Pharmacology and Pharmcotherapy of Lipid Drugs and Disorders 2

Question 1

What is the most potent oral LDL- lowering agents

Answer 1

Statins

Question 2

What are the significant health benefits of using statins

Answer 2

significant reduction in coronary heart disease death, nonfatal MI, revascularization procedures, strokes and total mortality

Question 3

What is the MOA of HMG CoA reductase

Answer 3

Competitively inhibit HMG CoA reductase

Question 4

T/F: Statins can lower triglycerides due to causing a reduction in hepatocellular cholesterol prompting more LDL receptors on liver and reducing the secretion of VLDL while increasing clearance

Answer 4

True

Question 5

What are the two main enzymes of the liver that metabolize statins

Answer 5

3A4 and 2C9

Question 6

What statin would be used if patients can’t handle side effects, why

Answer 6

Pravastatin, has no CYP metabolism

Question 7

What are the low intensity statins

Answer 7

Pravastatin 10, 20 mg/ Lovastatin 20 mg

Question 8

What are the moderate intensity statins

Answer 8

Atorvastatin 10 mg/ Rouvastatin 10 mg/ Simvastatin 20 mg, 40 mg/ Pravastatin 40 mg/ Lovastatin 40 mg/ Fluvastatin 40 mg BID

Question 9

What are the high intensity statins

Answer 9

Atorvastin 40, 80 mg/ Rosuvastatin 20 mg

Question 10

T/F: Low intensity statins are mostly used to treat hyperlipidemia

Answer 10

False: Low-intensity statins reserved for those who cannot tolerate higher intensity statins

Question 11

Who would qualify for moderate-intensity doses when high intensity doses would predispose patients to side effects

Answer 11

Greater than 75 years, impaired renal or hepatic impairment, history

Question 12

T/F: Efficacy is greater when taken in the morning

Answer 12

False: Increased efficacy when taken in the evening to coincide with nighttime upturn in endogenous cholesterol biosynthesis

Question 13

What are the contraindications for statins

Answer 13

Pregnancy, Lactation, active liver disease

Question 14

What medications can simvastatin interact with at a maximum dose of 10 mg, 20 mg

Answer 14

Verapamil and Dilitiazem/ Amiodarone, Amlodipine, Ranolazine

Question 15

What is the most unique adverse effect to statins, what are the other adverse effects

Answer 15

Myalgia and Rhabdomyolysis, headache, fatigue, GI upset

Question 16

T/F: It is advised to check LFT levels at baseline but not routinely monitored. IF LFTs are high the statin should be decreased or held until normalized

Answer 16

True

Question 17

If a patient complains about severe muscle symptoms or fatigue possibly due to the statin what should be done

Answer 17

Discontinue Statin

Question 18

If a patient complains about mild to moderate muscle symptoms or fatigue possibly due to the statin what should be done

Answer 18

Evaluate other risk, discontinue the statin

Question 19

If the symptoms of mild to moderate muscle fatigue are resolved after a statin is discontinued what further options can be done

Answer 19

Re-initiate same or lower dose of same statin AND if the relationship is casual discontinue and start low dose of different statin till tolerated than gradually increase dose as tolerated

Question 20

T/F: ASCVD risk reduction benefit outweighs risk of diabetes and cognitive impairment in most patients

Answer 20

True

Question 21

When a statin is taken a lipid panel is done at baseline when would another one be done after initaition, when is the next after that

Answer 21

Within 4 to 12 weeks, every 3 to 12 months

Question 22

How much should LDLs reduce due to statin intensity use

Answer 22

Greater than 50% (high intensity), 30% to 50% (moderate intensity)

Question 23

If a patient is on a high intensity statin what would the LDL level need to be over time in order to consider adding on non-statin cholesterol-lowering medication

Answer 23

Greater than 70 mg/dl

Question 24

What is the first drug that would be added to a statin in order to lower cholesterol, what is the MOA

Answer 24

Ezetimibe, selectively inhibits absorption of dietary and biliary cholesterol at brush border of intestine

Question 25

What are the contraindications of ezetimibe

Answer 25

Acute liver disease, pregnancy, lactation

Question 26

What are the advere effects of using ezetimibe, drug interactions

Answer 26

Diarrhea and Abdominal pain/ Fibrates and Cholestyramine

Question 27

What do LDL- receptors on the hepatocyte do when LDL binds

Answer 27

Bind to free LDL circulating where they are brought into the cell metabolized to release the LDL-receptor then placed back on the surface

Question 28

T/F: PCSK9 proteins lead to lower chosterol

Answer 28

T/F: PCSK9 proteins lead to more circulating LDL since it doesn’t allow the LDL to be brought into the hepatocyte by the LDL-Receptors to be metabolized

Question 29

What type of medication is PCSK9 inhibitors, what is the MOA

Answer 29

Monoclonal antibody, indirectly decreases LDL levels by binding PCSK9 leading to more LDL receptors on hepatocytes

Question 30

What is a large adverse effect of PCSK9 inhibitors

Answer 30

Decrease in neurocognitive ability

Question 31

Why are PCSK9 not indicated to be used before ezetimibe

Answer 31

The cost does not outweigh the benefit

Question 32

What are the bile acid sequestrants

Answer 32

Cholestyramine, Colestipol, Colesevelam

Question 33

Though patients could add bile acid sequestrants they are not preferred over adding ezetimibe and PCSK9 inhibitors

Answer 33

True

Question 34

When would fibrates be first line medicationsm what are the fibrates

Answer 34

If the patient has triglycerides over 500 mg/dl/ gemfibrozil, fenofibrate, fenofibric acid

Question 35

T/F: Niacin can decrease TG and increase HDL but has not proven to reach clinical endpoints and therefore there is no scenario in which a patient would need to use Niacin

Answer 35

True