1. Hyperlipidemia Flashcards
What is the leading cause of death in America?
cardiovascular disease
For every __mg/dL decrease in LDL, there is a ~__% reduction in risk of CV events over 5 years.
38
25%
What is the cornerstone of therapy for hyperlipidemia?
Statins
Statins should only be used in severe or symptomatic hyperlipidemia. (T/F)
False: Statins should be used in all patients who meet criteria for treatment of hyperlipidemia and do not have a contraindication.
In patients with ASCVD, what intensity statin should be used?
high
In patients with LDL ≥ 190 mg/dL, what intensity statin should be used?
high
In patients aged 40-75 with diabetes and/or LDL 70-189 mg/dL, what intensity statin should be used?
moderate
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?
high
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?
moderate to high
What are high intensity statin regimens?
Atorvastatin 40-80 mg
Rosuvastatin 20-40 mg
What are moderate intensity statin regimens?
Atorvastatin 10-20 mg Rosuvastatin 5-10 mg Simvastatin 20-40 mg Pravastatin 40-80 mg Lovastatin 40 mg
What are low intensity statin regimens?
Simvastatin 10 mg
Pravastatin 10-20 mg
Lovastatin 20 mg
What is the goal for NLA guidelines?
specific LDL levels
According to the NLA guidelines, who are the high/very high risk patients?
diabetes
CKD
LDL > 190
ASCVD
What is the goal for ACC/AHA guidelines?
% reduction
What is the basis for the hypothesis of the ACC/AHA guidelines?
statin hypothesis
In the ACC/AHA guidelines, LDL level specific goals are __________.
abandoned
What is the basis for recommending statin regimens in the ACC/AHA guidelines?
statin intensity targets
Which risk calculator is used in the ACC/AHA guidelines?
ASCVD risk calculator
What is the basis for the hypothesis of the NLA guidelines?
LDL hypothesis
According to the NLA guidelines, LDL levels are targeted with emphasis on using ________ to achieve the goals.
statins
What risk calculator is used for the NLA guidelines?
Framingham risk calculator
What should you do if patient is not getting to goal due to intolerance?
- 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
What is the MOA for Ezetimibe?
Inhibits NPC1L1 protein, which reduces cholesterol absorption in the small intestine.
What is the dose for Ezetimibe?
- 10 mg PO daily
- Take either ≥ 2 hours before or ≥ 4 hours after BAS
What are the ADRs with Ezetimibe when used with statin?
- nasopharyngitis, URI
- myalgia, arthralgia
- diarrhea
What drugs does Ezetimibe interact with?
- cyclosporin
- fibrates
- BAS
What is the mechanism of action for PCSK9 inhibitors?
Human monoclonal antibody to PCSK9. Binds to PCSK9 and increase the number of LDL receptors available to clear circulating LDL.
What does PCSK9 do?
Removes LDL receptors
What are the PCSK9 agents?
- Alirocumab
- Evolocumab
How is Alirocumab dosed?
- initiate 75 mg SQ every 2 weeks
- if ineffective, may increase to 150 mg SQ every 2 weeks
How is Evolocumab dosed?
- 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
What are the ADRs of Alirocumab?
- nasopharyngitis
- injection site reactions
- influenza
What are the ADRs of Evolocumab?
- nasopharyngitis, URI, influenza
- back pain
- injection site reactions
What are the drug interactions with PCSK9 inhibitors?
There are no clinically significant drug interactions
What is the mechanism of action of bile acid sequestrants?
- 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.
What are the BAS agents?
- Colesevelam
- Cholestyramine
- Colestipol
What are the ADRs of BAS?
- constipation
- dyspepsia
- nausea
What are the drug interactions with BAS?
- cyclosporin
- glimepiride, glipizide
- levothyroxine
- olmesartan + medoxomil
- OCs
- phenytoin
- warfarin
How should drug interactions be handled with BAS?
Drugs with potential interactions should be taken at least 4 hours after BAS to avoid impeding absorption.
What is the MOA for phytosteroids?
- not fully understood
- related ti displacement of cholesterol from micellar phase
What are the ADRs of phytosteroids?
generally recognized as safe
What are drug interactions with phytosteroids?
BAS administration should be separated from phytosteroids by 2-4 hours
What are unmodifiable patient specific risk factors are considered in the ACC/AHA ASCVD risk estimator?
- gender
- age
- race
What are patient specific (lab values and vitals that are risk factors considered in the ACC/AHA ASCVD risk estimator?
- total cholesterol
- HDL cholesterol
- systolic BP
What are patient specific comorbidities that are risk factors considered in the ACC/AHA ASCVD risk estimator?
- treatment for HTN
- history of diabetes
- smoker
What are patient specific risk factors that are outlined by the NLA?
- age
- family history
- current cigarette smoking
- high BP
- low HDL
What are treatment goals?
The measurable endpoint to assist in determining the success of the plan.
What are monitoring parameters?
The means and frequency you will measure and assess your treatment.
How is Non-HDL-C calculated?
total cholesterol - HDL
