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Board Study Topics > 00 Dyslipidemia > Flashcards

00 Dyslipidemia Flashcards

1
Q

How do you calculate LDL?

A

LDL = CH - HDL - (TG/5). Can’t be done if TG > 400

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2
Q

What are the four major statin benefit groups?

A

1) Pts w/ clinical ASCVD. 2) Pts w/ LDL 190+. 3) Pts 40-70 w/ DM w/ LDL 70-189. 4) Pts 40-70 w/ LDL 70-189 and estimated 10-year ASCVD 7.5%+

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3
Q

When would you not use high-intensity statin therapy?

A

10-year ASCVD < 7.5% (even if diabetic)

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4
Q

How are statin intensities defined?

A

High-intensity is a daily dose that lowers LDL by > 50%. Moderate-intensity by 30-49%

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5
Q

What intensity therapy should someone with ASCVD receive?

A

All patients who are age < 75, as well as > 75 years, should receive high-intensity statin therapy

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6
Q

What should be done if TG > 200 after LDL goal is reached?

A

Set secondary goal for non-HDL cholesterol 30 mg/dL higher than LDL goal

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7
Q

What should be done if TG is 200-499 after LDL goal is reached?

A

Consider adding drug if needed to reach non-HDL goal: Intensify LDL-lowering drug, add nicotinic acid or fibrate to further lower VLDL

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8
Q

What should be done if TGs > 500?

A

First lower TGs to prevent pancreatitis: very low-fat diet, fibrate or nicotinic acid

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9
Q

What is the only class of medication that consistently shows reduction in overall mortality rates?

A

HMG-CoA Reductase Inhibitors

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10
Q

What is the “Rule of 6” for HMG-CoA Reductase Inhibitors?

A

Every doubling of dose gives additional 6% reduction in LDL from baseline

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11
Q

What are the only High Intensity statin options?

A

Atorvastatin 40-80mg. Rosuvastatin 20-40mg

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12
Q

What are some Low Intensity statin options?

A

Pravastatin 10-20mg. Lovastatin 20mg. Simvastatin 10mg. Fluvastatin 20-40mg. Pitavastatin 1mg

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13
Q

What is the generic name of Livalo?

A

Pitavastatin

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14
Q

What is the generic name of Crestor?

A

Rosuvastatin

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15
Q

What is the generic name of Lipitor?

A

Atorvastatin

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16
Q

What is the generic name of Zocor?

A

Simvastatin

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17
Q

What is the generic name of Pravachol?

A

Pravastatin

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18
Q

What is the generic name of Mevacor?

A

Lovastatin

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19
Q

What is the generic name of Altoprev?

A

Lovastatin

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20
Q

What is the generic name of Lexcol?

A

Fluvastatin

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21
Q

Which statin is not significantly metabolized by CYP450 and may be less likely to be involved in a DDI?

A

Rosuvastatin & Pravastatin. Atorvastatin is metabolized by CYP3A4, but less so than other 3A4 statins

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22
Q

What population should be dose adjusted with Rosuvastatin?

A

Start with lower doses in Asian population and > 65 years (reach higher plasma concentration)

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23
Q

What concurrent medication causes you not to exceed 10mg dose of Simvastatin?

A

Verapamil. Diltiazem

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24
Q

What concurrent medication causes you not to exceed 20mg dose of Simvastatin?

A

Amiodarone. Amlodipine. Ranolazine

25
Q

What medications are contraindicated with Simvastatin use?

A

Azoles. Macrolides. HIV PIs. Gemfibrozil. Cyclosporine

26
Q

What are the statin ADRs?

A

GI. HA. Myalgia. Rhabdomyolysis. Hepatotoxicity. Proteinuria (dose related w/ rosuvastatin). Increase in BG

27
Q

What are the contraindications to statin use?

A

Active hepatic disease. Unexplained elevated LFTs. Pregnancy (Category X). Breastfeeding

28
Q

Which statins are CYP 3A4 substrates?

