Therapeutics HLD

  1. Calculation for LDL:
    • LDL = TC – (HDL + TG/5)
    • only works if TG’s are less than 400 mg/dL (At this point need direct LDL measurement)
  2. Cimetidine causes which anti-HLD drug to increase?
  3. Which HLD drugs are most likely to cause Rhabdomyolysis?
    Simvastatin, Atorvastatin and Lovastatin
  4. Simvastatin, Atorvastatin and Lovastatin can interact with what other drugs and potentially cause Rhabdomyolysis?
    • Niacin
    • Gemfibrozil
    • Erythromycin
    • Clarithromycin
    • Cyclosporine
    • Ketoconazole
    • Amiodarone
    • Verapamil
    • Diltiazem
    • Nefazodone
    • Fluvoxamine
    • (Nothing good ever comes carrying kites and very dark flocked nets)
  5. Which drugs do statins cause and increase in concentration of?
    Warfarin and Digoxin (raise INR 0.2-0.3 )
  6. What group are statins CI in?
    Pregnancy and Acute liver failure
  7. Which Statins are renally eliminated and should be reduced with renal insufficient patients/
    • Lovastatin
    • Rosuvastatin
    • Pitavastatin
    • Pravastatin
    • Simvastatin
  8. What Labwork should be performed for patients on Statins?
    • Liver function = baseline, annual and if issues
    • CPK = baseline or if issues
    • Creatinine =if rhabdo suspected
    • (maybe ALT = do not want greater than 3 =stop statin)
  9. What is the MOA for ezetimibe (Zetia)?
    Inhibits intestinal absorption of Cholesterol
  10. Ezetimibe (Zetia) reduces LDL by what amount?
    18-23% (thus, use as an adjunct to statins not alone)
  11. Eezetimibe (Zetia) interacts with what other drug?
    • Fibrates = reduce Zetia to 5mg/day
    • Could cause gallstones
  12. Fenofibrate
  13. Gemfibrozil
  14. Major Statin Benefit Group 1:
    • Clinical atherosclerotic cardiovascular disease (ASCVD)
    • >21 years of age
  15. Major Statin Benefit Group 2:
    • Primary prevention in individuals
    • >21 years of age
    • LDL-C >190 mg/dL
  16. Major Statin Benefit Group 3:
    • Diabetes
    • 40-75 years
    • LDL-C 70-189 mg/dL
    • Without clinical ASCVD
  17. Major Statin Benefit Group 4:
    • Without clinical ASCVD or diabetes
    • LDL-C 70-189 mg/dL
    • Estimated 10-year ASCVD risk >7.5%
    • 40-75 year olds
  18. Colestipol Colestid
    • Cholestyramine Questran
    • Colesevelam hydrochloride WelChol
  19. Which is the best Bile acid resin to use?
    Colesevelam hydrochloride (WelChol)
  20. Why is Colestipol (Colestid) not commonly used?
    Huge tabs that are hard to swallow
  21. Why is Cholestyramine (Questran) not commonly used?
    Gritty with an aweful taste
  22. Which Vitamins are reduced when taking Bile Acid Resins?
  23. What is the MOA of Niacin?
    • Inhibits mobilization of free fatty acids from fat deposits
    • Which leads to inhibition of VLDL secretion
  24. What advice can you give patients to help reduce facial/neck flushing with Niacin?
    Tak 80-650 mg ASA or 200 mg IBU 20 minutes to 1 hour before taking Niacin
  25. What is the main SE of Niacin?
  26. Monitoring for Niacin:
    • lipids, uric acid, glucose, LFTs
    • After 3 wks, then after full dose reached & Q6-8 wks for 1st yr, then Q 6 mo
  27. What is the MOA of Fibrates?
    • Block the secretion of very LDL from the liver
    • Promote reuptake of LDL
    • Activate lipoprotein lipase
    • Promote bile acid secretion
  28. What are fibrates mainly used for?
    Lower TG
  29. What is the main side effect of Fibrates?
    • Gall stones
    • (Cholelithiasis)
  30. BAS with statin or niacin is a recommended or contraindicated combination?
  31. Ezetimibe with statin is a recommended or contraindicated combination?
  32. Statins with gemfibrozil is a recommended or contraindicated combination?
    • Not recommended
    • Increases risk of myopathies
  33. Ezetimibe with a fibrate is a recommended or contraindicated combination?
    • Not recommended
    • can increased the risk of gallstones
    • If needed, reduce zetia to 5mg daily
  34. Niacin and gemfibrozil is a recommended or contraindicated combination?
    • Recommended
    • Relatively safe
    • Gives enhanced TG lowering
    • but monitor LFTs closely
    • (Omacor® is another option to add for TG lowering)
  35. Vytorin® =
  36. Advicor® =
    Niacin extended release/lovastatin
Card Set
Therapeutics HLD
Therapeutics HLD