To Review Ch 38- Statins

Question 1

Which statins can be taken any time of the day?

Answer 1

Crestor, Lipitor, Livalo, Lescol XL and Pravachol

Simvastatin is taken in the evening.
Lovastatin IR is taken in the evening while lovastatin ER is taken at bedtime.
Fluvastatin (Lescol) is taken with evening meal.

Question 2

High Intensity statins
Low Intensity Statins

(No longer treating to LDL goal)

Answer 2

H: Atorvastatin (Lipitor) 40-80
Rosuvastatin (Crestor) 20-40

L:   S 10
      A x
      L 20
      P 1
      F 20-40
      R x
      P 10-20

Question 3

Which agents will help to lower triglycerides?

Answer 3

• Fibrates (but can increase LDL when TG are high)> Fenofibrate (Antara, Fenoglide, Fibricor, Lipofen, Lofibra, Tricor, Triglide, Trilipix)

Gemfibrozil (Lopid) only fibrate BID 600mg, 30mins before bkft and dinner

Niacin (Niacor, Niaspan, Slo-Niacin)- should be taken 4-6hrs separate from bile acids (can dec. absorption)
Fish Oils (Lovaza, Vascepa, Epanova, Omtryg)

Statins and Ezetimibe- not so much

Colesevelam (Welchol) is contraindicated in TG>500
Bile acids can increase TG; cause constipation (maintain adequate fluid intake and take a multivitamin at another time of day)

Question 4

Bind to and inhibit microsomal triglyceride transfer protein (MTP) in the endoplasmic reticulum

Answer 4

Lomitapide (Juxtapid) for familial Hypercholesterolemia (HoFH)

hepatotoxic
preg X
REMS

Question 5

Inhibit apo B-100 synthesi

Answer 5

Mipomersen (Kynamro)

hepatotoxic
preg B
REMS

Question 6

Advicor

Answer 6

Lovastatin (Mevacor) + Niacin (Niacor)

Increased risk of hepatotoxicity

Question 7

Caduet

Answer 7

Atorvastatin/Amlodipine

Question 8

LIPTRUZET

Answer 8

Ezetimibe/Atorvastatin

Question 9

Vytorin

Answer 9

Ezetimibe/simvastatin

Question 10

Simcor

Answer 10

Niacin/simvastatin

Question 11

Which formulation of niacin has the highest risk for liver damage?

Answer 11

Slo-Niacin has the highest risk of hepatotoxicity

IR (Niacor) has more flushing/itching = Hot beverages and spicy food should be avoided to decrease flushing

CR - SR (Slo-Niacin) have less flushing but more hepatotoxicity

Niaspan has less flushing and less hepatotoxicity (take QHS after low fat snack)

Question 12

SE of Lovaza Omega 3 ethyl ester

Answer 12

Well tolerated but can cause dyspepsia, burping, taste pervesions

can increase LDL, 4 caps daily or 2 BID (1g each, total 4g)
Fish oils increase risk of bleeding

Question 13

Conditions are the fenofibrate agents contraindicated?

Answer 13

• Gallbladder disease
• Severe liver disease
• Nursing mothers
• Severe kidney disease Crcl

Question 14

drugs could raise lipoprotein levels

Answer 14

beta blockers
cyclosporine
amiodarone
glucocorticoids
steroids
tacrolimus
protease inhibitors
atypical antipsychotics

Question 15

Niacin and gout

Answer 15

Niacin can raise uric acid levels and should be used with caution in patients with gout.

Question 16

Myalept

Answer 16

Metreleptin (Myalept) is indicated in leptin deficiency with congenital or acquired generalized lipodystrophy

Question 17

Statins taken with meal

Answer 17

Lovastatin IR (Mevacor)
Fluvastatin IR (Lescol)

Question 18

Factors for ASCVD Risk

Answer 18

Gender
Age
Race
TC
HDL
SBP
HTN Tx
Diabetes Dx
Smoking status

NOT LDL

Question 19

cholesterol-lowering drug classes require liver enzyme monitoring at baseline due to a risk of hepatotoxicity?

Answer 19

Niacins, statin, and the fibrates

could possibly cause liver damage and liver enzymes should be monitored.

In recent years it has been recognized that statins do not cause liver damage worse than placebo in most patients, but the guidelines state to check at baseline and consider if the statin could be contributory if the liver is damaged and no other cause can be identified.

Question 20

Niacin SEs

Answer 20

Flushing
pruritus
N/V
diarrhea
GI distress
hyperglycemia
hyperuricemia (gout)
cough
hepatotoxicity
orthostatic hypotension
hypophosphatemia

Question 21

Niacin CIs

Answer 21

Active liver disease
Active PUD
Arterial bleeding
Arterial hemorrhage

Question 22

This patient should not be started on ??? due to liver impairment

Answer 22

a statin, ezetimibe, or a fibrate