Clinical Questions Flashcards
What is the desirable LDL level?
< 100
What is the desirable HDL level?
Men >/= 40
Women >/= 50
What is the desirable TG level?
< 150
What medications increase LDL and TG?
Diuretics
Efavirenz
Steroids
Cyclosporine/Tacrolimus
Atypical antipsychotics (Metabolic syndrome! Olanzapine and Quetiapine)
Protease inhibitors
What medications increase LDL only?
Fish oil
What medications increase TG only?
Propofol
IV lipid emulsions
Bile acid sequestrants
What natural supplements help lower TG or chosterol?
Red yeast rice can naturally lower cholesterol
OTC fish oil can lower TG (increases LDL)
A 43 year old male patient with diabetes has and LDL of 90 mg/dL. We do not his ASVCD risk, but he is a non-smoker and has no other comorbidities besides his hypertension, diabetes, and hyperlipidemia. What would be your recommendation to help lower his LDL?
Moderate intensity statin.
Rosuvastatin 10 mg
Atorvstatin 20 mg
Simvastatin (Zocor) 20 mg
Lovastatin (Altoprev) 40 mg
Pravastatin (Pravachol) 80 mg
A 74 yo patient comes in with lab results:
LDL 85
HDL 38
TG 130
His ASCVD risk is 10%. What would you treatment recommendation be?
Moderate intensity statin
Rosuvastatin 10 mg
Atorvstatin 20 mg
Simvastatin (Zocor) 20 mg
Lovastatin (Altoprev) 40 mg
Pravastatin (Pravachol) 80 mg
A 65 yo female patient comes in with labs:
LDL 120
HDL 32
TG 160
PMH: smoker, COPD, HTN, Obsesity,
Her ASVCD risk is 15%.
What treatment would you recommend?
What if her ASVCD was 21% then what would you recommend?
Moderate intensity
ASCVD > 20% recommend High intensity statin:
Rosuvastatin 20 mg
Atorvastatin 40 mg
What LDL level would indicate immediate treatment of high intensity statin?
> /= 190
At what age in diabetic patients do you start to consider statin therapy?
40 years old
What is the statin equivalent doses?
Pitavastatin 2 mg
Rosuvastatin 5 mg
Atorvastatin 10 mg
Simvastatin 20 mg
Lovastatin 40 mg
Pravastatin 40 mg
Fluvastatin 80 mg
A patient is on Simvastatin 40 mg, but can no longer be on it due to drug interaction with Pacerone. What would be the dose equivalent of Rosuvastatin or Atorvastatin? What intensity are these?
Rosuvastatin 10 mg
Atorvastatin 20 mg
Medium intensity
How much of a decrease in LDL do you expect with statin therapy?
20 - 55%
A 55 yo patient has HLD. He is currently on Pravachol 80 mg. His PMH includes: Obesity, HTN. His LDL today is 150. What would your recommendation be?
After 3 months on your recommendation, his LDL is still 120.
Increase to a high intensity statin
Add Ezetimibe
A patient is on Crestor 40 mg daily and Zetia 10 mg daily for primary hypercholesterolemia. During follow-up the LDL was 110 mg/dL. What would be your next recommendation?
Add PSK9 inhibitor
- Alirocumab (Praluent)
-Evolocumab (Repatha)
A patient is taking Cardizem, Prilosec, Zetia, and Zocor. What drug interaction do you need to watch out for? What are to dosing recommendations?
Cardizem (Diltiazem) and Zocor (Simvastatin)
CYP3A4 inhibitor with substrate
MAX Simvastatin dose is 10 mg/day (lova 20 mg/day)
A patient is taking Pacerone, Naproxen, Zetia, and Zocor. What drug interaction do you need to watch out for? What are to dosing recommendations?
Pacerone (amiodarone) and Zocor (Simvastatin
CYP3A4 inhibitor with substrate
MAX simvastatin dose is 20 mg/day (Lova 40 mg/day)
When are fish oils indicated?
adjunct to diet when TG are >/= 500
*** Vascepa is indicated in high risk (ASCVD) diabetic patients when TG are 150 - 499
What treatment for high TG can prolong the bleeding time when use in combination with warfarin?
Fish oils - Lovaza and Vascepa
What formulation of Niacin is the best?
Niaspan
decreased flushing and hepatotoxicity!!!
What do all 3 formulations of Niacin need to be taken with?
FOOD
**take Niaspan with a low fat snack at bedtime
What natural supplements may help at lowering BP?
Fish oil
Coenzyme Q10
L-arginine
garlic
