Ch 20 Hyperlipidemia

Study online at quizlet.com/_6hpos1

1. 1. Clinical ASCVD ≤ 75 YO → High intensity 15. Clinical ASCVD 1. Acute Coronary Syndrome (angina,
Intensity > 75 YO → Moderate intensity Types (3) MI, revascularization)
• Angina
2. 2. LDL ≥ 190 Intensity High intensity
• Myocardia infarction
3. 3. DM + 40-75 YO + LDL Moderate intensity • Revascularization
70-189 Intensity Risk assessment - high intensity 2. Peripheral Artery disease
4. 4. 40-75 YO + LDL 70- 5-7.5% → risk assess - moderate • Aortic aneurysm
189 Intensity 7.5-20% → moderate 3. Stroke/TIA
≥20% → high 16. Fibric Acid - GI related
5. Bile Acid - ↑ Triglycerides (TG) Derivatives adverse - hepatotoxicity (monitor LFTs)
Resin/Sequestrant - flatulence effects - increase effects of anticoagulants
adverse effects - bloating 17. Fibric Acid - History of gallstones
- abdominal pain Derivatives - severe hepatic or renal dysfunction
- heartburn contraindications - use with simvastatin
- constipation
18. Fibric Acid Gemfibrozil should not be initiated
6. Bile Acid - Biliary obstruction Derivatives drug with a statin therapy due to
Resin/Sequestrant - chronic constipation interactions increased risk of myopathy
contraindications - TG > 500 mg/dL (Gemfibrozil)
7. Bile Acid - Cholestyramine 19. Fibric Acid - Gemfibrozil
Resin/Sequestrant drug - Cholesevelam Derivatives drugs - Fenofibrate
8. Bile Acid Taken 1 hour before or 4 hours 20. Fibric Acid - 1st line for hypertriglyceridemia
Resin/Sequestrant drug after any other drugs Derivatives MOA Stimulates lipoprotein lipase and
interactions inhibits VLDL production, primarily
9. Bile Acid Bind to bile acids in the intestines decreases triglycerides
Resin/Sequestrant to prevent absorption 21. Myopathy symptoms - pain
MOA *take with food - tenderness
10. Cholesterol Absorption - Headache - stiffness
Inhibitor adverse - diarrhea - cramping
effects - abdominal pain - weakness
- generalized fatigue
11. Cholesterol Absorption CV death, nonfatal MI, unstable
- muscle symptoms + CPK > 10 x
Inhibitor *Composite angina requiring hospitalization,
ULN
outcome coronary revascularization, or
nonfatal stroke 22. Niacin adverse - Flushing*
effects - Pruritus*
12. Cholesterol Absorption Ezetimibe
- rash
Inhibitor drug
- hepatotoxicity
13. Cholesterol Absorption - Ezetimibe 10 mg daily +
23. Niacin Baseline Labs Glucose/A1C, LFTs, uric acid
Inhibitor IMPROVE-IT simvastatin 40 mg daily
Trial - secondary - 2% absolute risk reduction of 24. Niacin - Hepatic dysfunction
prevention composite outcome* compared to contraindications - severe hypotension
simvastatin 40 mg alone - hyperglycemia
- gout
14. Cholesterol Absorption Inhibits absorption of cholesterol
- new onset atrial fibrillation
Inhibitor MOA at small intestine
- active peptic ulcer
25. Niacin MOA Decreases VLDL synthesis, inhibit
lipolysis, increases lipoprotein lipase
activity
26. Omega-3 Fatty Acids adverse
effects
27. Omega-3 Fatty Acids
contraindications
28. Omega-3 Fatty Acids MOA
29. Other Lipid Lowering
Therapies (6)
30. Proprotein convertase
subtilisin/kexin type 9 (PCSK9)
inhibitors drugs
31. Statin Adverse effects
32. Statin benefit groups
33. Statin Contraindications
34. Statin Drug Interactions
35. Statin Intolerance defined as
36. Statin Intolerance mild-
moderate symptoms
37. Statin Intolerance mild-
moderate symptoms Assess
- Belching 38. Statin Intolerance -Give original or lower dose to
- fishy taste mild-moderate establish causal relationship
- upset stomach symptoms if -If causal, give low dose of different
- back pain symptoms resolve statin
- diarrhea and increase dose as tolerated
*Do NOT recommend D/C statin in pt
Known hypersensitivity to
who has mild to moderate symptoms
this drug
that resolve, after they resolve statin
Unknown mechanism, should be reinitiated
decrease triglycerides
39. Statin Intolerance discontinue and evaluate for
- Cholesterol absorption severe symptoms rhabdomyolysis
inhibitor
40. Statin Intolerance - CPK
- Bile acid resin/sequestrant
severe symptoms - creatinine
- Niacin
Assess - urine analysis for myoglobinuria
- Fibric acid derivatives
- Omega-3 fatty acids 41. Statin Monitoring adherence
- Proprotein convertase Fasting lipid panel
subtilisin/kexin type 9 for
(PCSK9) inhibitors
42. Statins are pregnancy
- Evolocumab (Repatha) contraindicated in
- Alirocumab (Praluent)
- Muscle pain, tenderness,
weakness, fatigue
- Gastrointestinal
complaints
- Headache
1. Clinical ASCVD
2. LDL ≥ 190
3. DM + 40-75 YO + LDL
70-189
4. 40-75 YO + LDL 70-189
- Pregnancy/Breastfeeding
- Liver disease
- Excessive alcohol
consumption
- Azole antifungals
- Erythromycin
- Cyclosporine
- Grapefruit juice
Myopathy
discontinue until able to
evaluate
Assess other causes that
might increase the risk
for muscle symptoms
(exercise)