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Hyperlipidemia
Cholesterol-lowering medications, cardiovascular risk factors, screening
| Question | Answer |
|---|---|
| The new cardiovascular risk calculator to estimate 10 year risk is meant for patients not receiving cholesterol-lowering therapy what age group and LDL range? | 40-75 years old with LDL 70-189 mg/dL |
| How often should you assess cardiovascular risk in patients 20-79 years old without atherosclerotic CVD? | every 4-6 years |
| What type of therapy is recommended for secondary prevention patients 75 years of age and younger? | High-dose statin |
| What type of therapy is recommended for primary prevention in adults with LDL 190 mg/dL or higher? | High-dose statin |
| What type of therapy is recommended for primary prevention in adults 40-75 yo with LDL 70-189 mg/dL and an estimated 10-year risk of 7.5% or higher | Moderate or High-dose statin |
| What type of therapy is recommended for primary prevention in diabetes patients 40-75 yo with LDL 70-189 mg/dL and an estimated 10-year risk of 7.5% or higher | High-dose statin |
| What type of therapy is recommended for primary prevention in diabetes patients 40-75 yo with LDL 70-189 mg/dL and an estimated 10-year risk of LESS than 7.5%? | Moderate-dose statin |
| What type of therapy is recommended for secondary prevention patients 75 yo and younger who cannot tolerate high-dose statins? | Moderate-dose statin |
| When should patients be given low-dose statin? | Cannot tolerate moderate/high dose, titrating. |
| What is the average LDL reduction produced by high-dose statins? | 50% or higher |
| What is the average LDL reduction produced by moderate-dose statins? | 30 to <50% |
| What is the average LDL reduction produced by low-dose statins? | <30% |
| What is the only generic high-dose statin available? (name and dose) | Atorvastatin 80mg daily |
| What is the considered high-dose for Crestor? | 20-40mg daily |
| What is the considered moderate-dose for Crestor? | 5-10mg daily |
| Zocor 40mg daily is considered what intensity? | moderate |
| Lovastatin 20mg daily is considered what intensity? | low |
| Fluvastatin 40mg daily is considered what intensity? | low |
| Pravastatin 40mg daily is considered what intensity? | moderate |
| Pitavastatin 2mg daily is considered what intensity? | moderate |
| Lipitor 10mg daily is considered what intensity? | moderate |
| What are some treatment options for triglyceride 500 mg/dL or higher? | Omega-3 fatty acids, niacin, fenofibrate |
| When should fasting lipid be checked after statin initiation? | 4-12 weeks after initiation |
| How often should fasting lipid be checked for patients stable on statins? | every 3-12 months |
| Statin dose reduction should be considered if 2 consecutive LDL readings are below what level? | 40 mg/dL |
| What lab should be assessed for hepatoxicity? | ALT |
| When should ALT be taken for those on statin therapy? | at baseline and only if symptoms occur |
| Name 4 risk factors for statin-induced myopathy | elderly, small size, high statin dose, liver or renal disease, diabetes, uncontrolled hypothyroidism, and interacting medications |
| Which statin is associated with the lowest risk of myopathy? | Fluvastatin (Lescol) - according to PRIMO study |
| The risk of myopathy is increased 5x by potent CYP3A4 inhibitors in which 2 statins? | lovastatin, and simvastatin |
| Which 3 statins are not extensively metabolized by the cytochrome P450 system? | Crestor, Livalo, Pravachol |
| Which fibric acid derivative is associated with higher myopathy risk when used with statins and should NOT be used in combination with them? | gemfibrozil |
| Patients on statins with muscle symptoms should have which lab done? | creatine kinase (also TSH to rule out hypothyroidism as cause) |
| In statin patients with muscle symptoms and creatine kinase <10x ULN, how often should CK be rechecked? | Weekly until resolution. If worsen, consider dose decrease or discontinuation of statin. |
| In statin patients WITHOUT muscle symptoms and creatine kinase 5-10x ULN, how often should CK be rechecked? | monthly/bi-monthly |
| Of the nonstatins, which class has the best evidence for cardiovascular event prevention? | bile acid sequesterants |
| What enzyme in the liver do statins inhibit? | hydroxyl-3-methylglutaryl-coenzyme A reductase |
| Which is the only statin shown to cause regression of atherosclerosis versus just slowing its progression? | Crestor |
| What is the major adverse effect that causes bile acid sequestrants to not be tolerated? | Constipation, gas |
| Of the bile acid sequestrants, which is associated with the least GI side effects? | colesevelam (Welchol) |
| Which medication can be used as a statin add-on to reduce LDL only if HDL and TG are within normal limits? | ezetimibe (Zetia) |
| What is the mechanism of action of ezetimibe (Zetia)? | Cholesterol absorption inhibitor |
| What is the first line option for TG>1000mg/dL? | fibric acid derivatives |
| Which non-statin lipid therapy has a dose-dependent risk of hyperglycemia and liver toxicity? | Niacin |
| Which non-statin lipid therapy is Associated with an increase in risk for recurrence of symptomatic Afib/flutter within first 3 months of therapy? | Omega-3 ethyl esters (Lovaza) |
| What effect does icosapent ethyl (Vascepa) have on lipids? | Lowers TGs |
| Which lipid-lowering therapy is also FDA approved to improve glycemic control in type 2 diabetes? | colesevelam (Welchol) |
| A 5-10% decrease in body weight can reduce TG levels by what percent? | 20% |
| What are some dietary changes that can reduce TG levels | reduce trans fat intake, increase fiber, restrict fructose, restrict alcohol to none-1 ounce/day |
| Which medication commonly increases TG levels in women? | Estrogens |
| In which patients is it appropriate to maintain on simvastatin 80 mg daily? | If they've been taking it for >12 months with no muscle toxicity |
| What drug classes can cause low HDL? (name one) | Beta blockers, benzodiazepines, anabolic steroids |
| Which class of lipid-lowering drugs can cause elevated TG and thus should not be used if patient has very high TGs? | Bile acid sequestrants |
| Which lipid agent raises HDL more than any other agent? | Niacin |
| Niacin is available in combination with what other agents? | lovastatin (Advicor) and simvastatin (Simcor) |
| Fluvastatin 40mg bid is considered what intensity? | moderate |
| Livalo 1mg daily is considered what intensity? | low |
| Which macrolide antibiotic is least likely to interact with statins? | Azithromycin |
| In patients who require short-term Biaxin and are on simvastatin, what should you do? | Hold statin while on Biaxin |
| For patients who require frequent or prolonged treatment with clarithromycin or erythromycin, which statin should be be used? | pravastatin, rosuvastatin, or fluvastatin |
| Which Cytochrome P450 enzyme does grapefruit juice inhibit? | 3A4 |
| What is the normal daily dose of Lovaza? | 4 grams daily |
| What is the daily recommended dose for Lopid? | 600mg daily |
Created by:
uamswest
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