Cardio-Dyslipidemia

Question 1

LDL preferred value

Answer 1

< 100 mg/dl

Question 2

HDL preferred value

Answer 2

> 40 mg/dl in men

> 50 mg/dl in women

Question 3

TG preferred value

Answer 3

< 150 mg/dl

>300 - 500 mg/dl really bad

Question 4

LDL calculation

Answer 4

TC - HDL - TG/5

Question 5

Natural products to treat dyslipidemia

Answer 5

fish oil
garlic
fibrous foods
niacin

Question 6

Drugs that increase LDL/TG levels

Answer 6

• Protease Inhibitors
• Atypical antipsychotics
• STEROIDS
• DIURETICS
• cyclosporine/ tacrolimus

Question 7

Drugs that increase TG levels only

Answer 7

• IV lipid emulsions
• propofol (propofol holidays)
• ETOH
• Beta-blockers

Question 8

Drugs that increase LDL levels only

Answer 8

• Fibric acids
• SGLT2 inhibitors (DM)
• TZDs (DM)

Question 9

What is considered Clinical ASCVD events (CA-STAMP)

Answer 9

• Coronary/arterial re-vascularization
• Angina
• Stroke
• TIA
• ACS
• MI
• PAD

Question 10

Name the STATINS in order from most potent to least potent.

Answer 10

Pharmacist Rock At Saving Lives/ Preventing Flu
P- pitavastatin 2 mg
R- rouvastatin 5 mg
A- atorvastatin 10 mg 
S- simvastatin 20 mg 
L- lovastatin 40 mg 
P- pravastatin 40 mg
F- fluvastatin 80 mg

Question 11

Name the appropriate STATIN therapy:

Clinical ASCVD less than or equal to age 75

Answer 11

HIGH intensity

Question 12

Name the appropriate STATIN therapy:

Clinical ASCVD greater than age 75

Answer 12

MODERATE intensity

Question 13

Name the appropriate STATIN therapy:

LDL > or equal to 190 mg/dl

Answer 13

HIGH intensity

Question 14

Name the appropriate STATIN therapy:
DM + elevated LDL (<190 mg/dl) + < 75 years of age
10-yr ASCVD > or equal to 7.5%

Answer 14

HIGH intensity

Question 15

Name the appropriate STATIN therapy:
DM + elevated LDL (<190 mg/dl) + < 75 years of age
10-yr ASCVD < 7.5%

Answer 15

MODERATE intensity

Question 16

Name the appropriate STATIN therapy:
Elevated LDL (<190 mg/dl) + < 75 years of age
10-yr ASCVD > or equal to 7.5%

Answer 16

MODERATE- HIGH intensity

Question 17

Name the appropriate STATIN therapy:
Elevated LDL (<190 mg/dl) + < 75 years of age
10-yr ASCVD < 7.5%

Answer 17

consider risk/benefit

Question 18

STATIN MOA/ Toxicities

Answer 18

HMG CoA Reductase Inhibitor- inhibits rate-limiting step in cholesterol production by breaking down the enzyme that yields cholesterol conversion

H- hepatoxicity
M- myalgias/myopathy/ muscle break down (elevated CPK)
G- glucose

Question 19

What statins must taken in the evening?

Answer 19

Simvastatin
Lovastatin
Fluvastatin

Question 20

What statins have limited dosing when taking with CYP 3A4 inhibitors?

Answer 20

Simvastatin

Lovastatin

Question 21

What is the max dose of SIMVASTATIN when taken with CCB and amiodarone?

Answer 21

Max 10 mg/day: verapamil and diltiazem (Non-DHP)

Max 20 mg/day: amiodarone and amlodipine

Question 22

Can atorvastatin be taken with cyclosporine?

Answer 22

NO- AVOID this combination

Question 23

Azoles, Macrolides, Protease Inhibitors and Cyclosporins should be avoided with what 2 statins?

Answer 23

Simvastatin and Lovastatin

Question 24

Name the drug class:

Works by blocking cholesterol absorption in the small intestines.

Answer 24

Zetia (ezetimibe)

Vytorin: simavastatin + zetia

Question 25

Name the drug class:

Works by binding bile acid and excreting it in the feces

Answer 25

BAS- bile acid sequestrants

Welchol (colesevalam)

Question 26

Name the drug class:

Works by activating PPAR-alpha

Answer 26

Fibrates

• gemfibrozil
• fenofibrate

Question 27

What CAN NOT be taken with fenofibrate due to increased risk of myopathy?

Answer 27

statins and zetia

Question 28

What drug TX can increase TGs?

Answer 28

BAS

Question 29

What drug TX can increase LDLs?

Answer 29

Fibrates~ if TGs levels are high.
Fish Oils
-Lovaza- omega-3-acid
-Vescepa- lcosapent ethyl esters
-Epanova- omega-3-COOH

Question 30

What drug TX can increase bleeding risk?

Answer 30

Fish oils

Question 31

What drug TX can cause flushing and hepatoxicity? What can you take to relieve the flushing?

Answer 31

Niacin IR (Niacor)
Niacin ER (Niaspan)
Niacin SR (Slo-Niacin)

-ASA or NSAID 30 minutes before

Question 32

How long should medications be separated when taking BSAs?

Answer 32

• 1 to 4 hours before or 4 to 6 hours after

Question 33

Can fibrates be taken with food?

Answer 33

Yes, 30 minutes before breakfast and dinner
Lopid (gemfibrozil)
ALSO…
Fenoglide, Lipofen (Tricor)
Other brand names: Antara, Tricor, Trilipix

Question 34

What statin must be taken with food?

Answer 34

lovastatin IR

Question 35

PCSK9 inhibitors (2)

Answer 35

ALIrocuMAB (Praluent)- sc q2wks

EVOlocuMAB (Repatha)- sc q2wks or qmonth

Question 36

Which PCSK9 inhibitor is indicated for familial, primary dyslipidemia and decreased CV events?

Answer 36

EVOlocuMAB (Rapatha)

Question 37

What are the most common SE associated with fish oils?

Answer 37

Dsypepsia, Erutation (burping), taste perversions 
Epanova only (flatulence- gas)

Question 38

Which formulation of Niacin has the highest risk of hepatoxicity?

Answer 38

Niacin (immediate release niacin)

Question 39

Vitamin B3 is also known as

Answer 39

Niacin

Question 40

General Niacin SEs

Answer 40

flushing, increase in UA, increase in BG

Question 41

Which STATIN can be considered in patient’s with renal impairment or CrCl <30 ml/min?

Answer 41

Lipitor (atorvastatin)

Question 42

When can BSA’s NOT be used?
Welchol (colesevelam)
Questran (Cholestyramine)

Answer 42

-TG > 500 mg/dl
- bowel obstruction
Welchol- safe in pregnancy

Question 43

When can fibrates NOT be used?

Answer 43

• gallbladder disease
• renal impairment CrCl < 30 ml/min
• severe liver disease

Question 44

What do Niacins, Statins and Fibrates all have in common?

Answer 44

LFTs must be monitored due to risk of hepatoxicity