Dyslipidemia

Question 0

Brand Name of fluvastatin

Answer 0

Lescol®

Question 1

Brand Name of lovastatin

Answer 1

Mevacor®

Question 2

Brand Name of pravastatin

Answer 2

Pravachol®

Question 3

Brand Name of simvastatin

Answer 3

Zocor®

Question 4

Brand Name of atorvastatin

Answer 4

Lipitor®

Question 5

Brand Name of rosuvastatin

Answer 5

Crestor®

Question 6

Brand Name of pitavastatin

Answer 6

Livalo®

Question 7

Patient Education for fluvastatin

Answer 7

Take with evening meal

Question 8

Patient Education for lovastatin

Answer 8

Take at bedtime. Avoid grapefruit juice.

Question 9

Patient Education for pravastatin

Answer 9

Take at bedtime.

Question 10

Patient Education for simvastatin

Answer 10

Take at bedtime. Avoid grapefruit juice.

Question 11

Patient Education for atorvastatin

Answer 11

May be taken any time of the day. Avoid grapefruit juice?

Question 12

Patient Education for pitavastatin

Answer 12

May be taken any time of the day.

Question 13

Patient Education for rosuvastatin

Answer 13

May be taken any time of the day.

Question 14

Name the three Bile Acid Sequestrants

Answer 14

colestipol (Colestid®)
cholestyramine (Questran®)
colesevelam (Welchol®)

Question 15

While Bile Acid Sequestrants can moderately decrease LDL levels (8-30%), and mildly increase HDL levels (3-5%), what is a major concern with this class of medication?

Answer 15

TGs can increase 12-15% with colestipol (Colestid®), and 12-25% with cholestyramine (Questran®). However, this effect is not seen with colesevelam (Welchol®).

ABSOLUTE CONTRAINDICATION FOR PTS WITH SEVERE HYPERTRIGLYCERIDEMIA.

Question 16

What are the Adverse Drug Reactions (ADRs) seen with Bile Acid Sequestrants (BAS)?

Answer 16

Constipation
Abdominal pain
Bloating
Fullness
Nausea
Flatulence
*These ADRs are less prevalent with colesevelam (Welchol®).

Question 17

What is the usual daily dose in divided doses, the (max daily dose), and the available preparations for cholestyramine (Questran®)?

Answer 17

4-16g (24g)

Powder

Question 18

What is the usual daily dose in divided doses, the (max daily dose), and the available preparations for colestipol (Colestid®)?

Answer 18

5-20g (30g)

Powder and tablet

Question 19

What is the usual daily dose in divided doses, the (max daily dose), and the available preparations for colesevelam (Welchol®)?

Answer 19

2.6-3.8g (4.4g)

Tablet and powder

Question 20

When counseling a patient about how to properly take a Bile Acid Sequestrant powder, how would you tell the patient to mix the powder and take the medication?

Answer 20

Tell the patient to mix powders with noncarbonated beverages such as juice, milk, or water. Be sure to ADD THE BEVERAGE TO THE POWDER, and drink immediately upon mixing. Drink the powders in divided doses twice a day before meals.

Question 21

How should a patient take a bile acid sequestrant with respect to their other medications?

Answer 21

Take BAS 4 hours before other medications. (Or one hour after other medications.)

Question 22

When taking a Bile Acid Sequestrant tablet, what should the patient always do?

Answer 22

Take the BAS tablet with a large glass of water.

Question 23

What is the only Cholesterol Absorption Inhibitor? What is its brand name and usual dosing?

Answer 23

ezetimibe (Zetia®)
10 mg daily

*Also available in combination with simvastatin (Vytotin®).

Question 24

What are three drug interactions seen with ezetimibe (Zetia®)?

Answer 24

gemfibrozil, cyclosporine, cholestyramine

Question 25

What are the rare side effects that can be seen see with the generally well tolerated cholesterol absorption inhibitor, ezetimibe (Zetia®)?

Answer 25

arthralgia diarrhea possible cholelithiasis

Question 26

What are the three formulations of Nicotinic Acid and what are their general effects on cholesterol?

Answer 26

immediate release niacin (Niacor®) sustained release niacin (Slo-Niacin®) extended release niacin (Niaspan®) LDL decrease: 10-25% HDL increase: 15-26% TG decrease: 20-40%

Question 27

What are some of the common side effects seen with niacin therapy?

Answer 27

``` FLUSHING itching hyperglycemia gout hepatotoxicicity (esp. with Niaspan®) ```

Question 28

What are a few key counseling points for patients taking niacin (especially with regards to flushing, food, and missed doses)?

Answer 28

Take 325 mg aspirin 30 minutes before taking niacin to minimize flushing. In order to protect the stomach, enteric coated aspirin is preferred. Take with food. If you miss a dose, skip it. NEVER DOUBLE UP.

Question 29

Name the two fibric acid derivatives (fibrates).

Answer 29

gemfibrozil | fenofibrate

Question 30

In general, fibrates have mixed effects on LDL, increase HDL from 10-30%, and have what effect on TGs?

Answer 30

Decrease TGs anywhere from 30-50%.

Question 31

Which fenofibrate formulations MUST be taken with food?

Answer 31

LoFibra (67, 134, 200 mg) original Tricor (54, 160 mg) Lipofen (50, 100, 150 mg)

Question 32

Which fenofibrates may be taken WITHOUT regard to food?

Answer 32

New Tricor (48 and 145 mg tablets) Antara (43 and 130 mg capsules) Triglide (50 and 160 mg tablets- no chipped or broken tablets) Trilipix (45 and 135 mg capsules- indicated with statins)

Question 33

Name the N3 Fatty Acids (fish oil) available as Rx only.

Answer 33

Lovaza

Question 34

By what percentage can N3 Fatty Acids decrease TGs?

Answer 34

35%

Question 35

How should N3 Fatty Acids be dosed and how may a patient minimize the fishy taste?

Answer 35

Dose 2 to 4 grams of EPA+DHA daily. | Refrigerate to minimize fishy taste.

Question 36

What is the pooled cohort equation and what does it estimate?

Answer 36

It is a risk calculator developed by the NHLBI Work Group. It estimates the 10-year hard ASCVD risk of 1st event. (Non-fatal MI, CHD death, fatal or non-fatal stroke)

Question 37

The pooled cohort equation is best used in which populations?

Answer 37

Non-Hispanic Caucasians and African Americans Aged 40-79 Those with LDL levels 70-189 mg/dL with and without diabetes

Question 38

The pooled cohort equation tends to OVERESTIMATE risk in which races?

Answer 38

Hispanics | Asians

Question 39

The pooled cohort equation tends to UNDERESTIMATE risk in which race?

Answer 39

American Indians

Question 40

Novel risk markers would be used when therapy decisions remain uncertain after quantitative risk assessment. What are examples of novel risk markers?

Answer 40

Premature CVD in family history hs-CRO CAC score* ABI *Some evidence says that CAC score may be the most useful marker.

Question 41

Premature CVD in family history is a novel risk marker. What would be a positive risk indicator for this?

Answer 41

1st degree relative Male < 55 yo Female < 65 yo

Question 42

hs-CRP is a novel risk marker. What would be a positive risk indicator for this?

Answer 42

> or equal to 2 mg/L

Question 43

CAC score is a novel risk marker. What would be a positive risk indicator for this?

Answer 43

> or equal to 300 Agatston units or > or equal to 75th percentile for age, sex, ethnicity

Question 44

ABI is a novel risk marker. What would be a positive risk indicator for this?

Answer 44

< 0.9

Question 45

For the screening and management of risk for ages 40-79 without ASCVD, what

Answer 45

Complete later