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Hyperlipidemia

Cholesterol-lowering medications, cardiovascular risk factors, screening

QuestionAnswer
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