Hyperlipidemia Pharm and Foundations II

Question 1

CVD (cardiovascular disease) risk factors: age

Answer 1

male: >45 female >55

Question 2

CVD risk factor: family hx of premature heart disease age

Answer 2

male <55 female <65

Question 3

Framingham vs. ACC/AHA 10-yr CVD risk score

Answer 3

Framingham: MI only. ACC/AHA also considers stroke risk. ACC/AHA also considers: statin therapy, DM, aspirin treatment, race.

Question 4

ATP III guide for target LDL level

Answer 4

<100 or <70 for for those with CAD (160-190 is high and >190 is very high

Question 5

ATP III guide for target HDL

Answer 5

40-60 (>50 for women)

Question 6

statins MOA

Answer 6

inhibits HMG-CoA reductase and upregulation of LDL receptors in liver

Question 7

Statins pleomorphic effects

Answer 7

decreases vascular inflammation (oxidative stress), stabilizes atherosclerotic plaque, inhibits thrombosis

Question 8

High intensity statin therapy options

Answer 8

Rosuvastatin 20-40; Atorvastatin 40-80

Question 9

Moderate intensity statin therapy options

Answer 9

Rosuvastatin 5-20; Atorvastatin 10-20; Simvastatin 20-40; Pravastatin 40-80; Lovastatin 40; Fluvastatin 40x2

Question 10

Low intensity statin therapy options

Answer 10

Lovastatin 20; Pravastatin 10-20

Question 11

Atorvastatin lipophillicity

Answer 11

lipophilic

Question 12

Rosuvastatin lipophillicity

Answer 12

hydrophilic

Question 13

Statins ADE (3)

Answer 13

myopathy/rhabdomyolysis, liver toxicity (increased LFTs), fasting plasma glucose increases 5-7mg/dL

Question 14

Atorvastatin drug interactions

Answer 14

CYP3A4 inhibitors/inducers: antivirals (vir), azoles, macrolides, red yeast rice (levels increased by grapefruit juice)

Question 15

Rosuvastatin drug interactions

Answer 15

CYP2C9 inhibitors/inducers: gemfibrozil, vir’s, red yeast rice. May increase effects of Warfarin

Question 16

ACC/AHA statin guideline for DM patient 40-75 y/o

Answer 16

at least a moderate intensity statin. If 10-yr CVD risk >20%, add ezitimibe to high intensity statin

Question 17

statin treatment for LDL>190

Answer 17

high intensity statin

Question 18

statin treatment for DM

Answer 18

at least moderate intensity statin

Question 19

Statin contraindications

Answer 19

PREGNANCY/BREASTFEEDING, active liver disease, unexplained elevated LFTs

Question 20

cholesterol absorption inhibitor

Answer 20

ezetimibe (Zetia)

Question 21

When to use Ezetimibe

Answer 21

add to high intensity statin when LDL >70 in high risk ASCVD. Could lower LDL an additional 25%

Question 22

never combine this with a statin

Answer 22

gemfibrozil. increased risk of myopathies

Question 23

Only lipid-lowering med considered safe in pregnancy

Answer 23

bile-acid binding resins (cholestyramine, colesevelam, colestipol)

Question 24

PCSK9 inhibitors

Answer 24

Alirocumab, Evolocumab

Question 25

Alirocumab/Evolocumab efficacy in lowering LDL

Answer 25

by 70%!!

Question 26

MTP inhibitor

Answer 26

lomitapide (Juxtapid)

Question 27

Indication for MTP inhibitor use

Answer 27

familiar hypercholesterolemia

Question 28

MTP inhibitor contraindications/ADE

Answer 28

pregnancy, hepatic impairment. HEPATIC TOXICITY

Question 29

mipomersen sodium indication

Answer 29

familial hypercholesterolemia

Question 30

mipomersen sodium MOA

Answer 30

inhibits production of apo B-100. *hepatotoxicity

Question 31

Fibrates MOA

Answer 31

catabolism of VLDL by upregulation of lipoprotein lipase (LPL). Lowers Trig by 35-50%

Question 32

Fibrates (3)

Answer 32

fenofibrate, Fenofibritic Acid, Gemfibrozil

Question 33

Nicotinic acid (Niacin) MOA

Answer 33

Inhibits synthesis and secretion of VLDL. Lowers LDL and Trig, raises HDL

Question 34

Nicotinic acid common side effect

Answer 34

flushing. Offset by taking ASA

Question 35

Bile acid sequestrants ADE

Answer 35

Binding other drugs

Question 36

Omega 3 fatty acids target effect

Answer 36

lower Tg's 20-50%