Dyslipidemia

Question 1

High Intensity Statins

Answer 1

• Decrease LDL 50% or more
  
  • atorvastatin (Lipitor) 40-80 mg daily
  • rosuvastatin (Crestor) 20-40 mg daily
    
    • THESE TWO DONT HAVE LOW DOSE

Question 2

Mod Intensity Statins

Answer 2

• Decrease LDL 30-49%
  
  • atorvastatin (Lipitor) 10-20mg
  • rosuvastatin (Crestor) 5-10mg
  • simvastatin (Zocor) 20-40mg
  • fluvastatin (Lescol) 40 mg BID, Lescol XL 80mg 80mg
  • lovastatin (Mevacor) 40mg
  • pitavastatin (Livalo) 2-4mg
  • pravastatin (Pravachol) 40-80mg

Question 3

low intensity statins

Answer 3

• decrease LDL 30% or less
  
  • simvastatin (Zocor) 10mg
  • pravastatin (Pravachol) 10-20
  • lovastatin (Mevacor) 20
  • fluvastatin (Lescol) 20-40mg
  • pitavastatin (Livalo) 1mg
    
    • ITS THE MODERATE STATINS - THE TWO HIGH STATINS and excluding fluvastatin XL

Question 4

Equivalent statin doses

Answer 4

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pitavastatin 2

rosuvastatin 5

atorvastatin 10

simvastatin 20

lovastatin 40

pravastatin 40

fluvastatin 80

* All moderate dosing

Question 5

Statin Toxicities

Answer 5

HMG coreductase inhibitors

H- hepatotoxicity

M- muscle (myalgia, rhabdo)

G- glucose (increase)

Question 6

ASCVD risk factors

Answer 6

• gender
• age
• race
• TC
• HDL
• systolic BP
• on BP meds with systolic>120
• diabetes
• smoker

Question 7

Statins with no renal adjustment

Answer 7

atorvastatin

fluvastatin

Question 8

least drug interactions

Answer 8

pravastatin

Not CYP metabolized

Question 9

simvastatin drug max

Answer 9

• 10mg if on verapamil, diltiazem, dronedarone
• 20mg amiodarone, amlodidpine, lomitapide, ranolazine

Question 10

simvastatin & lovastatin

Answer 10

Both are extensively 3A4 metabolized avoid:

azoles- itraconazole, ketoconazole, posaconazole, voriconazole

erythromycin, clarithromycin

protease inhibitors

cobicistat products

nefazodone

cyclosporin

grapefruit juice

Danazol (with simvastatin)

Question 11

ezetimibe

Answer 11

Inhibits cholesterol absorption at small intestine brush border

• Zetia
• with simvastatin (Vytorin)

Avoid in hepatic impairment

S.E. myalgia- muscle effects increase when added to statin therapy

AVOID: with gemfibrozil

Question 12

bile acid sequestrants

Answer 12

cholestyramine (Questran)

colesevelam (Welchol)- also used for DM2 glycemic control-can cause bowl obstruction, SAFE in PREGNANCY

colestipol (Colestid)

• Decrease absorption of fat soluable vitamins A, D, E, K
• lower LDL 10-30% but RAISE TG 5%-not recommended if TG are 300 or more
• S.E. tummy-constipation, ab pain, cramping bloating, gas

Question 13

fibrates

Answer 13

fenofibrate (Antara, TriCor, Trilipix)

gemfibrozil (Lopid)-do not give with statin or ezetimibe

For TG lowering (which increases HDL) normally lowers LDL but if TG very high can raise LDL

Contraindicated: severe liver diease, gallbladder disease

PPARà inhibitor

Question 14

niacin

Answer 14

decreases TG

hepatotoxicity, rhabdo in doses > 1 gram/day

• Niacor IR OTC-flushing/itching
• Niaspan ER higher hepato risk
• Slo-Niacin sustained release higher hepato risk

Question 15

fish oil

Answer 15

• Indicated as diet adjunct when TG 500 or more
• prolong bleeding!
• omega 3 acid ethyl esters (Lovaza)- EPA & DHA, can î LDL 44%
• icosapent ethyl (Vascepa)- EPA
• omega 3 carboxylic acids (Epanova)- mostly EPA +DHA can î LDL 15%

Question 16

PCSK9 inhibitors

Answer 16

Decrease LDL 60%

alirocumab (Praluent)

evolocumab (Repatha)- can reduce risk of MI, stroke, and coronary revascularization

Question 17

specialty drugs

Answer 17

hepatotoxic (has REMS)

lomitapide (Juxtapid)- daily pill, contraindicated in pregnancy

mipomersen (Kynamro)- SC