primary prevention
patient does not have a history of ASCVD
secondary prevention
patient DOES have a history of ASCVD
If TG>500
When receiving a patient's lipid panel, what is the first thing that we will treat if present?
LDL > 190; DM age 40-75
Which patients do not require a risk assessment? I.E. Will receive a statin immediately.
a
Patient over 40 years old with ASCVD risk <5%
a) Lifestyle changes
b) statin therapy
b
Patients over 40 years old with ASCVD risk >7.5%.
a) Lifestyle changes
b) statin therapy
age, smoking, blood pressure, TC/HDL, DM
What does the ASCVD risk calculator include? (5)
f; only primary
ASCVD risk is used in primary and secondary prevention. T/F
high-intensity
All patients <75 years old with ASCVD should receive a _______ statin.
reduce LDL by 50% or <70; non-HDL <100
What is the goal reduction in LDL & non-HDL for Secondary-Prevention?
atorvastatin 40-80mg; rosuvastatin 20-40mg
What are our high-intensity statins? What are the doses? (2)
simvastatin 10mg, pravastatin 10-20mg, Lovastatin 20mg, Fluvastatin 20-40mg
What are our low-intensity statins? What are the doses? (4)
less risk of CV event
A lower LDL =
pregnancy, active liver disease
Statins are Contraindicated in which patients? (2)
c
Which is most likely to cause drug interactions?
a) rosuvastatin
b) pitavastatin
c) simvastatin
d) lovastatin
e) pravastatin
a,b,e
Which are the safest options for HIV patients?
a) rosuvastatin
b) pitavastatin
c) simvastatin
d) lovastatin
e) pravastatin
grapefruit juice
What must we avoid in all statins?
simvastatin, 80mg
What dose of which statin would we NOT start on a patient?
pravastatin, rosuvastatin
Which statins are hydrophilic? (2)
a
Which is more likely to cause myalgia?
a) lipophilic
b) hydrophilic
atorvastatin, rosuvastatin, pitavastatin, fluvastatin XL
Which statins can we take anytime because of long half-lives? (4)
d
Which is to be taken at night with a meal?
a) rosuvastatin
b) pitavastatin
c) simvastatin
d) lovastatin
e) pravastatin
always treat patients with highest-tolerated dose of statin
How should we choose a Statin dose?
10-15%
A patient on lifestyle modifications should see a ______ decrease in their LDL-C.
4-12 weeks
When should we check a patient who has initiated a Statin's lipid panel?
liver function panel, creatine kinase
What safety monitoring do we do when a patient is on a statin?
when they report severe statin-associated muscle symptoms
When do we check a patient's Creatine Kinase?
(Baseline LDL-Current LDL)/Baseline LDL x 100
Formula for calculating % LDL Reduction?
30-49%
Moderate intensity statin reduction goal =
>=50 %
High-intensity Statin Reduction goal =
LDL <70; non-HDL < 100
What are our treatment thresholds for Secondary prevention?
a
Which statin is not included in the "rule of 7"?
a) rosuvastatin
b) pitavastatin
c) simvastatin
d) lovastatin
e) pravastatin
ezetimibe, PCSK9, bempedoic acid, inclisiran, BAS
Which agents lower LDL? (4)
icosapent ethyl, fibrate, niacin, omega 3
Which agents lower non-HDL? (4)
simvastatin + ezetimibe
Vytorin is a combination of what medications?
b, c
Which one requires prior-authorization to be dispensed?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
ASCVD; FH
Alirocumab & Evolocumab are only FDA-approved for use in patients with ______ or ______.
c
Which do we use when a patient has a latex allergy?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
b
Which has once monthly-pushtronex system?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
e
Which is a prodrug?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
d
Which one can NOT be interchanged for OTC products?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
If LDL/non-HDL not at goal on max tolerated statin
When do we initiate an add-on therapy with a statin?
a, b, c
Which requires no additional monitoring?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
b,c
Which is dispensed by specialty pharmacies?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
d
Which should we add if a patient's non-HDL is not at goal?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
a, e
Which two are available as a combination product?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
simvastatin 20mg, pravastatin 40mg
There are two statins that need their dose lowered when taking
Bempedoic Acid, what are they and what do we lower their dose to?
f
Which only needs a dose every 6 months?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
switch to hydrophilic statin, lower dose, alternate day dosing (rosuvastatin), add vitamin d or Coq 10
How can we manage statin-associated muscle symptoms?
jaundice, stomach pain/nausea, dark urine/light colored bowels, decreased appetite, fever, tiredness
What are Liver toxicities related to statins? (6)
lipophilic; hydrophilic
Cognitive impairment is more common in _______ statins than ______.
a
Which is a prodrug?
a) fibrate
b) niacin
c) icosapent ethyl
d) bile-acid sequestrant
d
Which requires several doses per day?
a) fibrate
b) niacin
c) icosapent ethyl
d) bile-acid sequestrant
d
Which should NOT be used in patients with TG>300?
a) fibrate
b) niacin
c) icosapent ethyl
d) bile-acid sequestrant
d
Which may result in an increase in TG?
a) fibrate
b) niacin
c) icosapent ethyl
d) bile-acid sequestrant
avoid other medications 1 hr before or 4 hrs after
Patient counseling for Bile-Acid Sequestrant drugs?
b
Which may actually increase LDL?
a) fenofibrate
b) gemfibrozil
taken with food
Fenofibrate is highly lipophilic and to be absorbed it must be __________.
true
Fenofibrate formulations are NOT equivalent on a mg-mg basis. T/F?