effect associated with | gemfibrozil and fish oils |
| what med can cause hypERglycemia | Niacin and statins |
| VASCEPA (icosapent ethyl) may cause serious side effects, including: | - Heart rhythm problems (atrial fibrillation and atrial flutter) - Possible allergic reactions if you are allergic to fish or shellfish - Serious bleeding |
| VASCEPA (icosapent ethyl) concurrent use w blood thinner | Risk of bleeding may increase |
| The most common side effects of VASCEPA include: | - Muscle and joint pain - Swelling of the hands, legs, or feet - Constipation - Gout - Heart rhythm problems (atrial fibrillation) |
| Praluent | Alirocumab, 75-150 mg SC Q2W or 300mg QM |
Created by:
dao.vo11017