Dyslipidemia

Question 1

what pt populations would benefit the most from statins

Answer 1

-clinical ASCVD
-baseline LDL>190
-DM
-Primary prevention

Question 2

HMG CoA Reductase Inhibitors (Statins) medications

Answer 2

-pravastatin
-fluvastatin
-lovastatin
-simvastatin
-pitavastatin
-atorvastatin
-rosuvastatin

Question 3

Statins mechanism of action

Answer 3

-inhibit HMG-CoA reductase
-decrease cholesterol synthesis in liver
-increase hepatic LDL receptors

Question 4

Potential benefits of Statins

Answer 4

-Reduce LDL
-Reduce plaque progression
-Regression of plaque
-Improved endothelial function
-Plaque stabilization
-Antiplatelet activity
-Antioxidation
-Antiinflammatory

Question 5

High-Intensity Statin medication and dosing

Answer 5

-Atorvastatin 40-80 mg/day
-Rosuvastatin 20 mg/day

Question 6

Moderate-Intensity Statin medication and dosing

Answer 6

-Atorvastatin 10-20 mg/day
-Rosuvastatin 10 mg/day
-Simvastatin 20-40 mg/day
-Pravastatin 40 mg/day
-Lovastatin 40 mg/day
-Fluvastatin 40 mg BID
-Pitavastatin 2-4 mg/day

Question 7

Prodrug Statins

Answer 7

-Lovastatin
-Simvastatin

Question 8

Statin adverse effects

Answer 8

-myalgias, GI, headache
-elevated ALT/AST
-myopathy with elevated CPK is rare
-contraindicated in pregnancy

Question 9

Fibric Acid Derivatives indication

Answer 9

to reduce triglycerides that are >500

Question 10

Fibric Acid Derivative medications

Answer 10

-Gemfibrozil - cannot combine with any other statin due to risk of myopathy

-Fenofibrate
-Fenofibric acid

Question 11

Fibric Acid Derivative adverse effects

Answer 11

-may cause elevation in INR in warfarin-treated pts

-use caution in renal dysfunction, dyspepsia, gallstones, myopathy

Question 12

Nicotinic acid (niacin) action

Answer 12

increase in HDL-C

Question 13

niacin adverse effects

Answer 13

-flushing - more with IR formula,
recommend taking 325mg aspirin 30
mins prior to minimize
-hepatotoxicity - more with ER formula
-Hyperglycemia
-hyperuricemia
-gastrointestinal upset

avoid in pts with DM, gout, PUD

Question 14

Bile Acid Sequestrants medications

Answer 14

-Cholestyramine
-Colestipol
-Colesevelam

Question 15

Bile Acid Sequestrants mechanism of action

Answer 15

Bind bile acid to form an insoluble complex

-cholesterol is a major precursor of bile acid

Question 16

Bile Acid Sequestrants adverse effects

Answer 16

-potential to increase triglycerides
-nausea, bloating, and cramping are most
common-colesevelam less likely to cause
-bind to and impair absorption of other
medications

Question 17

Ezetimibe mechanism of action

Answer 17

impairs dietary cholesterol absorption

Question 18

Ezetimibe adverse effects

Answer 18

minimal
-may increase LFTs

Question 19

Proprotein convertase subtilisin kexin-9 (PCSK9) - inhibitors medications

Answer 19

-Evolocumab (Repatha)
-Alirocumab (Praluent)

dosed as subQ injection every 2-4 weeks
only approved to be used in combination with a statin