Dyslipidemia

Question 1

Calculation for Non-HDL

Answer 1

TC-HDL

Question 2

What can elevated TG cause

Answer 2

acute pancreatitis

Question 3

Friedewald equation

Answer 3

LDL = TC - HDL - TG/5

Question 4

When can you not use the friedewald equation

Answer 4

when TG > 400 mg/dL

Question 5

Drugs that raise LDL and TG (4)

Answer 5

Protease Inhibitors
Steroids
Diuretics
Immunosuppressants

Question 6

Drugs that raise LDL only (2)

Answer 6

Fibrates

SGLT2 inhibitors

Question 7

Drugs that raise TG only (4)

Answer 7

IV lipid emulsions
propofol
beta-blockers
atypical antipsychotics

Question 8

Conditions that raise LDL and TG (6)

Answer 8

obesity
hypothyroidism
alcoholism
smoking
diabetes
renal/liver disease

Question 9

Desirable LDL level

Answer 9

<100

Question 10

Very high LDL level

Answer 10

> 190

Question 11

desirable HDL level

Answer 11

men >40

women > 50

Question 12

Normal TG levels

Answer 12

< 150

Question 13

Very high TG levels

Answer 13

> 500

Question 14

Natural product used to lower cholesterol

Answer 14

Red yeast rice

-contain naturally occurring HMG-CoA reductase inhibitors

Question 15

What ASCVD risk score indicated to start a statin

Answer 15

> 7.5%

Question 16

Risk-enhancing factors for ASCVD (10)

Answer 16

very high LDL
family history of premature ASCVD
metabolic syndrome
chronic kidney disease
history or preeclampisa
history of premature menopause
chronic inflammatory disorders
high CRP
high CAC
abnormal ABI

Question 17

A CAC score of what indicated use of a statin

Answer 17

> 100

Question 18

High-intensity statin group

Answer 18

LDL >190
DM 40-75 with LDL 70-189 and multiple ASCVD risk factors
40-75 w/ LDL 70-189 with 10-yr ASCVD > 20%

Question 19

Moderate-intensity statin group

Answer 19

DM 40-75 with LDL 70-189

40-75 with LDL 70-189 and 10-y ASCVD 7.5-19.9%

Question 20

List high intensity statins

Answer 20

Atorvastatin 40-80

Rosuvastatin 20-40

Question 21

What % do high intensity statins lower cholesterol by?

Answer 21

50%

Question 22

List Moderate intensity statins

Answer 22

Atorvastatin 10-20
Rosuvastatin 5-10
Simvastatin 20-40
Pravastatin 40-80
Lovastatin 40

Question 23

What % do moderate intensity statins lower cholesterol by?

Answer 23

30-40%

Question 24

List low intensity statins

Answer 24

simvastatin 10
pravastatin 10-20
lovastatin 20

Question 25

What % do low intensity statins lower cholesterol by?

Answer 25

<30%

Question 26

Which cholesterol lowering drugs cause liver damage (4)

Answer 26

Niacin fibrates exetimibe potentially statins

Question 27

Statin MOA

Answer 27

inhibit the enzyme HMG-CoA reductase which prevents the conversion of HMG-CoA to mevalonate. this is the rate-limiting step in cholesterol synthesis

Question 28

define myalgias

Answer 28

muscle soreness and tenderness

Question 29

define myopathy

Answer 29

muscle weakness +/- CPK elevations

Question 30

define myositis

Answer 30

muscle inflammation

Question 31

define rhabdomyolysis

Answer 31

muscle symptoms with very high CPK (>10000) + muscle protein in the urine (myoglobinuria) which leads to acute renal failure

Question 32

gemfibrozil + statin DDI

Answer 32

myalgias

Question 33

Which statins need taken in the evening

Answer 33

simvastatin | lovastatin

Question 34

which statins are CI with strong cyp3a4 inhibitors

Answer 34

simvastatin | lovastatin

Question 35

statins + niacin DDI

Answer 35

myopathies

Question 36

Max dose of simvastatin when used with CCB

Answer 36

10mg/day

Question 37

Max dose of simvastatin when used with amiodarone, smlodipine

Answer 37

20 mg/day

Question 38

ezitimibe MOA

Answer 38

inhibits absorption of cholesterol in the small intestine

Question 39

PCSK9 inhibitors MOA

Answer 39

bind to proprotein convertase subtilisin kexin type 9. PSCK9 inhibitors inhibit the binding of PCSK9 to LDL receptors thus increase the number of LDL receptors available to clear LDL

Question 40

List PCSK9i

Answer 40

Alirocumab | Evolucumab

Question 41

Bile Acid sequestrants MOA

Answer 41

bind bile acids in the intestines, forming a complex that is excreted in the feces

Question 42

List BAS

Answer 42

Cholestyramine colesevelam colestipol

Question 43

Which BAS can a pregnant women use

Answer 43

cholesevelam

Question 44

Fibrates MOA

Answer 44

peroxisome proliferator receptor alpha (PPARa) activators, which upregulate the expression of apolipoprotein c2 and apolipoprotein A1. apoc-2 increases lipoprotein lipase activity leading to increased catbolism of BLDL particles. this will decrease TG significally

Question 45

List fibrates

Answer 45

fenofibrate | gemfibrozil

Question 46

CI for fibrates

Answer 46

severe liver disease including primary biliary cirrhosis | gallbladder disease

Question 47

Niacin MOA

Answer 47

decreases rate of hepatic synthesis of VLDL (decreases TG) and LDL

Question 48

What is niacin also known as?

Answer 48

nicotinic acid | vitamin B3

Question 49

Major SE of niacin

Answer 49

flushing

Question 50

How to reduce flushing in niacin

Answer 50

ASA 325 30-60 min before dose

Question 51

When are fish oil indicated

Answer 51

TG > 500

Question 52

List fish oils

Answer 52

omega-3 acid ethyl esters (lovaza) -has EPA and DHA icosapent ethyl (Vascepa) -has EOA

Question 53

fish oil effect on LDL

Answer 53

Lovaza can inc by 44% | no increase seen with vascepa

Question 54

Lomitapide MOA

Answer 54

binds to and inhibits microsomal TG transer protein (MTP) which prevents the assembly of apoB containing lipoproteins

Question 55

Mipomersen MOA

Answer 55

oligonucleotide inhibitor of apoB synthesis

Question 56

Indication for lomitapide and mipomersen

Answer 56

Homozygous familial hypercholesterolemia