Hyperlipidemia Drug Therapy and Lipid Management - Vocabulary Flashcards

Vocabulary-style flashcards covering drugs, mechanisms, guidelines, and lipid-management concepts from the notes.

Atorvastatin

A high-efficacy statin that inhibits HMG-CoA reductase and lowers LDL; brand name Lipitor.

Lipitor

Brand name for atorvastatin.

Rosuvastatin

A high-efficacy statin; brand name Crestor.

Crestor

Brand name for rosuvastatin.

Simvastatin

A statin; brand name Zocor.

Zocor

Brand name for simvastatin.

Pravastatin

A statin; brand name Pravachol.

Pravachol

Brand name for pravastatin.

Lovastatin

A statin; brands Mevacor and Altoprev.

Mevacor

Brand name for lovastatin.

Altoprev

Extended-release brand name for lovastatin.

Fluvastatin

A statin; brand name Lescol.

Lescol

Brand name for fluvastatin.

Pitavastatin

A statin; brand name Livalo.

Livalo

Brand name for pitavastatin.

Ezetimibe

Cholesterol absorption inhibitor; brand name Zetia.

Zetia

Brand name for ezetimibe.

Cholestyramine resin

Bile acid sequestrant used to reduce LDL; brand name Questran.

Questran

Brand name for cholestyramine resin.

Colestipol

Bile acid sequestrant; brand name Colestid.

Colestid

Brand name for colestipol.

Colesevelam

Bile acid sequestrant; brand name WelChol.

WelChol

Brand name for colesevelam.

Alirocumab

PCSK9 inhibitor; brand name Praluent.

Praluent

Brand name for alirocumab.

Evolocumab

PCSK9 inhibitor; brand name Repatha.

Repatha

Brand name for evolocumab.

Bempedoic acid

ACL inhibitor used to lower LDL; brand name Nexletol.

Nexletol

Brand name for bempedoic acid.

PCSK9 inhibitors

Monoclonal antibodies that inhibit PCSK9, increasing LDL receptor activity.

ALIOPC9 inhibitors

Incorrect shorthand term for PCSK9 inhibitors; use PCSK9 inhibitors as the term.

Ezetimibe MOA

Inhibits cholesterol absorption in the small intestine.

Statins MOA

Inhibit HMG-CoA reductase, the rate‑limiting step in hepatic cholesterol synthesis.

Bile Acid Sequestrants MOA

Bind bile acids in the intestine to form a complex excreted in feces, reducing cholesterol reabsorption.

Fasting lipid panel

Blood test after 9–12 hours without caloric intake to measure lipids.

Lipid panel components

Measures total cholesterol (TC), HDL, and triglycerides; LDL is often calculated.

LDL

Low-density lipoprotein cholesterol; primary target of therapy.

HDL

High-density lipoprotein cholesterol; often termed “good” cholesterol.

Triglycerides (TG)

Amount of triglycerides in the blood; high levels increase pancreatitis risk.

LDL goal <70 mg/dL

LDL-C target for patients with ASCVD per guidelines.

LDL goal <100 mg/dL

LDL-C target for adults with LDL-C >190 mg/dL or certain risk profiles.

ASCVD

Atherosclerotic cardiovascular disease.

ASCVD events

History of ACS, MI, angina, revascularization, stroke, TIA, or PAD of atherosclerotic origin.

Friedewald formula

LDL = TC − HDL − (TG/5); not valid when TG > 400 mg/dL.

Fasting lipid panel requirement

No food/caloric beverages for at least 9–12 hours before blood draw.

Group 1 ASCVD management

High-intensity statin first-line; LDL goal <70 mg/dL.

Group 2 LDL >190 mg/dL

Adults 20–75 with LDL-C >190 mg/dL; goal LDL <100 mg/dL.

Group 3 Diabetes (40–75, LDL 70–189)

Moderate-intensity statin first-line; high-intensity if risk enhancers or 10-year ASCVD risk ≥7.5%.

DM Risk Enhancers

Long duration of diabetes, albuminuria, eGFR <60, retinopathy/neuropathy, ABI <0.9.

Group 4 Primary Prevention (40–75

No ASCVD/DM; LDL 70–189 mg/dL; intermediate risk: 10-year risk 7.5–19.9%.

Moderate-intensity statin

Lowers LDL by ~30–49%.

High-intensity statin

Lowers LDL by ≥50%.

Low-intensity statin

Lowers LDL by <30%.

Statin equivalency (conversion)

Pitavastatin 2 mg = Rosuvastatin 5 mg = Atorvastatin 10 mg = Simvastatin 20 mg = Lovastatin 40 mg = Pravastatin 40 mg = Fluvastatin 80 mg.

