NAPLEX _ Dyslipidemia

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  1. Statins:
    - MOA?
    - CI?
    - Warning?
    - SE?
    - Dosing Times?
    - Avoid With?
    • MOA: inhibits HMG-CoA --> prevents cholesterol synthesis
    • CI: Acute liver disease || Pregnancy || Breastfeeding
    • Warning: Skeletal muscle effects (myopathy, rhabdomyolysis)
    • SE: Myalgias || Arthralgias || Myopathy || short term Memory Loss
    • Take HS: Simvastatin || Fluvastatin || Lovastatin
    • Inc Risk Myopathies == avoid with fibrate (Gemfibrozil) and Niacin products
  2. Statin Equivalent Doses
    • "Pharmacist Rock At Saving Lives & Preventing Flu"
    • Pravastatin _ 2 mg
    • Rosuvastatin _ 5 mg
    • Atorvastatin _ 10 mg
    • Simvastatin _ 20 mg
    • Lovastatin _ 40 mg
    • Pitavastatin _ 40 mg
    • Fluvastatin _ 80 mg
  3. Lipitor
    Atorvastatin
  4. Lescol
    Lescol XL
    • Fluvastatin
    • - Lescol -- take in the evening
    • - Lescol XL -- taken daily
  5. Mevacor
    Altoprev
    • Lovastatin
    • - Mevacor -- IR _ take with evening meal
    • - Altoprev -- ER _ take HS
  6. Livalo
    Pitavastatin
  7. Pravachol
    Pravastatin
  8. Crestor
    • Rosuvastatin
    • -- exposures are 2x greater in Asian pts == consider 5 mg starting dose
  9. Zocor
    • Simvastatin
    • -- take in the evening
  10. Vytorin
    Simvastatin PLUS Ezetimibe
  11. Zetia
    Ezetimibe
  12. Ezetimibe:
    - MOA?
    - IMPROVE-IT Study?
    • MOA: inhibits absorption of cholesterol at the brush border of the small intestine
    • IMPROVE-IT: addition of moderate-intensity statin therapy in stable patients with recent ACS, who had LDL cholesterol levels within guideline recommendation, further lowered the risk of CV events (Ezetimibe + Statin >> Statins)
  13. Bile Acid Sequestrants:
    - MOA?
    - CI?
    - SE?
    - NOTES?
    • MOA: binds bile acid in the intestine, forming a complex that is excreted in the feces
    • CI: Colesevelam _ bowel obstruction || TG > 500 mg/dL || Hx of hyperglyceridemia-induced pancreatitis
    • SE: Constipation || Abd pain || Cramping || Gas || Bloating || Inc TG
    • NOTES: ACC/AHA guidelines do not recommend using these agents when TGs are >/= 300 mg/dL
    • - May decrease absorption of fat-soluble vitamins (A, D, E, K), folate, iron --> separate administration times
    • - Colesevelam _ may be considered as an option in Pregnant patients
    • - Colesevelam _ most commonly used || less drug interactions
  14. Welchol
    • Colvesevelam
    • -- Bile Acid Sequestrant
    • -- take with a meal and liquid
  15. Fibrates:
    - MOA?
    - CI?
    - SE?
    - NOTES?
    • MOA: PPARalpha activators --> upregulate the expression of apolipoprotein C2 (apoC--II) and apolipoprotein A1 (apoA-I) --> apoC-II increase lipoprotein activity ==> increase catabolism of VLDL particles [DEC TG signigicantly]
    • CI: Severe liver disease || Severe Renal disease || Gallbladder disease || Nursing mothers
    • SE: Abd pain || dyspepsia
    • NOTES: Signifcantly reduces TG --> but can increase LDL when TG are high
    • - Lopid _ BID dosing -- 30 min before breakfast and dinner
    • - Antara / Fibricor / Tricor / Triglide / Trilipix _ take QD, with or without food
    • - Fenoglide / Lofibra / Lipofen _ take QD, with food
  16. Antara / Fibricor / Tricor / Trilipex
    Fenoglide / Lofibra / Lipofen
    • Fenofibrate
    • Fenofibric Acid
    • -- Fibrates
    • -- Antara / Fibricor / Tricor / Triglide / Trilipix _ take QD, with or without food
    • -- Fenoglide / Lofibra / Lipofen _ take QD, with food
  17. Lopid
    • Gemfibrozil
    • -- Fibrates
    • -- take BID _ 30 minutes before breakfast and dinner
  18. Niacin
    - MOA?
