CV 9

Question 1

What is dyslipidemia defined as

Answer 1

abnormal fats in the blood

Question 2

increased Total Cholesterol or LDL-C = ??

Answer 2

increased ASCVD

Question 3

Increased HDL-C =

Answer 3

decreased ascvd

Question 4

what type of lipid tests are recommended

Answer 4

non fasting lipid tests
TG increase by -.2-0.3mmol/L after eating and LDL-C decrease by 0.1-0.2mmol/L

Question 5

when do you recommend fasting lipids

Answer 5

if TG are > 4.5mmol/L

Question 6

Drug induced dyslipidemia 5 classes

Answer 6

Alcohol
Antiepileptics
Antipsychotics
Progestins
Thiazide Diuretics

Question 7

Who do you screen?

Answer 7

men 40 years of age or older, women 40 years of age or older.
consider earlier in ethnic groups at increased risk such as south asian or indigenous individuals

Question 8

two signs of dyslipidemi

Answer 8

eruptive xanthomas
corneal arcus

Question 9

what are the two types of dyslipidemia

Answer 9

primary (familial hypercholesterolemia)
secondary (other causes)
- sedentary lifestyle
- excessive dietary fat intake
- diseases like CKD, LD, untreated hypothyroidism
- cigarette smoking
- drugs

Question 10

0-5-30 rule

Answer 10

0 cigs, 30 mins exercise, 5 servings of fruit and vegetables

Question 11

Atorvastatin dosing + brand name

Answer 11

Lipitor, 10-80mg PO daily

Question 12

Rosuvastatin dosing + brand name

Answer 12

Crestor 5-40mg PO daily

Question 13

Simvastatin dosing + brand name

Answer 13

Zocor 10-40mg PO daily

Question 14

What does doubling a statin dose do

Answer 14

further decreases LDL C by 6%, but most benefit comes from lower doses

Question 15

which statins can you take at any time

Answer 15

atorvastatin and rosuvastatin

Question 16

when should other statins be taken

Answer 16

PM meal or at HS

Question 17

is simvastatin 80mg recommended

Answer 17

NO.

Question 18

whats the approach to statin therapy when no statin indicated condition is there

Answer 18

framingham risk score, risk category

Question 19

what are statin indicated conditions

Answer 19

LDL >/= nto 5mmol/L
Familial Hypercholesterolemia or genetic dyslipidemia
DM or CKD
ASCVD

Question 20

familial hypercholesterolemia dominant or recessive

Answer 20

dominant!

Question 21

familial hypercholesterolemia heterozygous LDL-C range and homozygous LDL-C range

Answer 21

5-13, >13

Question 22

Primary Prevention risk categories

Answer 22

low risk = <10%, no statin therapy recommended
intermediate risk = 10-19%
High risk = >/= 20%, statin therapy recommended

Question 23

when do you initiate statin therapy in intermediate risk patients

Answer 23

if LDL-C is >/= to 3.5mmol/L
Men aged over 50 w/
woman ages over 60 w/ greater than one CV risk factor

Question 24

CV risk factors

Answer 24

• elevated waist-to-hip ratio
• low HDL-C (less than 1 in men and 1.3 in women)
  -current or recent (5 years or less) cig smoking
  -impaired fasting glucose
  -hypertension

Question 25

what didi a high dose of simvastatin cause

Answer 25

more myopathy, no difference in LDL compared to lower dose

Question 26

which statins use the CYP3A4 mechanism

Answer 26

ALS - atorva, lova, simva

Question 27

Statin drug interactions - what do cyp3A4 inhibitors do

Answer 27

increased statin levels macrolide ab, grapefruit juice, azole antigungals, protease inhibitors

Question 28

Statin drug interactions - CYP3A4 inducers

Answer 28

decreased statin levels - rifampin, carbamazepine, phenytoin, phenobarbital, st johns wort

Question 29

Which drugs increased statin levels

Answer 29

amiodarone, CCB, Colchicine, Cyclosporine

Question 30

Statin CI

Answer 30

pregnancy/lactation liver enzyme elevation hepatic disease

Question 31

some common ADRs of statins

Answer 31

Cataracts Diarrhea, nausea elevated liver enzymes DM Myopathy, arthralgias

Question 32

statin associated myalgia CK/ULN parameters

Answer 32

CK

Question 33

statin associated myositis CK/ULN parameters MILD

Answer 33

CK <10 times ULN stop statin follow CK until CK

Question 34

statin associated myositis CK/ULN parameters MOD/SEV

Answer 34

stop statin refer

Question 35

if a pt gets rhabdomyolysis what do you do

Answer 35

D/C statin and do not rechallenge

Question 36

Did coenzyme Q10 or VD help prevent SAM

Answer 36

NO.

Question 37

PCSK9 inhibitors

Answer 37

alirocumab, praluent, 75-150mg SC q 2 weeks Evolocumab, Repatha, 140mg SC q 2 weeks or 420 mg S q monthly

Question 38

EPA (Icosapent ethyl)

Answer 38

decreased TG by 20%

Question 39

Omega 3 works or nah?

Answer 39

NO!

Question 40

Are fibrates used for anything

Answer 40

decrease TG by 20-50% and LDL-C by 5-20$ primarily used to reduce risk of pancreatitis

Question 41

is niacin used

Answer 41

no bc of serious ADRs

Question 42

are bile acid sequesttrants used

Answer 42

no, never used.

Question 43

in patients with ASCVD, what do you do

Answer 43

max statin treatment. If LDL-C >1.8mmol/L or ApoB >0.7g/L or non hdl c > 2.4mmol/L, use ezetimibe +/- PCSK9 inhibitor if between 1.8-2.2 or use PCSK9 +/- ezetimibe if greater than 2.2