Grapefruit interaction

Grapefruit juice can interact with atorvastatin, simvastatin, and lovastatin to raise levels.

Administration timing (rosuvastatin/atorvastatin/pitavastatin)

Can be taken anytime due to longer half-lives.

Lovastatin dosing with meals

Lovastatin IR should be taken with the evening meal for absorption.

Hydrophilic statins

Pravastatin is the most hydrophilic; rosuvastatin and fluvastatin are highly hydrophilic after that.

Rhabdomyolysis

Severe muscle breakdown; rare but serious statin side effect.

CK measurement

Creatine kinase level checked if myalgia occurs.

Contraindications to statins

Pregnancy (Category X), breastfeeding, active liver disease.

Monitoring schedule

Lipid panel rechecked 4–12 weeks after dose change; then every 3–12 months.

Simvastatin 80 mg risk

New patients should not start on 80 mg due to myopathy risk; max with diltiazem/verapamil is 10 mg; with amlodipine or amiodarone is 20 mg.

Lovastatin dosing limits

Max 20 mg/day with diltiazem/verapamil; max 40 mg/day with amiodarone.

Strong CYP3A4 inhibitors

Itraconazole, ketoconazole, erythromycin, clarithromycin, HIV protease inhibitors; avoid with simvastatin/lovastatin.

Gemfibrozil with statins

Gemfibrozil contraindicated with statins due to rhabdomyolysis risk.

Fenofibrate with statins

Fenofibrate preferred if a fibrate-statin combo is needed.

Bile acid sequestrants (BAS) use

Second-line monotherapy or add-on with statins for more LDL lowering.

BAS drug interactions

Can decrease absorption of other drugs; separate administration by at least 1 hour before or 4 hours after BAS.

BAS contraindication

Serum triglycerides >500 mg/dL.

PCSK9 inhibitors names

Alirocumab (Praluent) and Evolocumab (Repatha).

Alirocumab side effects

Nasopharyngitis, influenza, and injection-site reactions.

Evolocumab side effects

Nasopharyngitis, influenza, and injection-site reactions.

Red Yeast Rice warning

Should not be used with statins because it contains a lovastatin‑like active ingredient, risking myopathy.

Triglyceride levels and pancreatitis risk

TGs ≥500 mg/dL increase pancreatitis risk.

TG 150–499 mg/dL management

For ASCVD risk ≥7.5%, start/intensify statin therapy.

TG ≥500 mg/dL management

Consider TG-lowering therapy (fibrates first-line) to reduce pancreatitis risk.

Fibrate classes for TG lowering

Most beneficial classes are fibrates and omega-3 fatty acids.

Gemfibrozil dose

Gemfibrozil 600 mg twice daily before meals.

Fenofibrate dose

Fenofibrate 48 mg or 145 mg once daily.

Icosapent ethyl dose

Icosapent ethyl (Vascepa) 4 g/day.

Omega-3-acid ethyl esters dose

Omega-3-acid ethyl esters (Lovaza) 4 g/day.

Fibrate safety with statins

Gemfibrozil is contraindicated with statins; fenofibrate preferred when combining.

Omega-3 FDA note on interactions

Omega-3 fatty acids have no drug interactions with statins.

Niacin side effects

Most common IR niacin side effect is flushing; aspirin 325 mg 30 minutes before can help.

Niacin formulations

Niacor (IR), Slo-Niacin (SR), Niaspan (ER).

Niacin flushing management

Use aspirin pretreatment to reduce flushing.

Non-statin LDL-lowering agents

BAS, PCSK9 inhibitors, ezetimibe, and bempedoic acid as alternatives or add-ons.

LDL calculation origin

LDL often calculated from the lipid panel values (Friedewald equation).

Group 1 ASCVD events list

ACS, MI, angina, revascularization, stroke, TIA, or PAD of atherosclerotic origin.

Atherosclerotic cardiovascular disease

Disease involving plaque buildup in arteries.

Low-density lipoprotein receptor

Receptor whose numbers increase with PCSK9 inhibition, lowering LDL.

Aspirin premedication for niacin

325 mg aspirin given 30 minutes before niacin to reduce flushing.

Ezetimibe MOA

Inhibits intestinal cholesterol absorption.

HDL role

High-density lipoprotein involved in reverse cholesterol transport.

LDL goal for Group 2

LDL goal for ASCVD patients

Fasting lipid panel timing after dose change

Recheck lipids 4–12 weeks after starting or adjusting a dose.

Statin safety monitoring

Monitor lipid panel; check CK if myalgia.

Dosing equivalence interpretation

Clinical equivalence allows switching between statins to achieve similar LDL reduction.