    - Warnings?
    - SE?
    - NOTES?
    • MOA: decreases the rate of hepatic synthesis of VLDL (dec TG) and LDL
    • Warnings: Hepatotoxicity
    • SE: Flushing || Pruritis (itching) || N/V/D || hyperglycemia || hyperuricemia (gout)
    • NOTES: Niaspan == best clinical choice _ less flushing and less hepatotoxicity
    • - CR and SR Formulation == less flushing but MORE hepatotoxicity
    • - IR == poor tolerability due to flushing/itching
    • - Reduce flushing -- ASA 325 mg  (or ibuprofen 200 mg) 30-60 min before dose
  19. Niaspan
    • ER Niacin
    • -- take HS after a low-fat snack (most flushing will occur at night
  20. Fish Oils
    - Indication?
    - Warnings?
    - SE?
    - NOTES?
    • Indication: Omega Fatty Acids == as adjunct to diet in patients with TGs > 500 mg/dL
    • Warnings: caution in patients with fish and/or shellfish allergy
    • SE: Eructation (burping) || dyspepsia
    • NOTES: can prolong bleeding time --> monitor INR
    • - Lovaza _ can INC LDL
  21. Lovaza
    • Omega-3 Acid Ethyl Esters
    • -- Fish Oils
    • -- take 4 caps D -OR- 2 caps BID
  22. PCSK9 (Proprotein Convertase Subtilisin Kexin Type 9 Inhibitors)
    - MOA?
    - SE?
    - NOTES?
    • MOA: binds to PCSK9 --> inhibits binding of PCSK9 to LDLR (PCSK9 binds to LDL receptors on hepatocyte surfaces to promote LDLR degradation) ==> increases number of LDLR to clear circulating LDL
    • SE: Injection site reaction
    • NOTES: monoclonal antibodies == for FH
    • - Alirocumab == indicated for heterozygous familial hypercholesterolemia (HeFH or ASCVD)
    • - Evolocumab == incidated for BOTH HoFH and HeFH
  23. Praluent
    • Alirocumab
    • -- PCSK9 _ indicated for HeFH
    • -- SC injection (thigh, abdomen, upper arm)
    • -- store in refrigerator
  24. Repatha
    • Evolocumab
    • -- PCSK9 _ indicated for HoFH and HeFH
    • -- SC injection
    • -- store in refrigerator
  25. Juxtapid
    • Lomitapide
    • -- PO daily
    • -- REMS program _ risk of hepatotoxicity
    • -- CI: Pregnancy
    • -- Avoid CYP 3A4 inhibitors
    • -- $$$ ($433,000/yr)
  26. Kynamro
    • Mipomersen
    • -- SC once weekly
    • -- REMS program _ risk of hepatotoxicity
    • -- CI: Active Liver disease
    • -- $$$ ($433,000/yr)
  27. Requires REMS program (2)
    • Lomitapide (Juxtapid)
    • Mipomersen (Kynamro)
  28. Injectable Medications (3)
    • Alirocumab (Praluent)
    • Evolocumab (Repatha)
    • Kynamro (Mipomersen)
  29. Most Hepatotoxic (2 classes)
    • Niacin
    • Statins
  30. 4 Statin Benefit Group
    • 1 - presence of clinical ASCVD, including Heart Disease (ACS, S/P, MI, stable or unstable angina, coronary or other arterial revascularization), Stoke, TIA or peripheral arterial disease thought to be of atherosclerotic origin
    • 2 - Primary elevations of LDL >/= 190 mg/dL
    • 3 - Diabetes and age 40-75 years with LDL between 70-189 mg/dL
    • 4 - Patients 40-75 years of age with LDL between 70-189 mg/dL and estimated 10-year ASCVD risk of >/= 7.5% (using global risk assessment tool)
