Dyslipidemia

Question 1

Omega-3 MOA

Answer 1

• Lowers TG by 60%

- Unclear how exactly - decreases hepatic circulation of TGs OR decreases TG synthesis

Question 2

ADEs of omega 3

Answer 2

Fishy burp

Indigestion

Question 3

When are omega 3s given?

Answer 3

TG over 500 mg/dL

Question 4

Cholesterol absorption inhibitor MOA and examples

Answer 4

Decrease intestinal absorption of dietary and biliary cholesterol
(Ezetimibe)

Question 5

Metabolism of cholesterol absorption inhibitors

Answer 5

Glucuronidation w/an active metabolite

advantage - NO CYP

Question 6

Which lipid lowering med is metabolized via glucuronidation (therefore no CYP interactions)?

Answer 6

Cholesterol absorption inhibitors

Question 7

Cholesterol absorption inhibitors and ASCVD risk

Answer 7

Lowers LDL but NOT proven to lower ASCVD risk

Question 8

Fibrates MOA and examples

Answer 8

• Activate PPAR-alpha (metabolism/catabolism of lipids)

- Gemfibrozil, fenofibrate

Question 9

Nicotinic acid MOA

Answer 9

Decreases TG synthesis (maybe in adipose tissue?)

Question 10

ADEs of nicotinic acids

Answer 10

Flushing, N/V, myopathy

Question 11

How to combat flushing with nicotinic acid?

Answer 11

Take full dose of aspirin (325 mg)

Question 12

Bile acid sequestrants MOA and examples

Answer 12

• Anion exchange resins that bind to bile acids (excreted in feces)
• Cholestyramine, colestipol

Question 13

How are bile acid sequestrants metabolized?

Answer 13

Not absorbed or metabolized (excreted in feces)

Question 14

ADEs of bile acid sequestrants

Answer 14

GI - flatulence, abdominal pain, constipation, N/V

Question 15

Statins MOA

Answer 15

Inhibit HMG-CoA reductase (rate limiting step of cholesterol synthesis)

Question 16

ADEs of statins

Answer 16

Dizziness, HA, abdominal pain, myopathy

Question 17

Statins lowest to highest potency

Answer 17

Fat People Love Seconds At Restaurants

also the order of short to long half life

Question 18

Which statin is NOT CYP metabolized?

Answer 18

Pravastatin (sulfation)

Question 19

Which statin has LOW protein binding?

Answer 19

Pravastatin

Question 20

Which statins are NOT lipophilic?

Answer 20

Pravastatin

Rosuvastatin

Question 21

Substances that INCREASE statin concentrations

Answer 21

Nicotinic acid, fibrates
Azole antifungals
Macrolide abx
Amiodarone
Grapefruit juice
ETOH

Question 22

What labs should be checked at baseline prior to a lipid lowering med being added?

Answer 22

Fasting lipid panel
ALT
CK
Glucose (fasting or A1c)

Question 23

What lab should be checked at baseline prior to adding niacin?

Answer 23

Uric acid

Question 24

What lab should be checked at baseline prior to adding bile acid sequestrants?

Answer 24

TGs

Question 25

What lab should be checked at baseline prior to adding fibrates?

Answer 25

Serum Cr or GFR

Question 26

Factors useful for assessing ASCVD risk

Answer 26

Family hx
CRP over 2
CAC over 300
ABI less than 0.9

Question 27

Factors that are NOT useful for assessing ASCVD risk

Answer 27

ApoB
CKD
Albuminuria
Cardiorespiratory fitness
Carotid intima media thickness (CIMT)

Question 28

How should adults 20-79 yo w/o current ASCVD be screened?

Answer 28

Assess traditional risk factors every 4 to 6 years

Question 29

How should adults 40-79 yo w/o current ASCVD be screened?

Answer 29

Estimate 10 yr ASCVD risk every 4-6 years

Question 30

Patient education on prescribing a statin?

Answer 30

It is to reduce risk of heart attack and stroke

Question 31

Patients on a statin should contact provider when what occurs?

Answer 31

Unexplained muscle pain

Change in urine color (dark brown)

Question 32

Safety monitoring of statins

Answer 32

• ALT and AST (only as needed)

- Myopathy symptoms (test CK as needed)

Question 33

What is the goal of treatment if TGs are over 1000 mg/dL?

Answer 33

Emergent! Avoid acute pancreatitis

• Goal is to decrease TG levels rather than long term prevention of ASCVD
• Use fibrates (niacin and omega 3 can also be considered)

Question 34

How is the ASCVD 10 yr risk used?

Answer 34

ONLY in statin naive patients

Question 35

What intensity statin in 40-75 yo and ASCVD over 7.5%?

Answer 35

Moderate OR high intensity

Question 36

What intensity statin in 40-75 yo with DM?

Answer 36

Moderate intensity

Question 37

What intensity statin in 21 yo or older and LDL over 190?

Answer 37

High