Pharmacology and Pharmoctherapy of Lipid Drugs and Disorders

Question 1

Uncontrolled hyperlipidemia significantly increases risk of what coronary heart diseases

Answer 1

Coronary artery disease, cerebovascular disease, peripheral vascular disease

Question 2

What are non-modifiable cardiovascular risk factors

Answer 2

Increased age, male sex, first degree relative family history, Race

Question 3

What are modifiable cardiovascular risk factors

Answer 3

Cigarette smoking, hypertension, obesity, diabetes, physical inavtivity, high LDL, poor diet

Question 4

T/F: Lipid panels should start being done at 20

Answer 4

True

Question 5

T/F: LDL is calculated and cannot be calculated if triglyceride levels are greater than 300

Answer 5

False: LDL is calculated and cannot be calculated if triglyceride levels are greater than 400

Question 6

What is optimal LDL levels, high LDL levels, very high LDL levels

Answer 6

less than 100, 160-189, greater than 190

Question 7

What is a high level for HDL

Answer 7

greater than 160

Question 8

What is a very high reading for serum triglycerides

Answer 8

Greater than 500

Question 9

What are the ASCVD risk groups

Answer 9

Clinical ASCVD, Severe hypercholesterolemia, Diabetes, Primary Prevention

Question 10

What is primary prevention

Answer 10

Therapy aimed to prevent first ASCVD event

Question 11

What is secondary prevention

Answer 11

Therapy aimed to prevent a subsequent event

Question 12

T/F: Patients who are part of the secondary prevention are considered to have clinical ASCVD

Answer 12

True

Question 13

What is ASCVD

Answer 13

Atherosclerotic cardiovascular disease

Question 14

History of what diseases would make someone be diagnosed with ASCVD

Answer 14

Myocardial Infarction, Stable or unstable angina, Coronary or other aterial vascularization

Question 15

What current diseases would a patient have in order to be diagnosed with ASCVD

Answer 15

Acute coronary syndrome, Stroke or transient ischemic attack, peripheral arterial disease

Question 16

What are secondary causes of dyslipidemia

Answer 16

Medication-related, uncontrolled diabetes mellitus, alcohol, malnutrition, liver disease

Question 17

What are the two determinants on if a patient is considerd high-risk for future ASCVD events if they are in the Clinical ASCVD group

Answer 17

History of multiple major ASCVD events, 1 major event and multiple high-risk conditions

Question 18

What are major ASCVD events

Answer 18

Recent Acute coronary syndrome, history of myocardial infarction, history of ischemic stroke, symptomatic peripheral arterial disease

Question 19

What are high risk conditions for ASCVD events

Answer 19

Age greater than 65, diabetes mellitus, hypertension, CKD (eGFR 15-59ml/min/1.73m2), current smoking, persistent LDL-C elevation (greater than 101) despite max statin and ezetimibe , history of congestive heart failure

Question 20

T/F: If someone is in the Clinical ASCVD group they should be assessed to either be on a high intensity statin or a low intentisty statin

Answer 20

False: Everyone in the Clinical ASCVD group should be on a high intensity statin whether very high risk or not

Question 21

If a patient is in the clinical ASCVD group and is on a max tolerated statin with LDL greater than 70 what medication would it be reasonable to add

Answer 21

Ezetimibe

Question 22

If a patient is in the clinical ASCVD group an is very high risk, on a statin, and on ezetimibe and their LDL is greater than 70 what medication would it be reasonable to add

Answer 22

PCSK9 inhibitor

Question 23

What is a baseline LDL for someone in the severe hypercholesterolemia group

Answer 23

Baseline LDL greater than 190 mg/dL

Question 24

T/F: Patients in the severe hypercholesterolemia group have high lifetime ASCVD risk

Answer 24

True

Question 25

What medication should all severe hypercholesterolemia patients be on

Answer 25

Maximally tolerated statin

Question 26

When is adding ezetimibe reasonable for a patient who is in the severe hypercholesterolemia group

Answer 26

There is a less than 50% reduction in LDL with statin

Question 27

When is adding a PCSK9 reasonable for a patient who is in the severe hypercholesterolemia group

Answer 27

If the patient is on a statin and ezetimibe with LDL greater than 130 mg/dL

Question 28

When a patient is in the diabetes group what is their risk of ASCVD events

Answer 28

Intermediate to high-risk

Question 29

What is medication is required if a patient is in the diabetes group

Answer 29

At least a moderate intensity statin

Question 30

When would it be appropriate to give someone a high intensity statin if the patient is in the diabetes group

Answer 30

If the patient has multiple ASCVD risk factors or risk modifiers

Question 31

What are the diabetic specfic risk modifiers

Answer 31

DM1 greater than 20 years or DM2 greater than 10 years, Albuminuria, eGFR less than 60ml/min/1.73m2, retinopathy, neuropathy, ankle brachial index less than 0.9

Question 32

When would it be reasonable to add ezetimibe to statin therapy for a patient in the diabetes group

Answer 32

ASCVD risk is greater than 20%

Question 33

What is the goal LDL reduction for patients in the diabetic group

Answer 33

Reduce LDL by 50%

Question 34

If a patient is in the primary prevention risk and has an ASCVD risk of of less than 5% (low risk) what is the therapy

Answer 34

Lifestyle changes only

Question 35

If a patient is in the primary prevention risk and has an ASCVD risk of 5% to 7% (borderline risk) what is the therapy

Answer 35

Lifestyle changes, consider a moderate intensity statin if risk enhancers are present

Question 36

If a patient is in the primary prevention risk and has an ASCVD risk 7.5% to 20% (intermediate risk) what is the therapy

Answer 36

Lifestyle changes, moderate intensity statin if risk enhancers are present

Question 37

T/F: Patients in the primary prevention with intermediate risk can be considered for a hgih intesnsity statin and addition of ezetimibe if the high intensity statin is not tolerated

Answer 37

True

Question 38

If a patient is in the primary prevention risk and has an ASCVD risk greater than or equal to 20% (high risk) what is the risk

Answer 38

Lifestyle changes and a high intensity statin

Question 39

What is the goal for patients in the primary prevention group with intermediate risk, high risk

Answer 39

30% to 49%, 50%

Question 40

What are the risk enhancers for patients in the primary prevention group

Answer 40

Persistently elevated LDL greater than 160 mg/dl, persistently elevated triglycerides greater than 175 mg/dl, metabolic syndrome