  31. Classification Of Cholesterol and TG Levels (mg/dL)
    - LDL
    - HDL
    - TG
    - Non-HDL
    • LDL: < 100 = Desirable || >/= 190 = Very High
    • HDL: < 40 (men) = Low || < 50 (women) = Low
    • TG: < 150 = Desirable || >/= 500 = Very High
    • Non-HDL: < 150 = Desirable || >/= 220 = Very High
  32. High-Intensity Statin _ Treatment Options (2)
    • Atorvastatin _ 40 - 80 mg Daily
    • Rosuvastatin _ 20 - 40 mg Daily 
    • -- Daily dose Decrease LDL > 50%
  33. Low-Intensity Statin _ Treatment Options (5)
    • Simvastatin _ 10 mg Daily
    • Pravastatin _ 10 - 20 mg Daily
    • Lovastatin _ 20 mg Daily
    • Fluvastatin _ 20 - 40 mg Daily
    • Pitavastatin _ 1 mg Daily
    • -- Daily dose Decrease LDL < 30%
  34. Moderate-Intensity Statin _ Treatment Options (7)
    • Atorvastatin _ 10 - 20 mg Daily
    • Rosuvastatin _ 5 - 10 mg Daily
    • Simvastatin _ 20 - 40 mg Daily
    • Pravastatin _ 40 - 80 mg Daily
    • Lovastatin _ 40 mg Daily
    • Fluvastatin XL _ 80 mg Daily
    • Fluvastatin _ 40 mg BID
    • Pitavastatin _ 2 - 4 mg Daily
    • -- Daily dose Decrease LDL 30% - 40%
  35. HIGH-INTENSITY Statin Treatment Intensity Based on Patient Risk
    • Secondary Prevention:
    • -- Clinical ASCVD </= 75 years of age
    • Primary Prevention:
    • -- Primary elevation of LDL >/= 190 mg/dL
    • -- Diabetes and Age 40-75 years with LDL between 70-189 mg/dL and estimated 10-year ASCVD risk  >/= 7.5%
    • -- Age 40-75 years with LDL between 70-189 mg/dL and estimated 10-year ASCVD risk  >/= 7.5%
  36. MODERATE-INTENSITY Statin Treatment Intensity Based on Patient Risk
    • Secondary Prevention:
    • -- Clinical ASCVD > 75 years of age
    • Primary Prevention:
    • -- Age 40-75 years with LDL between 70-189 mg/dL and estimated 10-year ASCVD risk  >/= 7.5% _ (moderate and high intensity)
    • -- Diabetes and Age 40-75 years with LDL between 70-189 mg/dL and estimated 10-year ASCVD risk < 7.5%
  37. Statin Equivalent Doses
    • "Pharmacists Rock At Saving Lives & Preventing Flu"
    • Pravastatin _ 2 mg
    • Rosuvastatin _ 5 mg
    • Atorvastatin _ 10 mg
    • Simvastatin _ 20 mg
    • Lovastatin _ 40 mg
    • Pitavastatin _ 40 mg
    • Fluvastatin _ 80 mg
  38. Drug-Drug Interactions _ SIMVASTATIN
    - Max 10 mg/day (3)
    - Max 20 mg/day (4)
    • Max 10 mg/day:
    • -- Verapamil || Diltiazem || Dronedarone
    • Max 20 mg/day:
    • -- Amiodarone || Amlodipine || Lomitapide || Ranolazine
  39. Drug-Drug Interactions _ LOVASTATIN
    - Max 20 mg/day (5)
    - Max 40 mg/day (2)
    • Max 20 mg/day:
    • -- Danazol || Diltiazem || Verapamil || Dronedarone || Amlodipine
    • Max 40 mg/day:
    • -- Amiodarone || Ticagrelor

Card Set Information

Author:
HNguyen0287
ID:
334326
Filename:
NAPLEX _ Dyslipidemia
Updated:
2017-10-13 01:26:19
Tags:
NAPLEX Dyslipidemia RxPREP
Folders:
RxPREP
Description:
RxPREP _ Dylipidemia Chapter Brand-Generic
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