00 Dyslipidemia

Question 1

How do you calculate LDL?

Answer 1

LDL = CH - HDL - (TG/5). Can’t be done if TG > 400

Question 2

What are the four major statin benefit groups?

Answer 2

1) Pts w/ clinical ASCVD. 2) Pts w/ LDL 190+. 3) Pts 40-70 w/ DM w/ LDL 70-189. 4) Pts 40-70 w/ LDL 70-189 and estimated 10-year ASCVD 7.5%+

Question 3

When would you not use high-intensity statin therapy?

Answer 3

10-year ASCVD < 7.5% (even if diabetic)

Question 4

How are statin intensities defined?

Answer 4

High-intensity is a daily dose that lowers LDL by > 50%. Moderate-intensity by 30-49%

Question 5

What intensity therapy should someone with ASCVD receive?

Answer 5

All patients who are age < 75, as well as > 75 years, should receive high-intensity statin therapy

Question 6

What should be done if TG > 200 after LDL goal is reached?

Answer 6

Set secondary goal for non-HDL cholesterol 30 mg/dL higher than LDL goal

Question 7

What should be done if TG is 200-499 after LDL goal is reached?

Answer 7

Consider adding drug if needed to reach non-HDL goal: Intensify LDL-lowering drug, add nicotinic acid or fibrate to further lower VLDL

Question 8

What should be done if TGs > 500?

Answer 8

First lower TGs to prevent pancreatitis: very low-fat diet, fibrate or nicotinic acid

Question 9

What is the only class of medication that consistently shows reduction in overall mortality rates?

Answer 9

HMG-CoA Reductase Inhibitors

Question 10

What is the “Rule of 6” for HMG-CoA Reductase Inhibitors?

Answer 10

Every doubling of dose gives additional 6% reduction in LDL from baseline

Question 11

What are the only High Intensity statin options?

Answer 11

Atorvastatin 40-80mg. Rosuvastatin 20-40mg

Question 12

What are some Low Intensity statin options?

Answer 12

Pravastatin 10-20mg. Lovastatin 20mg. Simvastatin 10mg. Fluvastatin 20-40mg. Pitavastatin 1mg

Question 13

What is the generic name of Livalo?

Answer 13

Pitavastatin

Question 14

What is the generic name of Crestor?

Answer 14

Rosuvastatin

Question 15

What is the generic name of Lipitor?

Answer 15

Atorvastatin

Question 16

What is the generic name of Zocor?

Answer 16

Simvastatin

Question 17

What is the generic name of Pravachol?

Answer 17

Pravastatin

Question 18

What is the generic name of Mevacor?

Answer 18

Lovastatin

Question 19

What is the generic name of Altoprev?

Answer 19

Lovastatin

Question 20

What is the generic name of Lexcol?

Answer 20

Fluvastatin

Question 21

Which statin is not significantly metabolized by CYP450 and may be less likely to be involved in a DDI?

Answer 21

Rosuvastatin & Pravastatin. Atorvastatin is metabolized by CYP3A4, but less so than other 3A4 statins

Question 22

What population should be dose adjusted with Rosuvastatin?

Answer 22

Start with lower doses in Asian population and > 65 years (reach higher plasma concentration)

Question 23

What concurrent medication causes you not to exceed 10mg dose of Simvastatin?

Answer 23

Verapamil. Diltiazem

Question 24

What concurrent medication causes you not to exceed 20mg dose of Simvastatin?

Answer 24

Amiodarone. Amlodipine. Ranolazine

Question 25

What medications are contraindicated with Simvastatin use?

Answer 25

Azoles. Macrolides. HIV PIs. Gemfibrozil. Cyclosporine

Question 26

What are the statin ADRs?

Answer 26

GI. HA. Myalgia. Rhabdomyolysis. Hepatotoxicity. Proteinuria (dose related w/ rosuvastatin). Increase in BG

Question 27

What are the contraindications to statin use?

Answer 27

Active hepatic disease. Unexplained elevated LFTs. Pregnancy (Category X). Breastfeeding

Question 28

Which statins are CYP 3A4 substrates?

Answer 28

"SAL": Simvastatin, Atorvastatin, Lovastatin

Question 29

Which statins MUST be dosed at bedtime?

