Hyperlipidemia Therapy – Flashcards
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LDL Lowering Agents
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HMG-CoA Inhibitors BAS Niacin Ezetimibe
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TG Lowering Agents
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Fibrates Omega 3
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Hypercholesterolemia first line treatment
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Statin
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Statin Contraindications
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Pregnancy Liver disease
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Max starting dose for Simvastatin
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40mg
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Statin ADEs
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Elevated LFT Myalgias
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Statin monitoring
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Fasting lipid profile LFT CPK
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How long after statin initiation is a fasting lipid profile performed?
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6-8 weeks
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Contraindication for BAS
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Complete biliary obstruction
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Cholestyramine dose
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4g packet QD/BID titrated to 8-16g BID
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Colesevelam dose
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3 tabs BID
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BAS ADEs
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Constipation Obstruction Impaired drug absorption
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How long after BAS initiation is a fasting lipid profile performed?
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6-8 weeks
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Second line therapy after statin or as an add on to statin therapy
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Niacin
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This can be used for primary hypercholeterolemia in combo with BAS
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Niacin
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This is considered first line or an alternative for HTGemia and DM dyslipidemia
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Niacin
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Niacin Contraindications
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Active liver disease Peptic ulcers
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Niacin Initial dose
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500mg HS
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Niacin tritrate up to this dose
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2000mg
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Niacin IR initial dose
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125-250mg BID
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Niacin ER initial dose
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125-250mg BID
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Niacin ADEs
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Flushing Elevated LFT Hyperglycemia Hyperuricemia Myopathy
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Niacin Monitoring
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Fasting lipid panel ALT Fasting glucose Uric Acid
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_ is an add-on therapy with statins by blocking the NPC1L1 protein.
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Ezetimibe
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Ezetimibe CI
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Active Liver Disease
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Ezetimibe dose
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10mg QD
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Fibric acid CIs
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Hepatic, Renal dysfunction Gallbladder disease Biliary Cirrhosis
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Fibric Acid ADEs
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GI disturbance Elevated LFT Myopathy SCr increase
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Ezetimibe renal adjustment
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1/3 original dose
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Fibric Acid DDI
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Statins
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Lovaza dose
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4 caps QD
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Lovaza prophylaxis dose for MI
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1g QD
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Lovaza ADEs
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Dyspepsia Bleeding
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TGY still elevated after TLC
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Statin, fibrate
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After statin dose optized, LDL, non-HDL or TG remains elevated
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Statin, niacin
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After statin dose optized, LDL non-HDL remains elevated
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Statin Ezetimibe
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Patient is intolerant of statins
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Ezetimibe, niacin
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High intensity statins lower LDL by >_%
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50
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Moderate intensity statins lower LDL by _-_%
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30, 50
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Low intensity statins lower LDL by <_%
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30
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Group 1
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>21 ASCVD
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Group 2
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>21 LDL >190
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Group 3
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40-75 No ASVCD DM LDL 70-189
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Group 4
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40-75 No DM, ASVCD LDL 70-189 Risk >7.5%
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Group 1 <75 Treatment
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High Intensity Statin
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Group 1 >75 Treatment
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Moderate Intensity Statin
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Group 2 Treatment
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High Intensity Statin
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In Group 2, only consider other cholesterol lowering agents when
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Statin has been maximized
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Group 3 Treatment
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Moderate Intensity Statin
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Group 3 with ASCVD risk >7.5%
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High Intensity Statin
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Group 4 Treatment
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Moderate, High Intensity Statin
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High Intensity Statin for patients with these three conditions
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ASCVD 190 Risk >7.5%
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Moderate Intensity Statin
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>75 40-75, DM, LDL 70-189 40-75 LDL 70-189, Risk >7.5
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Lovastatin, CrCl <30mL/min
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Careful with doses over 20mg
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Simvastatin, CrCl <30mL/min
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5mg QD
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Rosuvastatin, CrCl <30mL/min
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5-10mg QD
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Pravastatin, CrCl <30mL/min
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10mg QD
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Pitavistatin CrCl <30mL/min
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CI
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Fluvastatin CrCl <30mL/min
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CI
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Fluvastatin CrCl 30-60
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1-2mg QD
