dyslipidemia

Question 1

what is the process of enterohepatic recycling

Answer 1

bile acid from the liver seeps into the intestines which converts them to salts and returned to the liver
bile seeping into the intestines contain fats

Question 2

what is considered high LDL

Answer 2

> 190

Question 3

what is considered high TG

Answer 3

> 500

Question 4

friedewald equation

Answer 4

LDL=TC-HDL- TG/5
9-12 hours of fasting required

Question 5

what drugs commonly increase LDL and TG

Answer 5

diuretics
efavirenz
steroids
immunosupressants
atypical antipsychotics
protease inhibitor

Question 6

what drugs increase LDL only

Answer 6

fish oil

Question 7

what drugs increase TG only

Answer 7

IV lipids
propofolol
bile acid sequestrants

Question 8

what are the essentials in ASCVD calculations

Answer 8

age race
TC HDL
SBP and HPT meds if yes or not
diabetes or smoking?

Question 9

what natural products help with dyslipedimia

Answer 9

red yeast rice
garlic
OTC fish oils ( can increase LDL)

Question 10

what are some cholesterol lowering drug that can cause liver damage

Answer 10

Fibrates
Statins
ezetimibe
niacin

Question 11

high intensity statin is for pepople with

Answer 11

high ascvd risk >20%
secondary prevention
multiple ASCVD RISK
ELEVATION OF >190

Question 12

MODERATE INTENSITY STatin is used in

Answer 12

low risk patients <20
diabetes regardless of ASCVD

Question 13

what are high intensity statin

Answer 13

atorvastatin 40-80
rosuvastatin 20-40

Question 14

what are low intensity statin

Answer 14

not atorvastatin or rosuvastatin
simva 10
pravastatin 10-20
lova 20
fluvastatin 20-40
pitavastatin 1

Question 15

how to avoid risk of myalgia

Answer 15

avoid gemfibrozil + statin
do not use simva 80mg
avoid OTC drug interaction
hold statin and start with a lower dose

Question 16

how much LDL HDL and TG does statin lowers

Answer 16

LDL by 20-55%
hdl increase by 5-15%
TG by 10-30%

Question 17

what should not be used with statins

Answer 17

CYP 3A4 inhibitors
Grape fruit
PI
cyclosporine
macrolide
azole antifungals

lower simva and lova to 20-40 max
amiodarone
non DHP CCB

Question 18

when to add ezetimibe or PCSK9 inhibitor

Answer 18

when statin is max and LDL still >70

Question 19

what is the MOA of ezetimibe

Answer 19

inhibits absorption of cholesterol in the small intestines

Question 20

what is the MOA of PCSK9 inhibitor

Answer 20

increases LDL receptor degradation
praluent- alirocumab once every 2 weeks
repatha- evolocumab once every 2 weeks

LDL decrease 60%
non- HDL 35%
TC 36%

Question 21

how are bile acids controlled

Answer 21

colesevelam or welchol- can lower A1C by 0.5%
choletyramine-
colestipol- NOT IN pregnant population

** AE- constipation , can increase LDL 5%
seperate other drugs 1-4 hours or 4-6 hours after
can decrease ADEK

Question 22

what are the MOA of fibrates

Answer 22

PPARa activators to increase lipoprotein lipase activity
fenofibrate trillipix
gemfibrozil or lopid

** AE- should not be used with ezetimibe or statins
Dyspepsia
liver damage
gallbladder disease

Question 23

how does niacin work

Answer 23

decreases TG and LDL and increase HDL bingin
also known as VIT B3

titrate slow
**AE - muscle pain, hepatoxic

Question 24

which fish oil can increase LDL

Answer 24

lovaza Omega 3

Question 25

fish oil are used to

Answer 25

decrease TG

**AE- dyspepsia, burping, hypersensitivity to fish or shellfish

Question 26

lomitapide or juxtapid

Answer 26

specialty med
$$$$
evkeeza for primary hyperlipidemia