Dyslipidemia

Question 1

non HDL cholesterol goal

Answer 1

<130

Question 2

LDL goal no ASCVD or DM

Answer 2

<100

Question 3

HDL goal

Answer 3

> 40 men
50 women

Question 4

TG goal

Answer 4

<150

Question 5

LDL equation

Answer 5

LDL = TC - HDL - TG/5

Question 6

ASCVD events

Answer 6

MI, stroke/TIA, stable angina, PAD

Question 7

what medications increase LDL only

Answer 7

fibrates
non-Vascepa fish oils

Question 8

what medications increase TG only

Answer 8

IV lipids
propofol
clevidipine
BAS

Question 9

what medications increase both LDL and TG

Answer 9

diuretics
efavirenz
CYA
tacro
atypical APs
protease-i

Question 10

when should a statin always be started

Answer 10

DM
clinical ASCVD secondary prevention
LDL 190+

Question 11

patient 63yo male with a PMH significant for MI, t2DM x3 years
What intensity statin should they be on?
What is the LDL goal?

Answer 11

diabetics with ASCVD hx should always be put on a high intensity statin
LDL goal is <55 due to ASCVD event and risk

Question 12

patient 69yo female a PMH of OP, RA, gout and depression. LDL 195
What intensity statin should they be on?
What is the LDL goal

Answer 12

high, all patients with an LDL 190+ should be placed on high intensity statin regardless of ASCVD or DM status
LDL goal is <100

Question 13

LDL goals

Answer 13

no ASCVD +/- DM–> <70
ASCVD or high risk –> <55
no ASCVD or DM –> <100

Question 14

moderate intensity statins

Answer 14

rosuvastatin 5-10
atorvastatin 10-20
simvastatin 20-40
lovastatin 40
pravastatin 40-80
fluvastatin 80

Question 15

moderate intensity statins

Answer 15

rosuvastatin 5-10
atorvastatin 10-20
simvastatin 20-40
lovastatin 40
pravastatin 40-80
fluvastatin 80

Question 16

moderate intensity statins

Answer 16

rosuvastatin 5-10
atorvastatin 10-20
simvastatin 20-40
lovastatin 40
pravastatin 40-80
fluvastatin 80

Question 17

high intensity statins

Answer 17

rosuvastatin 20-40
atorvastatin 40-80

Question 18

how should a lipid panel be monitored in dyslipidemia

Answer 18

q4-12 weeks after initiation or dose change then yearly thereafter

Question 19

which are the hydrophilic statins

Answer 19

rosuvastatin
pravastatin

Question 20

what medications inhibit statin metabolism via 3A4

Answer 20

G PACMAN
grapefruit
protease-i
azole antifungals
cya, cisplatin
macrolides (erythro, clarithro)
amiodarone
non-DHP CCB (dilt, verap)

Question 21

when do we initiate add on treatment to statins

Answer 21

when the patient is on a maximally tolerated statin

Question 22

zetia
avoid in …
dosing
LDL lowering %?

Answer 22

avoid in pregnancy, breast feeding, liver disease
10mg po qd
dec LDL 18-23%

Question 23

PCSK9i
medications in class (brand and generic)
LDL and HDL lowering expected

Answer 23

alirocumab (Praluent)
evolocumab (Repatha)
dec LDL ~60%
dec HDL ~36%

Question 24

which drugs are the BAS?
effects on lipids?
CI?

Answer 24

colesevelam (Welchol)
cholestyramine
dec LDL 10-30%, inc TG 5%
CI in TG >500, bowel obstruction, inc TG 2/2 pancreatitis

Question 25

which lipid-lowering drug is safe in pregnancy

Answer 25

colesevelam (Welchol)

Question 26

which lipid lowering drugs impair absorption of ADEK, folic acid and iron

Answer 26

BAS (colesevelam, cholestyramine)

Question 27

when is it appropriate to initiate fish oil

Answer 27

when TG 500+

Question 28

which fish oil increases LDL?

Answer 28

omega-3 acid ethyl esthers (Lovaza)

Question 29

fish oil will decrease TG by ___%

Answer 29

45%

Question 30

which meds are fibrates

Answer 30

fenofibrate (Tricor) and gemfibrozil (Lopid)

Question 31

when is fenofibrate CI

Answer 31

gallbladder disease, CrCl </=30, severe liver disease

Question 32

when is gemfibrozil CI

Answer 32

gallbladder disease, CrCl </=30, severe liver disease, use with simvastatin, repaglinide, zetia, statins, SUs, warfarin, colchicine

Question 33

Niacin major SE

Answer 33

flushing and liver toxicity

Question 34

BAS counseling points

Answer 34

take w meals
constipation
dec absorption of ADEK, Fe, folate

Question 35

fibrates can cause

Answer 35

cholelithiasis
pancreatitis

Question 36

PCSK9-inhibitors Repatha and Praluent are good at room temp for

Answer 36

30 days