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957 Block 3 > 1. Hyperlipidemia > Flashcards

1. Hyperlipidemia Flashcards

1
Q

What is the leading cause of death in America?

A

cardiovascular disease

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2
Q

For every __mg/dL decrease in LDL, there is a ~__% reduction in risk of CV events over 5 years.

A

38

25%

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3
Q

What is the cornerstone of therapy for hyperlipidemia?

A

Statins

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4
Q

Statins should only be used in severe or symptomatic hyperlipidemia. (T/F)

A

False: Statins should be used in all patients who meet criteria for treatment of hyperlipidemia and do not have a contraindication.

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5
Q

In patients with ASCVD, what intensity statin should be used?

A

high

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6
Q

In patients with LDL ≥ 190 mg/dL, what intensity statin should be used?

A

high

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7
Q

In patients aged 40-75 with diabetes and/or LDL 70-189 mg/dL, what intensity statin should be used?

A

moderate

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8
Q

In patients with 10 year risk for CVD ≥ 7.5%, age 40-75, and LDL 70-189 mg/dL WITH diabetes, what intensity statin should be used?

A

high

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9
Q

In patients with 10 year risk for CVD ≥ 7.5%, age 40-75, and LDL 70-189 mg/dL WITHOUT diabetes, what intensity statin should be used?

A

moderate to high

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10
Q

What are high intensity statin regimens?

A

Atorvastatin 40-80 mg

Rosuvastatin 20-40 mg

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11
Q

What are moderate intensity statin regimens?

A 
Atorvastatin 10-20 mg
Rosuvastatin 5-10 mg
Simvastatin 20-40 mg
Pravastatin 40-80 mg
Lovastatin 40 mg
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12
Q

What are low intensity statin regimens?

A

Simvastatin 10 mg
Pravastatin 10-20 mg
Lovastatin 20 mg

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13
Q

What is the goal for NLA guidelines?

A

specific LDL levels

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14
Q

According to the NLA guidelines, who are the high/very high risk patients?

A

diabetes
CKD
LDL > 190
ASCVD

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15
Q

What is the goal for ACC/AHA guidelines?

A

% reduction

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16
Q

What is the basis for the hypothesis of the ACC/AHA guidelines?

A

statin hypothesis

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17
Q

In the ACC/AHA guidelines, LDL level specific goals are __________.

A

abandoned

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18
Q

What is the basis for recommending statin regimens in the ACC/AHA guidelines?

A

statin intensity targets

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19
Q

Which risk calculator is used in the ACC/AHA guidelines?

A

ASCVD risk calculator

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20
Q

What is the basis for the hypothesis of the NLA guidelines?

A

LDL hypothesis

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21
Q

According to the NLA guidelines, LDL levels are targeted with emphasis on using ________ to achieve the goals.

A

statins

22
Q

What risk calculator is used for the NLA guidelines?

A

Framingham risk calculator

23
Q

What should you do if patient is not getting to goal due to intolerance?

A
  • Look for drug interactions
  • Reduce dose by half and see if tolerated
  • Alternative day regimen
  • Try different statin
  • Co-Q10 supplements
  • Ensure muscle soreness is not confused with myalgia
  • Attempt to re-start if symptoms resolve
24
Q

What is the MOA for Ezetimibe?

A

Inhibits NPC1L1 protein, which reduces cholesterol absorption in the small intestine.

25
Q

What is the dose for Ezetimibe?

A
  • 10 mg PO daily

- Take either ≥ 2 hours before or ≥ 4 hours after BAS

26
Q

What are the ADRs with Ezetimibe when used with statin?

A
  • nasopharyngitis, URI
  • myalgia, arthralgia
  • diarrhea
27
Q

What drugs does Ezetimibe interact with?

A
  • cyclosporin
  • fibrates
  • BAS
28
Q

What is the mechanism of action for PCSK9 inhibitors?

A

Human monoclonal antibody to PCSK9. Binds to PCSK9 and increase the number of LDL receptors available to clear circulating LDL.

29
Q

What does PCSK9 do?

A

Removes LDL receptors

30
Q

What are the PCSK9 agents?

A
  • Alirocumab

- Evolocumab

31
Q

How is Alirocumab dosed?

A
  • initiate 75 mg SQ every 2 weeks

- if ineffective, may increase to 150 mg SQ every 2 weeks

32
Q

How is Evolocumab dosed?

A
  • Primary hypercholesterolemia with clinical ASCVD or HeFH: 140 mg SQ every 2 weeks or 420 mg SQ monthly
  • In HoFH give 420 mg SQ monthly
33
Q

What are the ADRs of Alirocumab?

A
  • nasopharyngitis
  • injection site reactions
  • influenza
34
Q

What are the ADRs of Evolocumab?

A
  • nasopharyngitis, URI, influenza
  • back pain
  • injection site reactions
35
Q

What are the drug interactions with PCSK9 inhibitors?

A

There are no clinically significant drug interactions

36
Q

What is the mechanism of action of bile acid sequestrants?

A
  • Non-absorbed, lipid lowering polymer binds bile acids in intestine and impedes their reabsorption.
  • Total bile acid ↓, hepatic enzyme cholesterol (7α-hydroxylase), is unregulated
  • ↑ conversion of cholesterol to bile acids.
37
Q

What are the BAS agents?

A
  • Colesevelam
  • Cholestyramine
  • Colestipol
38
Q

What are the ADRs of BAS?

A
  • constipation
  • dyspepsia
  • nausea
39
Q

What are the drug interactions with BAS?

A
  • cyclosporin
  • glimepiride, glipizide
  • levothyroxine
  • olmesartan + medoxomil
  • OCs
  • phenytoin
  • warfarin
40
Q

How should drug interactions be handled with BAS?

A

Drugs with potential interactions should be taken at least 4 hours after BAS to avoid impeding absorption.

41
Q

What is the MOA for phytosteroids?

A
  • not fully understood

- related ti displacement of cholesterol from micellar phase

42
Q

What are the ADRs of phytosteroids?

A

generally recognized as safe

43
Q

What are drug interactions with phytosteroids?

A

BAS administration should be separated from phytosteroids by 2-4 hours

44
Q

What are unmodifiable patient specific risk factors are considered in the ACC/AHA ASCVD risk estimator?

A
  • gender
  • age
  • race
45
Q

What are patient specific (lab values and vitals that are risk factors considered in the ACC/AHA ASCVD risk estimator?

A
  • total cholesterol
  • HDL cholesterol
  • systolic BP
46
Q

What are patient specific comorbidities that are risk factors considered in the ACC/AHA ASCVD risk estimator?

A
  • treatment for HTN
  • history of diabetes
  • smoker
47
Q

What are patient specific risk factors that are outlined by the NLA?

A
  • age
  • family history
  • current cigarette smoking
  • high BP
  • low HDL
48
Q

What are treatment goals?

A

The measurable endpoint to assist in determining the success of the plan.

49
Q

What are monitoring parameters?

A

The means and frequency you will measure and assess your treatment.

50
Q

How is Non-HDL-C calculated?

A

total cholesterol - HDL

957 Block 3 (6 decks)

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