Hyperlipidemia

Question 1

Normal TC, TG, LDL

Answer 1

TC < 200

TG < 150

LDL < 100

Question 2

ASCVD Group Tx

Answer 2

1. Very High Risk

-High intensity statin
-Ezetimibe (if LDL still 70+)
-PCSK9i

2. Not High Risk

<= 75 yr old
-High intensity statin (to reduce LDL 50%)
-Mod intensity statin if high is not tolerated
-Ezetimibe

> 75
-Mod or high statin

Question 3

ASCVD Group Classification

Answer 3

Any cardio event
-ACS
-MI
-IS
-PAD

High risk conditions
-65+
-Hetero fam hc
-CABG, PCI
-Diabetes
-HTN
-CKD
-Smoking
-CHF

Question 4

High vs Low Intensity Statins

Answer 4

High
-A 40-80
-R 20-40

Low
-Sim 10
-Prava 10-20
-Lova 20
-Fluva 20-40
-Pita 1

Question 5

Statins: AEs

Answer 5

-SAMS, myopathy, myalgias, rhabdo
-Elevated TAs (ALT, AST)
-New onset diabetes

Question 6

Statins: CI

Answer 6

-Active liver disease
-Pregnancy, BF

Simvastatin 80 should only be continued in pts who have tolerated dose for 12+ months, NO NEW STARTS

-Avoid GFJ, >1 Q daily

Question 7

Ezetimibe: dose, AE

Answer 7

Zetia

10 mg PO QD

AE: diarrhea

Question 8

PCSK9i: dose, AE

Answer 8

Ali 75 mg to 150 mg SC every 2 weeks

Evolo 140 mg to 420 mg SC every 2 weeks or 420 mg monthly

AE:
-Injection site rxn
-Flu like sx, nasopharyngitis, respiratory tract infections

Question 9

Severe Hypercholesterolemia Group Tx

Answer 9

LDL 190+

1. Max tolerated statin
2. Ezetimibe
3. Bild acid sequestrate

Can add PCSK9i if baseline LDL > 220 and > 130 on statin

Question 10

BAS: chol, cols

Answer 10

AE:
-GI, constipation, bloating, nausea, flatulence

Many DDIs
-Vitamin ADEK
-Warfarin, levothyroxine, phenytoin
*Take 1 hr before or 4 hrs after BAS

CI:
-Bowel obs
-Hx of hypertriglyceridemia-induced pancreatitis

Question 11

Diabetes Group Tx

Answer 11

1. Age 20-39
   -Mod statin
2. Age 40-75
   -High statin (if ASCVD risk factors, 50+)
   -If not then mod
   -Then add ezetimibe

Question 12

Prevention Group Tx

Answer 12

1. 0-19 age
   -lifestyle
   -familial HC = statin
2. 20-39 age
   -statin if family hx, premature ACSVD, LDL > 160
3. 40-75 age w/o diabetes (LDL 70-190)
   -<5: lifestyle
   -5-7.5: mod statin
   -7.5-20: mod statin
   -20+: statin

Question 13

Inclisiran

Answer 13

AE:
-Injection site rxn
-Bronchitis

284 mg SQ 3 mo, then Q 6 mo

Question 14

Bempedoic Acid

Answer 14

AE: LUMI180
-Resp tract infections
-Muscle spasms, back pain
-High UA
-High LFTs

180 mg QD

combo with ezetimibe 180/10 QD

Question 15

Niacin

Answer 15

For HDL improvement

AE: LUFI
-Flushing
-Liver tox
-High UA
-Insulin resistance

No CV benefit

Question 16

Hypertriglyceridemia Tx

Answer 16

150-499 TGs

1. Max statin
2. Icosapent ethyl

Question 17

Omega 3 FAs

Answer 17

AE:
-GI
-Bleeding
-Fishy breath

EE, Lovaza 4 g QD

Ico ethyl 2 g QD

Question 18

Fibrates

Answer 18

Consider for 20+ yo with TG 500+

-GI
-Gallstones
-Myopathies

Gem 600 mg BID

Question 19

Familial Hypercholesterolemia

Answer 19

HeFH (hetero)
-Statins
-PCSK9i
-Bempedoic acid

HoFH (homo)
-Evinacumab
-Lomitapide
-Evolocumab
-Statins

SPB ELES

Question 20

Lomitapide

Answer 20

AE:
-Liver tx (BBW/REMS)
-GI (NV, AP)
-Vitamin deficiency

LV is G

Question 21

Pregnancy Tx

Answer 21

-BAS (cols) are safe in pregnancy
-Hydrophilic statins preferred if needed (pravastatin, rosuvastatin, fluvastatin)