Dyslipidemia

Question 1

Friedewald equation

Answer 1

LDL = TC - HDL - (TG/5)

Question 2

what are the two high intensity statins?

Answer 2

atorvastatin 40-80mg
rosuvastatin 20-40mg

Question 3

what are the two hydrophilic statins?

Answer 3

pravastatin
rosuvastatin

*also lower risk

Question 4

4 statin contraindications

Answer 4

-acute liver disease
-unexplained, persistent elevations of serum transaminases
-pregnancy
-breastfeeding

Question 5

drugs that are contraindicated with simvastatin

Answer 5

itraconazole, ketoconazole, posaconazole
erythromycin, clarithromycin, telithromycin
HIV protease inhibitors
gemfibrozil
cyclosporine
nefazodone
danazol

Question 6

do not exceed 10mg simvastatin daily with….

Answer 6

verapamil
diltiazem

Question 7

do not exceed 20mg simvastatin daily with…

Answer 7

amiodarone
amlodipine
ranolazine

Question 8

statin monitoring: when should FLP be assessed?

Answer 8

1. baseline
2. 4-12 weeks following initiation of statin
3. every 3-12 months

Question 9

cholestyramine contraindications

Answer 9

complete biliary obstruction

Question 10

colesevelam contraindications

Answer 10

Hx bowel obstruction
serum TG > 500mg/dL
Hx hypertriglyceridemia-induced pancreatitis

Question 11

niacin contraindications

Answer 11

1. active hepatic disease
2. unexplained persistent liver transaminase elevations
3. active peptic ulcer
4. arterial hemorrhage

Question 12

fibrates contraindications

Answer 12

1. history of gallbladder disease
2. ESRD or dialysis
3. persistent liver disease

Question 13

fibrates increase the levels of which drugs?

Answer 13

1. statins
2. ezetimibe
3. sulfonylureas
4. warfarin

Question 14

mechanism of action of PCSK9 inhibitors:

Answer 14

inhibits the binding of PCSK9 to LDL receptors, (since PCSK9 breaks down LDL receptors which causes our serum cholesterol to increase)

Question 15

mechanism of action of statins

Answer 15

inhibit HMG CoA-reductase, which ultimately inhibits cholesterol synthesis

Question 16

mechanism of action of bile acid resins

Answer 16

reduce reabsorption of bile acids, which increases synthesis of bile acids from cholesterol

Question 17

what do statins and bile acid resins have in common?

Answer 17

they both reduce liver cholesterol which drives upregulation of LDL receptors in the liver

Question 18

Upregulation of LDL receptors in the liver leads to ___________ serum cholesterol

Answer 18

reduced

Question 19

Which statins are taken at night? Why?

Answer 19

Simvastatin, Lovastatin, Fluvastatin, Pravastatin

short half-life, so they work better on nocturnal cholesterol synthesis

Question 20

When should bile acids be taken?

Answer 20

Before meals