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PAT 20A/B Chapter Notes - Chapter N/A: Ritonavir, Amlodipine, Pitavastatin

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Audrey Kenmir

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(2)PAT20 Fall Week 5 Drug Classifications (Atherosclerosis)
1. Anti-Lipidemics
a) HMG-CoA Reductase Inhibitors "statin" *Metabolic Agent* (Anti-hyperlipidemia)
HMG-CoA Reductase Inhibitors: atorvastatin (Lipitor), lovastatin (Mevacor),
rosuvastatin (Crestor)
Action: inhibits the enzyme HMG-CoA reductase that converts substrate HMG-CoA
into mevalonate (causes cholesterol formation); blocks the hepatic synthesis of very-
low-density lipoprotein (causes LDL formation).
Use: management of hypercholesterolemia and mixed hyperlipidemias.
Pharmacokinetics (Atorvastatin):
Onset- PO: unknown
Peak- PO: unknown
Duration- PO: 20-30 hrs
Side/Adverse Effects:
CNS: headache, dizziness, insomnia, weakness
CV: chest pain, peripheral edema
GI: altered taste, abdominal cramps, heartburn, nausea, vomiting, diarrhea,
constipation, flatus, drug-induced hepatitis, pancreatitis, increased liver enzymes
MS: rhabdomyolysis, arthralgia, arthritis, myalgia, myositis
RESP: bronchitis
OTHER: hypersensitivity reactions
Hypersensitivity; active liver disease or unexplained persistent increased AST/ALT;
concurrent use of gemfibrozil or azole antifungals, nelfinavir or ritonavir (with
lovastatin or simvastatin); concurrent use of pitavastatin with cyclosporine or
lopinavir/ritonavir; severe renal impairment; potential for fetal anomalies and
disruption of lipid metabolism in breast-fed infants; live disease or alcoholism;
concurrent use of amidodarone, azole anti-fungals, cyclosporine, fibrates,
gemfibrozil, macrolide anti-biotics, niacin, protease inhibitors, verapamil.
-Use with erythromycin, gemfibrozil, niacin can invoke rare cases of
-Use with oral anticoagulants requires close monitoring of INR/PT.
-Risk of myopathy increases with concurrent use of amiodarone, azole antifungals,
clarithromycin, clofibrate, cyclosporine, diltiazem, erythromycin, gemfibrozil,
nefazodone, nelfinavir, large doses of niacin, ritonavir, saquinavir, telithromycin,
and verapamil.
-Hormonal contraceptives and digoxin levels may increase.
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