E3: Dyslipidemia Therapeutics

Question 1

High-intensity statins
LDL-C Lowering: ___ %

Answer 1

1. Atorvastatin 40mg
   Atorvastatin 80mg
2. Rosuvastatin 20mg
   Rosuvastatin 40mg

Decrease by greater than or equal to 50%

Question 2

Moderate Intensity Statins
LDL-C Lowering: ___ %

Answer 2

1. Atorvastatin 10mg & 20mg
2. Rosuvastatin 5mg & 10mg
3. Simvastatin 20-40mg
   Others: Pravastatin 40/80, Lovastatin 40/80, Fluvastatin 80/40

Decrease by 30-49%

Question 3

Low-intensity Statins
LDL-C Lowering: ___ %

Answer 3

Simvastatin 10mg
Others: Pravastatin 10-20mg, Lovastatin 20mg, Fluvastatin 20-40mg

Question 4

Which statin requires no dose adjustment based on CrCl

Answer 4

Atorvastatin

Question 5

Which two statins do NOT have to be taken in the evening

Answer 5

Atorvastatin, Rosuvastatin

Question 6

Statins in pregnancy and breastfeeding

Answer 6

Most pregnant patients should stop taking statins
Breastfeeding is not recommended

Question 7

At what value should we consider adding an agent to target triglycerides

Answer 7

TG >500

Question 8

What agent(s) should be added if TG is >500

Answer 8

Fenofibrate (Triglide)

Question 9

What non-statin add on can cause flushing? How to treat the flushing

Answer 9

Niacin, take ibuprofen

Question 10

When should a lipid panel be measured after medication initiation? What 2 things are critical to monitor in patient

Answer 10

4 to 12 weeks
Monitor adherence
Monitor SE (muscle pain, CK relative to 10x ULN, transaminase elevation relative to 3x ULN)

Question 11

After initial lipid panel, how often should lipid panels be monitored thereafter?

Answer 11

Q3-12 months

Question 12

What to do if statins can’t be tolerated

Answer 12

Stop statin for 2-3 weeks and allow CK elevation to drop back to normal, restart statin (at lower dose)

Attempt at lowest FDA approved daily dose and trial of alternative dosing regimens

True statin intolerance: Ezetimibe or PSCK9 if clinical ASCVD) as first line

Question 13

TG 175-499

Answer 13

1. Treat lifestyle/secondary factors
2. Optimize LDL therapy
3. Consider icosapent ethyl if 1+ ASCVD high risk-features

Question 14

TG 500-999

Answer 14

1. Treat lifestyle/secondary factors (DM, thyroid, liver/kidney issues)
2. Maximize statin per ASCVD risk
3. Add FENOFIBRATE, isocosapent ethyl or omega-3 ethyl esters

Question 15

TG 1000+

Answer 15

Consider simultaneous statin and nonstatin therapies

Question 16

Pharmacogenomics
SCLO1B1:
CYP2C9:
ABCG2:

Answer 16

SCLO1B1: transporter that facilitates hepatic uptake of statins for elimination; Simvastatin
CYP2C9: Fluvastatin
ABCG2: Rosuvastatin