Statins

Question 1

How do bile acid sequestrants work?

Answer 1

• they reduce the enterohepatic circulation of bile acids
• reduce LDL-C by increasing intrahepatic LDL receptors

Question 2

Omega-3 FAs are only approved to treat pts with fasting TGs > _____.

Answer 2

500mg/dL

Question 3

How do plant sterols and stanol esters work?

Answer 3

by preventing mixed micelle formation in the intestine –> reduce cholesterol absorption

Question 4

By how much do fibrates lower TGs?

Answer 4

20-40%

Question 5

Niacin raises HDL-C by _____%.

Answer 5

10-30%

Question 6

When do you choose a high intensity statin?

Answer 6

• LDL-C > 190
• DMII

Question 7

What are the SEs of fibrates?

Answer 7

• raised serum creatinine
• higher risk of myopathy

Question 8

How does niacin work?

Answer 8

it decreases catabolism of apo A1 –> decrease synthesis of VLDL, LDL + increases HDL

Question 9

What are bile acid sequestrants?

Answer 9

• high molecular weight polymers that bind bile acids in the intestines in exchange for Cl-
• neither absorbed nor metabolized
• reduce the enterohepatic circulation of bile acids
• reduce LDL-C by increasing intrahepatic LDL receptors

Question 10

High dose omega-3 FAs or fish oils lower triglycerides by ______%.

Answer 10

15-35

Question 11

These drugs work by by preventing mixed micelle formation in the intestine –> reduce cholesterol absorption.

Answer 11

plant sterols and stanol esters

Question 12

What are the SEs of statins?

Answer 12

• hepatic transaminase elevation
• rhabdomyolysis
• myopathy/myalgias
• new onset DMII

Question 13

What are the SEs of niacin?

Answer 13

• flushing
• rash
• GI distress
• hepatotox
• myopathy
• glucose intolerance
• hyperuricemia
• gout

Question 14

By how much do fibrates raise HDL-C?

Answer 14

5-15%

Question 15

What is combined hyperlipidemia?

Answer 15

increased LDL-C and increased TGs

Question 16

What are the indications for initiation of a statin?

Answer 16

• 2a prevention bc of high ASCVD risk
• LDL-C > 190 with age > 21
• 1a prevention in DMII age 40-75 and LDL-C btw 70-189
• 1a prevention w/o DMII with ASCVD risk > 7.5% and age 40-75 with LDL-C 70-189

Question 17

What is the major pharm. effect of omega-3 FAs and fish oils?

Answer 17

to reduce VLDL triglyceride production and secretion

Question 18

By how much do PCSK9 inhibitors reduce LDL-C?

Answer 18

by 60%

Question 19

By how much do bile acid sequestrants reduce LDL-C?

Answer 19

10-30%

Question 20

How are PCSK9 inhibitors administered?

Answer 20

sub-q every 2 weeks

Question 21

How do fibrates work?

Answer 21

by inducing PPARalpha-related gene expression –> increase intra-hepatic fatty acid oxidation –> reduce VLDL TG synthesis and secretion

Question 22

Name 2 high intensity statins.

Answer 22

• atorvastatin
• rosuvastatin

Question 23

Niacin lowers LDL-C by _____%.

Answer 23

5-25%

Question 24

These drugs work by inducing PPARalpha-related gene expression –> increases in intra-hepatic fatty acid oxidation –> reduction in VLDL TG synthesis and secretion.

Answer 24

fibrates

Question 25

What are the SEs for plant sterols and stanol esters?

Answer 25

none

Question 26

By how much do plant sterols and stanol esters reduce LDL-C?

Answer 26

by 5-10%

Question 27

When would you prescribe an Ezetimibe?

Answer 27

as an add-on therapy

Question 28

What are the SEs for Ezetimibe?

Answer 28

none

Question 29

What are the SEs for bile acid sequestrants?

Answer 29

* nausea * bloating * constipation * bind to other medications

Question 30

This drug decreases catabolism of apo A1 --\> a decrease synthesis of VLDL, LDL and increases HDL.

Answer 30

niacin

Question 31

These drugs inhibit HMG CoA reductase and increase LDL receptors, therefore increasing the uptake/catabolism of LDL.

Answer 31

statins

Question 32

This is a cholesterol lowering med that selectively inhibits cholesterol absorption.

Answer 32

Ezetimibe

Question 33

When would you prescribe PCSK9 inhibitors?

Answer 33

as adjuncts to diet and maximal statin therapy for pts with heterozygous familial hypercholesterolemia or atherosclerotic CV disease

Question 34

How do you lower LDL-C with meds?

Answer 34

statins/HMG CoA reductase inhibitors

Question 35

Name 2 low intensity statins.

Answer 35

* pravastatin * lovastatin

Question 36

When very high triglycerides (TGs) are present (\>1000mg/dL), there is a risk of \_\_\_\_\_.

Answer 36

pancreatitis

Question 37

\_\_\_\_\_\_ lowers LDL-C and TG while raising HDL-C.

Answer 37

Niacin

Question 38

Niacin lowers TG by \_\_\_\_\_%.

Answer 38

15-35%

Question 39

How do statins reduce LDL-C?

Answer 39

* inhibit HMG CoA reductase * increase LDL receptors and therefore uptake/catabolism of LDL

Question 40

When do you choose a moderate intensity statin?

Answer 40

ASCVD risk \> 7.5%

Question 41

What are the SEs for PCSK9 inhibitors?

Answer 41

* injection site rxns * drug-induced Abs * allergies * neurocognitive events

Question 42

What is Ezetimibe?

Answer 42

a cholesterol lowering med that selectively inhibits cholesterol absorption

Question 43

When would you prescribe fibrates?

Answer 43

* as 2a prevention + a statin for DMII pts * pts with existing ASCVD who are hypertriglyceridemic and have low HDL-C

Question 44

These are cholesterol meds that are high molecular weight polymers that bind bile acids in the intestines in exchange for Cl- and are neither absorbed nor metabolized; they reduce the enterohepatic circulation of bile acids- they reduce LDL-C by increasing intrahepatic LDL receptors.

Answer 44

bile acid sequestrants

Question 45

When would you prescribe a bile acid sequestrant?

Answer 45

* as an add-on therapy if statin isn't tolerated * in pregnancy