-
Bile Acid Sequestrants
- MOA = dec. LDL (inc. TG)
- Start low dose due to ADR
- ADR (GI, esophageal obstruction, dec. abs. of fat soluble vitamin and folic acid)
- **Dec. abs. of warfarin, niacin, digoxin
- **Admn meds 1-2 hours before meal or 4 hours after BAS
-
Colesvelam
Brand - Welchol
Low potential for Drug interactions
-
Colestipol
Brand - Colestid
-
Cholestyramine
Brand - Questran
-
Statins
- Inhibit HMG-CoA reductase
- **Dec. LDL
- Reduce NUMBER of LDL particles (not size)
- **most efficient at HS
- **AE: Inc. LFTs, Myopathy/Rhabdomyolsys
-
Lovastatin
- Brand - Mevicor
- IR = take w evening meal (20-80 mg)
- SR = HS (10-60 mg)
- CYP 3A4 - Avoid Grapefuit juice, Inc warfarin
- Gemfibozil - do not exceed 20mg
- amiodrone & verapamil - no more than 40 mg
-
Rosuvastatin
- Brand - Crestor
- **Hydrophilic
- *Primary prevention CVD
- QD 5-40mg
- Admn anytime w or w/o food
- **minimal 2c9/2c19 - Inc. Warfarin
-
Atorvaststin
- Brand - Lipitor
- *Admn anytime of day w or w.o food
- *Do NOT need renal adjustment
- **CYP 3A4
- Cyclosporine - dont exceed 10mg/day
- -azole, mycin, protease inhibitor - dont exceed 20 mg
-
Simvastatin
- Brand - Zocor
- 20-80 mg/evening
- **CYP 3A4 - Inc warfarin
- azole, -mycin, Gemofibrozil, cyclosporine - dont exceed 10 mg/day
- Amiodorone, Verapamil, Dilitiazem - no more than 10 mg
- amlodipine, ranolazine - no more than 20 mg
-
Pravastatin
- Brand - Pravachol
- **Least Potent**
- Hydrophilic
- No CYP450
- **Admn anytime w or w/o food
-
Pitavastatin
- Brand - Liralo
- **Minimal 2C9/2C8
- *Admn anytime w or w/o food
- **CI w cyclosporine
- Erythromycin - 1mg
- Rifampin - 2mg
- Niacin - low dose
-
Fluvastatin
- Brand - Lescol
- **Admn 20-80 at PM - QHS
- ** NO RENAL ADJUSTMENT
-
Fibrates
- MOA - Stimulate PPAR receptor
- Inc. HDL, Dec. TG
- AE - Gallstone, Inc. LFT, Myopathy
- Inc. INR - interact with warfarin
**Preferrable over Niacin when TG>400
-
Gemfibrozil
- Brand - Lopid
- (Dec. CV in secondary prevention)
- **600mg BID, 30 min before AM and PM meal
*Monitor lipid levels, CBC, and LFTs every 3 months (1st yr) then periodically)
-
Fenofibrate
- Brand - Tricor, Triglide, Antara, Lofib
- no regard to meal
- Monitior LFTs and lipid levels
-
Ezetimibe
- Brand - Zetia
- **CHO absorption Inhibitor (intestinal brush boarder)
- **Dec. LDL
- *Not inhibitor/Inducer of CYP 450
-
Nicotinic Acid
- MOA - Inc. HDL (Most Potent)
- **Change LDL to large and fluffy
- IR = flushing
- SR = Hepatotoxicity
ADR - Hyperglycemia, Hyperurincemia
-
Fish Oil
- Rx = Lovaza --> 4g/day
- **Dec. TG
- AE - GI, Inc. bleeding - caution w ASA/ warfarin
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