Dyslipidemia

Question 1

What is the non-pharmacologic therapy for dyslipidemia?

Answer 1

lifestyle modifications: healthy diet, weight loss, exercise, stop smoking

Question 2

What are the pharmacologic options for dyslipidemia?

Answer 2

• statins
• fibric acids
• bile acid resins
• nicotinic acid
• 2-azetidione

Question 3

What is another name for the statin drug class?

Answer 3

-HMG CoA Reductase Inhibitors

Question 4

What it the statin MOA?

Answer 4

• inhibit HMG CoA reductase, which is an enzyme in cholesterol production
• statins reduce, but don’t completely block, cholesterol synthesis
• increase LDL catabolism
• also have anti-inflammatory activity (decrease CRP)

Question 5

Adverse Effects of Statins

Answer 5

• hepatic toxicity
• myopathy (myalgia, myositis, rhabdomyolysis)
• neuropathy
• small increased risk of DM at high doses
• non-serious and reversible cognitive side effects (memory loss, confusion)

Question 6

Statin CI

Answer 6

• pregnancy (cat X) and lactation
• active or chronic liver dz
• concomitant use of CSA (cyclosporin A), gemfibrozil, niacin

Question 7

Drug Interactions of Statins

Answer 7

• reports of myopathy when administered with CSA, gemfibrozil, clofibrate, niacin, azole antifungals, erythromycin, nefazodone, protease inhibitors
• may potentiate oral anticoagulants
• increased effect/toxicity of levothyroxine (thyroid med)

Question 8

What kind of dose-response relationship do statins have?

Answer 8

-non-linear: substantial reduction in LDL at starting doses; each doubling of dose reduces LDL 6% more

Question 9

When is dosing of statins most effective?

Answer 9

evening dosing usually yields greater effects on LDLs

Question 10

Which statins have the most drug interactions?

Answer 10

lovastatin and simvastatin

Question 11

MOA of Bile Acid Resins

Answer 11

• increase LDL catabolism

- decrease cholesterol absorption

Question 12

AEs of Bile Acid Resins

Answer 12

-GI SXS MOST COMMON

Question 13

Bile Acid Resins CI

Answer 13

• monotherapy for TGs > 500 MG/DL
• familial dysbetalipoproteinemia
• hx of severe constipation

Question 14

Bile Acid Resins Drug Interactions

Answer 14

• binds with many coadministered acidic drugs (eg warfarin, NSAIDs, beta blockers)
• take 1 hour before or 4 hours after

Question 15

Fibric Acid MOA

Answer 15

• increase VLDL clearance

- decreased VLDL synthesis

Question 16

Fibric Acid AE

Answer 16

• GI complaints most common

- can increase bile lithogenicity

Question 17

Fibric Acid CI

Answer 17

• hepatic or severe renal dysfunction

- pre-existing gallbladder dz

Question 18

Nicotinic Acid/Niacin MOA

Answer 18

-decrease LDL and VLDL synthesis

Question 19

Nicotinic Acid/Niacin AE

Answer 19

• flushing most common
• may cause glucose intolerance and increase uric acid levels
• hepatotoxicity

Question 20

Nicotinic Acid/Niacin CI

Answer 20

• liver disease
• type 2 DM
• hout
• hyperuricemia

Question 21

Ezetimibe MOA

Answer 21

blocks cholesterol absorption

Question 22

Ezetimibe AE

Answer 22

-may cause fatigue, abd pain, diarrhea, arthralgia, back pain

Question 23

Ezetimibe CI

Answer 23

-combination with statins in active liver dz or pts with persistent LFT elevations

Question 24

Which dyslipidemia class is best at reducing LDL?

Answer 24

statins

Question 25

Which dyslipidemia class is best at reducing TG?

Answer 25

fibric acids and nicotinic acid/niacin

Question 26

Which dyslipidemia class is best at increasing HDL?

Answer 26

niacin/nicotinic acid

Question 27

Which dyslipidemia class actually causes an increase in TG?

Answer 27

bile acid resins

Question 28

MOA of Plant Stenol Esters

Answer 28

-decrease cholesterol absorption, TC, and LDL

Question 29

What labs must be monitored for statin therapy?

Answer 29

- baseline ALT - ALT as clinically indicated thereafter - CK prn myositis

Question 30

What labs must be monitored for fibric acid therapy?

Answer 30

- baseline ALT and alk phos - ALT and alk phos 6-12 wks x2, then q12 mo thereafter - fasting lipid profile 6-12 wks after dose change, q12mo - CK prn myositis

Question 31

What labs must be monitored for bile acid resin therapy?

Answer 31

-fasting lipid profile 6-12 wks after stable dose then q12mo

Question 32

What labs must be monitored for nicotinic acid therapy?

Answer 32

- baseline ALT and alk phos, - ALT and alk phos 6-12 wks, q12mo - after stable dose achieved x2 mos, fasting lipid profile, uric acid and glucose - fasting lipid profile q12 mo thereafter - CK prn myositis

Question 33

ACC/AHA Statin Benefit Groups

Answer 33

- pts with clinical ASCVD - pts with LDL >190 - pts 40-75 yo with DM and LDL 70-189 (but no clinical ASCVD) - pts w/o clinical ASCVD or DM with LDL 70-189 with 10 year risk of ASCVD >7.5%