Answer 29

"I LovA Sleeping with Fleece": Lovastatin (Altoprev), Simvastatin, Fluvastatin

Question 30

Which statin must be taken with meals?

Answer 30

I Lov Meal times": Lovastatin (Mevacor)

Question 31

What is the statin order for dose equivalencies?

Answer 31

PRASP=LF

Question 32

What is the generic name of Vytorin?

Answer 32

Simvastatin + Ezetimibe

Question 33

What is the generic name of Caduet?

Answer 33

Atorvastatin + Amlodipine

Question 34

What is the generic name of Simcor?

Answer 34

Simvastatin + Niacin

Question 35

What is the generic name of Zetia?

Answer 35

Ezetimibe (intestinal cholesterol absorption inhibitor)

Question 36

What is the benefit of using Zetia (Ezetimibe)?

Answer 36

Lowers LDL

Question 37

What is the generic name of Liptruzet?

Answer 37

New product: Ezetimibe + Atorvastatin

Question 38

What are the benefits of using Bile Acid Sequestrants?

Answer 38

Lowers LDL. Increases HDL. Slightly increases TGs (~5%)

Question 39

What do you need to be cautious about with Bile Acid Sequestrants?

Answer 39

Binds! Including other medications! DDIs! Give meds 2 hours before or 4 hours after to avoid the binding (Welchol - less, but still present)

Question 40

What is the generic name of Welchol?

Answer 40

Colesevelam (Bile Acid Sequestrant)

Question 41

What is the generic name of Colestid?

Answer 41

Colestipol (Bile Acid Sequestrant)

Question 42

What are the ADRs associated with Bile Acid Sequestrants?

Answer 42

Constipation. Abdominal pain/cramping. Gas/bloating (less GI side effects with Welchol). Potential increase in TGs. Decreased absorption of other medications

Question 43

What are the contraindications to Bile Acid Sequestrant use?

Answer 43

Complete biliary obstruction. Bowel obstruction. Cholelithiasis (gall stones). High TG (> 500). Hx of hypertriglyceridemia-induced pancreatitis

Question 44

What are the benefits of Nicotinic Acid (Niacin)?

Answer 44

Increase HDL. Decrease LDL. Decrease TG

Question 45

What is the generic name of Niaspan?

Answer 45

Extended release niacin

Question 46

What is the hallmark ADR of Niacin and how can it be avoided?

Answer 46

Flushing/itching. Pretreat with ASA 325mg or Ibuprofen 200mg 30 min prior to dose

Question 47

What are some other ADRs of Niacin?

Answer 47

Hepatotoxicity! HA, GI upset, Hyperuricemia/gout, Hyperglycemia

Question 48

When is Niacin contraindicated?

Answer 48

Active liver disease. Active PUD. Arterial bleeding. Caution in gout

Question 49

What are the benefits of Fibrates?

Answer 49

Increase HDL. Decrease LDL and TGs

Question 50

What is the generic name of Lopid?

Answer 50

Gemfibrozil (Fibrate)

Question 51

What is the generic name of Tricor?

Answer 51

Fenofibrate (Fibrate)

Question 52

What is the generic name of Trilipix?

Answer 52

Fenofibric Acid (Fibrate - micronized capsule)

Question 53

What are the ADRs with Fibrates?

Answer 53

GI upset. Cholelithiasis (gall stones). Myositis. Increased LFTs. Increased CPK. Myopathy (especially when given with statins). Abdominal pain

Question 54

What are the contraindications to Fibrate use?

Answer 54

Severe liver disease. Severe renal disease. Gallbladder disease. Nursing mothers

Question 55

What are the benefits of Omega 3 Fatty Acids?

Answer 55

Decrease TGs. Increase HDL & LDL

Question 56

What is the generic name of Vascepa?

Answer 56

Icosapent (new agent). Indicated for high TG levels > 500

Question 57

What is the generic name of Juxtapid?

Answer 57

Lomitapide (new agent). Indicated for homozygous familial hypercholesterolemia

Question 58

What are the contraindications for Juxtapid use?

Answer 58

Pregnancy (Category X). Moderate to severe hepatic impairment. Active liver disease

Question 59

Which statin can be given BID?

Answer 59

Fluvastatin