Hosam Mohamed-
primary prevention
patient does not have a history of ASCVD
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secondary prevention
patient DOES have a history of ASCVD
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If TG>500
When receiving a patient's lipid panel, what is the first thing that we will treat if present?
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LDL > 190; DM age 40-75
Which patients do not require a risk assessment? I.E. Will receive a statin immediately.
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a
Patient over 40 years old with ASCVD risk <5%
a) Lifestyle changes
b) statin therapy
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b
Patients over 40 years old with ASCVD risk >7.5%.
a) Lifestyle changes
b) statin therapy
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age, smoking, blood pressure, TC/HDL, DM
What does the ASCVD risk calculator include? (5)
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f; only primary
ASCVD risk is used in primary and secondary prevention. T/F
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high-intensity
All patients <75 years old with ASCVD should receive a _______ statin.
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reduce LDL by 50% or <70; non-HDL <100
What is the goal reduction in LDL & non-HDL for Secondary-Prevention?
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atorvastatin 40-80mg; rosuvastatin 20-40mg
What are our high-intensity statins? What are the doses? (2)
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simvastatin 10mg, pravastatin 10-20mg, Lovastatin 20mg, Fluvastatin 20-40mg
What are our low-intensity statins? What are the doses? (4)
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less risk of CV event
A lower LDL =
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pregnancy, active liver disease
Statins are Contraindicated in which patients? (2)
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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
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grapefruit juice
What must we avoid in all statins?
-
simvastatin, 80mg
What dose of which statin would we NOT start on a patient?
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pravastatin, rosuvastatin
Which statins are hydrophilic? (2)
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a
Which is more likely to cause myalgia?
a) lipophilic
b) hydrophilic
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atorvastatin, rosuvastatin, pitavastatin, fluvastatin XL
Which statins can we take anytime because of long half-lives? (4)
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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.
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4-12 weeks
When should we check a patient who has initiated a Statin's lipid panel?
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liver function panel, creatine kinase
What safety monitoring do we do when a patient is on a statin?
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when they report severe statin-associated muscle symptoms
When do we check a patient's Creatine Kinase?
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(Baseline LDL-Current LDL)/Baseline LDL x 100
Formula for calculating % LDL Reduction?
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30-49%
Moderate intensity statin reduction goal =
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>=50 %
High-intensity Statin Reduction goal =
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LDL <70; non-HDL < 100
What are our treatment thresholds for Secondary prevention?
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a
Which statin is not included in the "rule of 7"?
a) rosuvastatin
b) pitavastatin
c) simvastatin
d) lovastatin
e) pravastatin
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ezetimibe, PCSK9, bempedoic acid, inclisiran, BAS
Which agents lower LDL? (4)
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icosapent ethyl, fibrate, niacin, omega 3
Which agents lower non-HDL? (4)
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simvastatin + ezetimibe
Vytorin is a combination of what medications?
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b, c
Which one requires prior-authorization to be dispensed?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
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ASCVD; FH
Alirocumab & Evolocumab are only FDA-approved for use in patients with ______ or ______.
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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
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b
Which has once monthly-pushtronex system?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
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e
Which is a prodrug?
a) ezetimibe
b) evolucumab
c) alirocumab
d) Icosapent Ethyl
e) bempedoic acid
f) Inclisiran
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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?
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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
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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
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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?
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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 ______.
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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 __________.
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true
Fenofibrate formulations are NOT equivalent on a mg-mg basis. T/F?
