Cholesterol-lowering medications, cardiovascular risk factors, screening
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| 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
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| How often should you assess cardiovascular risk in patients 20-79 years old without atherosclerotic CVD? | every 4-6 years
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| What type of therapy is recommended for secondary prevention patients 75 years of age and younger? | High-dose statin
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| What type of therapy is recommended for primary prevention in adults with LDL 190 mg/dL or higher? | High-dose statin
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| 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
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| 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
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| 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
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| What type of therapy is recommended for secondary prevention patients 75 yo and younger who cannot tolerate high-dose statins? | Moderate-dose statin
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| When should patients be given low-dose statin? | Cannot tolerate moderate/high dose, titrating.
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| What is the average LDL reduction produced by high-dose statins? | 50% or higher
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| What is the average LDL reduction produced by moderate-dose statins? | 30 to <50%
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| What is the average LDL reduction produced by low-dose statins? | <30%
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| What is the only generic high-dose statin available? (name and dose) | Atorvastatin 80mg daily
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| What is the considered high-dose for Crestor? | 20-40mg daily
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| What is the considered moderate-dose for Crestor? | 5-10mg daily
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| Zocor 40mg daily is considered what intensity? | moderate
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| Lovastatin 20mg daily is considered what intensity? | low
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| Fluvastatin 40mg daily is considered what intensity? | low
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| Pravastatin 40mg daily is considered what intensity? | moderate
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| Pitavastatin 2mg daily is considered what intensity? | moderate
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| Lipitor 10mg daily is considered what intensity? | moderate
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| What are some treatment options for triglyceride 500 mg/dL or higher? | Omega-3 fatty acids, niacin, fenofibrate
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| When should fasting lipid be checked after statin initiation? | 4-12 weeks after initiation
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| How often should fasting lipid be checked for patients stable on statins? | every 3-12 months
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| Statin dose reduction should be considered if 2 consecutive LDL readings are below what level? | 40 mg/dL
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| What lab should be assessed for hepatoxicity? | ALT
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| When should ALT be taken for those on statin therapy? | at baseline and only if symptoms occur
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| Name 4 risk factors for statin-induced myopathy | elderly, small size, high statin dose, liver or renal disease, diabetes, uncontrolled hypothyroidism, and interacting medications
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| Which statin is associated with the lowest risk of myopathy? | Fluvastatin (Lescol) - according to PRIMO study
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| The risk of myopathy is increased 5x by potent CYP3A4 inhibitors in which 2 statins? | lovastatin, and simvastatin
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| Which 3 statins are not extensively metabolized by the cytochrome P450 system? | Crestor, Livalo, Pravachol
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| Which fibric acid derivative is associated with higher myopathy risk when used with statins and should NOT be used in combination with them? | gemfibrozil
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| Patients on statins with muscle symptoms should have which lab done? | creatine kinase
(also TSH to rule out hypothyroidism as cause)
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| 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.
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| In statin patients WITHOUT muscle symptoms and creatine kinase 5-10x ULN, how often should CK be rechecked? | monthly/bi-monthly
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| Of the nonstatins, which class has the best evidence for cardiovascular event prevention? | bile acid sequesterants
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| What enzyme in the liver do statins inhibit? | hydroxyl-3-methylglutaryl-coenzyme A reductase
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| Which is the only statin shown to cause regression of atherosclerosis versus just slowing its progression? | Crestor
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| What is the major adverse effect that causes bile acid sequestrants to not be tolerated? | Constipation, gas
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| Of the bile acid sequestrants, which is associated with the least GI side effects? | colesevelam (Welchol)
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| Which medication can be used as a statin add-on to reduce LDL only if HDL and TG are within normal limits? | ezetimibe (Zetia)
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| What is the mechanism of action of ezetimibe (Zetia)? | Cholesterol absorption inhibitor
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| What is the first line option for TG>1000mg/dL? | fibric acid derivatives
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| Which non-statin lipid therapy has a dose-dependent risk of hyperglycemia and liver toxicity? | Niacin
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| 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)
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| What effect does icosapent ethyl (Vascepa) have on lipids? | Lowers TGs
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| Which lipid-lowering therapy is also FDA approved to improve glycemic control in type 2 diabetes? | colesevelam (Welchol)
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| A 5-10% decrease in body weight can reduce TG levels by what percent? | 20%
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| 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
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| Which medication commonly increases TG levels in women? | Estrogens
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| 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
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| What drug classes can cause low HDL? (name one) | Beta blockers, benzodiazepines, anabolic steroids
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| 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
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| Which lipid agent raises HDL more than any other agent? | Niacin
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| Niacin is available in combination with what other agents? | lovastatin (Advicor) and simvastatin (Simcor)
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| Fluvastatin 40mg bid is considered what intensity? | moderate
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| Livalo 1mg daily is considered what intensity? | low
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| Which macrolide antibiotic is least likely to interact with statins? | Azithromycin
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| In patients who require short-term Biaxin and are on simvastatin, what should you do? | Hold statin while on Biaxin
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| For patients who require frequent or prolonged treatment with clarithromycin or erythromycin, which statin should be be used? | pravastatin, rosuvastatin, or fluvastatin
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| Which Cytochrome P450 enzyme does grapefruit juice inhibit? | 3A4
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| What is the normal daily dose of Lovaza? | 4 grams daily
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| What is the daily recommended dose for Lopid? | 600mg daily
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