A

“SAL”: Simvastatin, Atorvastatin, Lovastatin

29
Q

Which statins MUST be dosed at bedtime?

A

“I LovA Sleeping with Fleece”: Lovastatin (Altoprev), Simvastatin, Fluvastatin

30
Q

Which statin must be taken with meals?

A

I Lov Meal times”: Lovastatin (Mevacor)

31
Q

What is the statin order for dose equivalencies?

A

PRASP=LF

32
Q

What is the generic name of Vytorin?

A

Simvastatin + Ezetimibe

33
Q

What is the generic name of Caduet?

A

Atorvastatin + Amlodipine

34
Q

What is the generic name of Simcor?

A

Simvastatin + Niacin

35
Q

What is the generic name of Zetia?

A

Ezetimibe (intestinal cholesterol absorption inhibitor)

36
Q

What is the benefit of using Zetia (Ezetimibe)?

A

Lowers LDL

37
Q

What is the generic name of Liptruzet?

A

New product: Ezetimibe + Atorvastatin

38
Q

What are the benefits of using Bile Acid Sequestrants?

A

Lowers LDL. Increases HDL. Slightly increases TGs (~5%)

39
Q

What do you need to be cautious about with Bile Acid Sequestrants?

A

Binds! Including other medications! DDIs! Give meds 2 hours before or 4 hours after to avoid the binding (Welchol - less, but still present)

40
Q

What is the generic name of Welchol?

A

Colesevelam (Bile Acid Sequestrant)

41
Q

What is the generic name of Colestid?

A

Colestipol (Bile Acid Sequestrant)

42
Q

What are the ADRs associated with Bile Acid Sequestrants?

A

Constipation. Abdominal pain/cramping. Gas/bloating (less GI side effects with Welchol). Potential increase in TGs. Decreased absorption of other medications

43
Q

What are the contraindications to Bile Acid Sequestrant use?

A

Complete biliary obstruction. Bowel obstruction. Cholelithiasis (gall stones). High TG (> 500). Hx of hypertriglyceridemia-induced pancreatitis

44
Q

What are the benefits of Nicotinic Acid (Niacin)?

A

Increase HDL. Decrease LDL. Decrease TG

45
Q

What is the generic name of Niaspan?

A

Extended release niacin

46
Q

What is the hallmark ADR of Niacin and how can it be avoided?

A

Flushing/itching. Pretreat with ASA 325mg or Ibuprofen 200mg 30 min prior to dose

47
Q

What are some other ADRs of Niacin?

A

Hepatotoxicity! HA, GI upset, Hyperuricemia/gout, Hyperglycemia

48
Q

When is Niacin contraindicated?

A

Active liver disease. Active PUD. Arterial bleeding. Caution in gout

49
Q

What are the benefits of Fibrates?

A

Increase HDL. Decrease LDL and TGs

50
Q

What is the generic name of Lopid?

A

Gemfibrozil (Fibrate)

51
Q

What is the generic name of Tricor?

A

Fenofibrate (Fibrate)

52
Q

What is the generic name of Trilipix?

A

Fenofibric Acid (Fibrate - micronized capsule)

53
Q

What are the ADRs with Fibrates?

A

GI upset. Cholelithiasis (gall stones). Myositis. Increased LFTs. Increased CPK. Myopathy (especially when given with statins). Abdominal pain

54
Q

What are the contraindications to Fibrate use?

A

Severe liver disease. Severe renal disease. Gallbladder disease. Nursing mothers

55
Q

What are the benefits of Omega 3 Fatty Acids?

A

Decrease TGs. Increase HDL & LDL

56
Q

What is the generic name of Vascepa?

A

Icosapent (new agent). Indicated for high TG levels > 500

57
Q

What is the generic name of Juxtapid?

A

Lomitapide (new agent). Indicated for homozygous familial hypercholesterolemia

58
Q

What are the contraindications for Juxtapid use?

A

Pregnancy (Category X). Moderate to severe hepatic impairment. Active liver disease

59
Q

Which statin can be given BID?

A

Fluvastatin

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