Dyslipidemia Pt. 1

Question 1

What are desirable Non-HDL, LDL, HDL, Triglycerides

Answer 1

Non-HDL: Less than 130 mg/dL
LDL: Less than 100 mg/dL
HDL: Greater 40 mg/dL (men), greater than 50 mg/dL (women)
Triglycerides: Less than 150 mg/dL

Question 2

What are very high LDL and triglycerides levels

Answer 2

LDL: Greater than 190 mg/dL
Triglycerides: Greater than or equal to 500 mg/dL

Question 3

T/F: Engage in aerobic physical activity 3 to 4 times per week for 40 minutes/session (decreases LDL 3 to 6 mg/dL)

Answer 3

True

Question 4

What are examples of non drugs that lower TG

Answer 4

Red yeast rice, OTC fish oils, niacin

Question 5

What are the statin equivalent doses (HINT: PRASLPF)

Answer 5

Pitvastatin-2 mg
Rosuvastatin- 5 mg
Atorvastatin- 10 mg
Simvastatin- 20 mg
Lovastatin- 40 mg
Pravastatin- 40 mg
Fluvastatin- 80 mg

Question 6

T/F: Symptoms of muscle damage from statins occurs in the first TWO WEEKS

Answer 6

False: Symptoms of muscle damage from statins occurs in the first 6 weeks

Question 7

What are the most common Statins

Answer 7

Atorvastatin (Lipitor)
Lovastatin (Altoprev)
Pravastatin (Pravachol)
Simvastatin (Zocor)
Rosuvastatin (Crestor)

Question 8

What are the contraindications to using statins

Answer 8

Pregnancy/breastfeeding, CYP3A4 inhibitors, liver disease

Question 9

What are warnings associated with Statins

Answer 9

Muscle damage, High creatine phosphokinase, age greater than 65 years, use of niacin, CPY3A4 inhibitors, Possible increase in FBG and A1C

Question 10

T/F: Statins can potentially cause an increase in blood sugar and A1C

Answer 10

True

Question 11

What and how should be monitored after someone starts a statin

Answer 11

Lipid panels should be taken 4 to 12 weeks after starting treatment then every 3 months or annually

Question 12

What are symptoms associated with statin use, what labs should be taken due to these symptoms

Answer 12

Myalgia: Check Creatine Phosphokinase
Little to no urine: Scr/BUN
Abdominal Pain or jaundice: LFTs for liver toxicity

Question 13

What are statin drug interactions that should be avoided (HINT G PACMAN

Answer 13

G: Grapefruit

P: Protease inhibitors
A: Azole Antifungals
C: Cyclosporine
M: Macrolides (except Azithromycin)
A: Amiodarone
N: Non-DHP CCBs

Question 14

Which statins are most likely to have drug drug interaction problems, less

Answer 14

Simvastatin and Lovastatin// Rosuvastatin and Pravastatin

Question 15

What is the MOA of Ezetimibe

Answer 15

Inhibits absorption of cholesterol in the SMALL INTESTINE

Question 16

T/F: If using concurrent bile acid sequestrants give Ezetimibe two hours before or four hours after bile acid sequestrants

Answer 16

True

Question 17

What is the MOA of bile acid sequestrants

Answer 17

BIND BILE ACIDS in the intestine forming a complex that is EXCRETED IN THE FECES

Question 18

What is the most commonly used bile acid sequestrants, why is it used most often

Answer 18

Colesevelam (Welchol): less drug interactions than other bile acid sequestrants

Question 19

What are the side effects of Colesevelam (Welchol)

Answer 19

CONSTIPATION, Abdominal Pain, Cramping, bloating, increased gas

Question 20

What is the key note for Colesevelam (Welchol)

Answer 20

Prolonged use can cause teeth discoloration, erosion of enamel or decay

Question 21

What drug antibiotic should be taken 4 hours prior to Colesevelam (Welchol)

Answer 21

Levofloxacin

Question 22

What absorption is affected by bile acid sequestratnt-s

Answer 22

Fat soluble vitamins: ADEK

Question 23

What is the MOA of Fibrates

Answer 23

Activation of Peroxisome Proliferator Receptor Alpha (PPAR alpha activator) increasing lipoprotein lipase activity catabolism of VLDL and decrases TG significantly

Question 24

What are the two main Fibrates

Answer 24

Fenofibrate (Antara, Tricor, andTrilpix)

Gemfibrozil (Lopid)

Question 25

What are the contraindications of fibrates

Answer 25

Severe liver disease including primary biliary cirrhosis, Gallbladder disease, CrCl less than or equal to 30 ml/min

Question 26

What is the warning associated with fibrates, side effects

Answer 26

Myopathy is higher risk when co administered with a statin// Dyspepsia (indegestion) and increased LFTs

Question 27

Which fibrate cannot be taken with statins and ezitimbi

Answer 27

Gemfibrozil

Question 28

T/F: Fibrates can increase the effects of sulfonyureas and warfarin

Answer 28

True

Question 29

What is the MOA of niacin

Answer 29

Decreases the rate of HEPATIC SYNTHEISIS OF VLDL

Question 30

What are warnings of niacin, side effects

Answer 30

Rhabdomyolysis with doses greater than or equal to 1 gram, Hepatotoxicity, Increased blood glucose and increased uric acid// Flushing, pruritus, vomiting. diarhhea, increased blood glucose, gout

Question 31

When should name brand Niacin (Niaspan) be taken

Answer 31

At bedtime after a low-fat snack

Question 32

In low risk patients how often should risk factors be assessed

Answer 32

Every 4 to 6 years

Question 33

What patients should receive a high intensity statin

Answer 33

History of CAD Stroke MI or TIA, LDL greater than 190 mg/dL, Age 40 to 75 with diabetes AND LDL BETWEEN 70 to 189 with comorbidities, Age 40 to 75 with LDL BETWEEN 70 TO 189 with an ASCVD risk greater than or equal to 20%

Question 34

What patients should receive a moderate intensity statin

Answer 34

Age 40 to 75 with diabetes LDL between 70 to 189, Age 40 to 75 with a ASCVD risk of 7.5 to 19.9%