Statin Lowering Agents

Question 1

What are the 5 aspects of care in the treatment approach to dyslipidemia?

Answer 1

1) Initiate therapeutic lifestyle changes
2) treat any secondary causes
3) Treat LDL
4) Consider specific treatment for hypertriglyceridemia (>200)
5) Consider TX of HDL if <40

Question 2

What are the 3 primary therapeutic lifestyle changes recommended for the treatment of dyslipidemia?

Answer 2

1) Reduce cholesterol-raising foods
2) LDL lowering options (plant stanols/sterols, fiber
3) Diet and exercise

Question 3

In a cholesterol-lowering diet for dyslipidemia, what is the max percentage of total calories that should come from saturated fats?

Answer 3

7%

Question 4

What is the dosage for plant stanols/sterols for reducing LDL?

Answer 4

2g/day

Question 5

What is the dosage for viscous fiver for reducing LDL?

Answer 5

10-25g/dy

Question 6

What are the underlying causes of dyslipidemia? (5)

Answer 6

1) DM2
2) Hypothyroidism
3) Obstructive liver disease
4) CKD (nephrotic syndrome)
5) Medications

Question 7

What medications can cause an increase LDL? (8)

Answer 7

1) Anabolic steroids
2) Cyclosporine
3) Glucocorticoids
4) O3FA (slightly)
5) Isotretinoin
6) Protease Inhibitors (for HIV)
7) Thiazides
8) TZD (slightly)

Question 8

What medications can increase TG? (10)

Answer 8

1) Antipsychotics
2) BB
3) Cyclosporine
4) Estrogen (oral)
5) Glucocorticoids
6) Isotretinoin
7) Protease inhibitors (for HIV)
8) Thiazides
9) Tamoxifen (SERM)
10) Raloxifene (SERM)

Question 9

What are the primary drug classes used in treating high LDL? (7)

Answer 9

1) HMG-CoA reductase inhibitors (Statins)
2) PCSK9
3) Bile acid sequestrants
4) Selective cholesterol absorption inhibitors
5) Niacin
6) Fibrates
7) Fish oil

Question 10

What percentage do statins decrease LDL?

Answer 10

20-60%

Question 11

What percentage does PCSK9 decrease LDL?

Answer 11

64%

Question 12

What percentage do bile acid sequestrants decrease LDL?

Answer 12

20-35%

Question 13

What class of drugs used to help decrease LDL can raise TG by 5-20%

Answer 13

Bile acid sequestrants

Question 14

What percentage do selective cholesterol absorption inhibitors decrease LDL?

Answer 14

18-25%

Question 15

What percentage does Niacin (Niaspan) decrease LDL?

Answer 15

20%

Question 16

What percentage do fibrates decrease

LDL?

Answer 16

10%

**May also raise by 10%

Question 17

What effect does fish oil ( O3FA) have on LDL?

Answer 17

Increase by 46%

Question 18

How should tx of hypertriglyceridemia (<200) be approached?

Answer 18

Attaining non-HDL goal?

Question 19

What HDL level warrants consideration of treatment?

Answer 19

> 40

Question 20

What is the dose range for Lovastatin (Mevacor)?

How does dosing affect LDL and HDL levels?

Answer 20

40-80 mg

Can decrease LDL by up to 40% on max dose and can increase HDL by 8.6%

Question 21

Does Lovastatin (Mevacor) cross BBB?

Answer 21

Yes

Question 22

What is the dose range for Simvastatin (Zocor)

How does dosing affect LDL and HDL levels?

Answer 22

20-40mg

Can decrease LDL by up to 47% and can increase HDL by 12%

Question 23

Does Simvastatin (Zocor) cross BBB?

Answer 23

Yes

Question 24

What is the dose range for Atorvastatin (Lipitor)?

How does dosing affect LDL and HDL levels?

Answer 24

10-80 mg

Can decrease LDL by up to 60% and can increase HDL by 6%.

Question 25

Is Atorvastatin (Lipitor) short-or long-acting?

Answer 25

LONG-Acting

Question 26

What is the dose range for Rosuvastatin (Crestor)? How does dosing affect LDL and HDL?

Answer 26

5-40 Mg Can decrease LDL by up to 60%+ and can increase HDL by 14%

Question 27

Is Rosuvastatin (Crestor) short or long-acting?

Answer 27

Long-acting?

Question 28

What is the conversion sequence for statins?

Answer 28

Rosuvastatin 5mg=Atorvastatin 10mg=Simvastatin 20mg=Lovastatin 40mg

Question 29

What Coenzyme does statin therapy reduce?

Answer 29

CoQ10, consider supplementation

Question 30

What's the MOA for statins?

Answer 30

Inhibit HMG CoA reductase Reduction in HMG CoA decreases intracellular cholesterol production, upregulation of LDL receptors in liver, and enhanced clearance of LDL out of circulation

Question 31

What time of day should statins be taken? Why?

Answer 31

Short-acting taken at night, long-acting doesn't matter when taken Short-acting best taken at night because that's when cholesterol synthesis most active (2-4 AM)

Question 32

Side Effects of Statins? (4)

Answer 32

Elevated liver enzymes Muscle issues (esp those with HIV) CNS/cognitive effects (r/t lipophilic BBB crossing Risk for development of DM

Question 33

What are the 45primary muscle issues that can occur with Statin treatment?

Answer 33

``` Myalgia Myopathy Myositis Myonecrosis Rhabdo ```

Question 34

How is myalgia r/t statin use manifested?

Answer 34

flu-like symptoms with normal CK

Question 35

How is myopathy r/t statin use manifested?

Answer 35

muscle weakness or CK elevation

Question 36

How is myositis r/t statin use manifested?

Answer 36

muscle inflammation

Question 37

How is myonecrosis r/t statin use manifested?

Answer 37

CK elevation

Question 38

How is Rhabdo r/t stain use manifested?

Answer 38

Myonecrosis + Myoglobinuria or ARK/AKI

Question 39

YES OR NO Do statins induce liver failure, transplant, or death in the general population?

Answer 39

Yes

Question 40

YES OR NO Should liver enzymes be monitored with long-term use?

Answer 40

NO

Question 41

YES OR NO Are statins contraindicated in chronic liver disease, cirrhosis, NASH or liver transplant?

Answer 41

NO

Question 42

YES OR NO Do statins need to have dose adjustments in HIV< HCV treatment?

Answer 42

Yes

Question 43

What are the risk factors for statin-induced myopathy? (5)

Answer 43

``` >60 years Female CKF Hypothyroidism Meds (drug interactions) ```