Cardiovascular Conditions: Dyslipidemia

Question 1

HDL cholesterol

Answer 1

“good cholesterol”

takes cholesterol from blood, moves to liver to be removed

lowers ASCVD risk

Question 2

Non-HDL cholesterol

Answer 2

includes lipoproteins that contribute to ASCVD

Non-LDL strong predictor of ASCVD

Non-HDL calc = TC - HDL

Question 3

Triglycerides (TGs)

Answer 3

hypertriglyceridemia associated with ASCVD risk

> 500mg/DL can cause acute pancreatitis

Question 4

Friedewald equation

Answer 4

LDL = TC - HDL - TG/5

Dont use if TGs > 400

Question 5

LDL lvls

Answer 5

< 100 = good
> 190 = very high

Question 6

Non-HDL lvls

Answer 6

< 130 = good

Question 7

HDL lvls

Answer 7

> 40 men = good
50 women = good

Question 8

TG lvls

Answer 8

< 150 = good
> 500 = very high

Question 9

Primary (familial) hypercholesterolemias

Answer 9

genetic defects that cause severe cholesterol elevations

Question 10

Why isASCVD risk not needed for pts with clinical ASCVD, diabetes or LDL > 190

Answer 10

all should be on statin

Question 11

Lifestyle changes to help lower cholesterol

Answer 11

limit smoking and drinking
rich in veggies, fruits, whole grains
limt saturated and trans fat, also cholesterol
fish rich in omega 3
exercise 3-4 times a week, at least 40min

Question 12

Natural products that can help lower LDL

Answer 12

red yeast
OTC fish oils can lower TGs
** garlic no longer considered effective**

Question 13

Cholesterol lowering drugs should not be used if AST/ALT is….

Answer 13

> 3 times upper limit of normal

Question 14

Statin indication if secondary prevention ASCVD

Answer 14

High intensity

Question 15

Statin indication if primary prevention with primary severe dyslipidemia, LDL > 190

Answer 15

High intensity

Question 16

Statin indication if diabetes, 40-75yrs old and LDL 70-189

Answer 16

High intensity if multiple ASCVD risk factors
Moderate intensity otherwise

Question 17

Statin indicating if 40-75yrs old, LDL 70-189

Answer 17

ASCVD risk > 20% = high intensity
ASCVD 7.5-19.9% = moderate intensity

Question 18

High intensity statin and doses

Answer 18

Atorva = 40-80
Rosuvastatin = 20-40

Question 19

Low intensity statin and doses

Answer 19

Simvastatin = 10
Pravastatin = 10-20
Lovastatin = 20
Fluvastatin = 20-40

Question 20

Muscle damage from statin

Answer 20

usually within 6 wks of starting
muscle soreness, tiredness or weakness
Rhabdomyolysis is most severe form

Question 21

Managing myalgias with statins

Answer 21

dont use simvastatin 80mg/day
dont use statin with gemfibrozil

stop statin, retry 2-4 weeks later at lower dose, if still doesnt work then stop and retry in few weeks with another statin

Question 22

Statin CI

Answer 22

Breastfeeding
Liver Disease
strong CyP3A4 inhib (w/ simvastatin/lovastatin)

Question 23

Statin warning

Answer 23

Muscle damage
increase CPK/renal failure = inc risk with inc dose/age/using w/ niacin
Dont use during pregnancy

Question 24

Statin monitoring

Answer 24

Lipid panel 4-12 wk after starting, then usually annually
LFTs at BL then if symptoms
Myalgia = check CPK
Dec urine = check SCr/BUN

Question 25

Which statins have the least drug interactions?

Answer 25

Pravastatin and rosuvastatin

Question 26

Max amlodipine dose with simvastatin/atorvastatin/lovastatin?

Answer 26

20mg/day

Question 27

Max simvastatin dose with Diltz/Verapamil?

Answer 27

10mg

Question 28

Max lovastatin dose with Dilt/Verapamil?

Answer 28

20mg

Question 29

Max simvastatin n lovastatin dose with Amiodarone?

Answer 29

20mg sim
40mg lovo

Question 30

Which statin should be used in the evening?

Answer 30

Simvastatin

rest can be used any time

Question 31

what to do if statin therapy isn’t lowering LDL?

Answer 31

can add Ezetimibe or PCSK9i ($$$$$$)

Question 32

Ezetimibe should not be used with….

Answer 32

Gemfibrozil

Question 33

Colesevelam CI

Answer 33

Bowel obstruction

Question 34

Bile acid sequestrates/binding resin Side effects

Answer 34

constipation
abdominal pain
cramping
bloating
gas
inc TG

Question 35

Cholestyramine notes

Answer 35

can cause tooth discoloration, erosion of enamel or decay

Question 36

Colesevelam can be used in pregnancy?

Answer 36

Yes

Question 37

Fenofibrate/Gemfibrozil CI

Answer 37

Severe liver disease
gallbladder disease
breastfeeding
dont use with simvastatin** (Gemfibrozil specifically)

Question 38

Fenofibrate/Gemfibrozil warnings

Answer 38

inc myopathy risk when used with statins

Question 39

Fenofibrate/Gemfibrozil SE

Answer 39

Dyspepsia ( gemfibrozil)
inc LFTs
abdominal pain
inc CPK

Question 40

Niacin warnings

Answer 40

Rhabdomyolysis
Hepatotoxicity
Inc BG/ uric acid

Question 41

Niacin Side effects

Answer 41

Flushing
pruritus (itching)
vomiting
diarrhea
inc BG
inc hyperuricemia (gout)

Question 42

Niacin monitoring

Answer 42

LFTs

Question 43

Niacin dosage notes

Answer 43

IR = poorly tolerated due to flushing/itching
CR/SR = less flushing but more hepatotoxicity
ER = preferred due to less of both but more $$

formulations not interchangeable

take 4-6hrs after bile sequestering agents

Question 44

How to reduce flushing with niacin

Answer 44

take aspirin 325mg or ibuprofen 200mg 30-60min before dose, take with food, avoid spicy foods

alc or hot Bev can worsen flushing

Question 45

How long to space drugs out after bile sequestrants?

Answer 45

1-4hrs before
4-6hrs after

Question 46

Fish oil Side effects

Answer 46

burping
taste

Question 47

Fish oil warnings

Answer 47

dont use if hypersensitivity to fish/or shellfish

Question 48

Fish oil effects on LDL?

Answer 48

Lovaza can inc LDL, not seen with Vascepa

Question 49

Fish oil drug interactions

Answer 49

Can increase bleeding time, careful with others ie Warfarin