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-Myopathy -Increased liver enzymes |
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Absolute: liver disease Relative: use with certain drugs (P450) Pregnancy (women wanting to get preg should be removed off of statins 6-12 months in advance) |
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4 Statins with least drug-drug interactions |
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-Pravastatin -Fluvastatin -Rosuvastatin -Pitavastatin |
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-Cholestyramine -Colestipol -Colesevelam |
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-GI distress -Constipation |
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Raised TG (especially >400 mg/dL) |
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Increases levels of: Digoxin, Warfarin, Thyroxine, and Thiazides |
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Nicotinic Acid Side effects |
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Definition
Flushing, hyperglycemia, hyperuricemia, upper GI distress, hepatoxicity |
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Nicotinic Acid Contraindications |
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Definition
Liver disease (use w/ caution), severe gout, peptic ulcer, uncontrolled diabetes |
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First line agent or an alternative for tx of Hypertriglyceridemia and Diabetic hyperlipidemia. |
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Nicotinic Acid: cutaneous flushing and itching |
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Definition
Appears to be prostaglandin mediated and can be reduced by aspirin 325mg given 30 mins before Niacin ingestion. |
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Produces large reductions in LDL and increases in HDL. |
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Niacin associated Hepatitis |
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More common wtih sustained release preparations. |
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-Gemfibrozil -Fenofibrate -Fenofibric Acid |
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dyspepsia, gallstones, myopathy (slight myopathy) |
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Fibric Acid Contraindications |
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Severe renal or hepatic disease |
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Fenofibric Acid and Statins COMBO |
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Reduces TG levels and increases HDL levels in pt with mixed dyslipidemia and CHD or a CHD equivalent. |
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Lowers LDL, May raise HDL, Doesnt have anything to do with TG |
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Ezetimibe Contraindications |
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Definition
-Hypersensitivity -Pts with active liver disease or unexplained persistent elevations in serum transaminases (AST, ALT) -Pregnant and nursing women |
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Omega-3 fatty acids -EPA -DHA
Approved by FDA for the tx of high triglyceride levels
NOT used as monotherapy, ,ALWAYS used as adjunctive therapy. |
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Lovaza (fish oil) Side effects |
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GI (burping, taste perversion, dyspepsia) |
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Atorvastatin + Amlodipine |
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Statins Monitoring Parameters |
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Definition
Baseline: Lipids, LFT's, CPK
Test @ 6wk: Lipids, LFT's
Maintenance: Lipids and LFT's |
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Niacin Monitoring Parameters |
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Definition
Baseline: Lipids, LFT's, Glucose
Test @ 6wk: Lipids, LFT's, Glucose
Maintenance: Lipids and LFT's |
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Fibrates Monitoring Parameters |
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Definition
Baseline: Lipids, LFT's, CBC
Test @ 6wk: Lipids, LFT's, CBC
Maintenance: Lipid and LFT's, CBC |
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BAS Monitoring Parameters |
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Definition
Baseline: Lipids
Test @ 6wk: Lipids
Maintenance: Lipids |
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Simvastatin with Fibrates & Nictonic Acid |
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Definition
Lower the dose of Simvastatin (max dose should be 10mg of Simvastatin when using with these drugs) |
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Simvastatin with Amiodarone or Verapamil |
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Definition
Max dose of Simvastatin is 20mg when used with these drugs. |
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Rosuvastatin with Fibrates and Nicotinic Acid |
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Definition
Lower dose of rosuvastatin when using fibrates and nicotinic acid, EXCEPT for fenofibrate (Tricor) |
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Definition
-Clinical CHD -Symptomatic carotid artery disease -Peripheral arterial disease -Abdominal aortic aneurysm |
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