1HDL should be between
40-60
2Best thing to treat hyperlipidemia if you don't have a genetic predisposition?
healthy diet and exercise
3Strategies for prevention
lifestyle modifications
management of chronic conditions
statin therapy for primary and secondary prevention
antiplatelet
4Whats the best antiplatelet primary and secondary prevention?
ASA
5Higher lipid profile increases a persons risk for?
CAD
Cerebrovascular disease
peripheral arterial disease
coronary heart disease
6What can be used to help prevent the diseases you are at risk for when you have high lipids?
statins
7Who should be screened?
anyone with a family hx at any age
anyone between the ages of 40-75
8Dyslipidemia
abnormal concentration of lipids in the blood (too high or low)
9Hyperlipidemia
elevated blood lipid levels (total cholesterol, LDL, triglycerides)
10Hypercholesterolemia
total cholesterol > 200
11Hypertriglyceridemia
triglyceride levels > 150
12Hyperlipoproteinnemia
elevated levels of certain lipoproteins
13What are some ASCVD risk factors?
age (older than 75), sex, current cigarette smoking, family hx of premature coronary heart disease, diagnosis of HTN, low HDL, elevated LDL
14Who should have an LDL less than 100 mg/dL
patients with DM or heart disease
15What are some examples of statins?
artorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin
16MOA for ezetimibe
blocks cholesterol absorption across the intestinal border
17MOA for statins
competitive inhibition of HMG-CoA reductase and make this enzyme unable to convert HMG-CoA to mevalonate and cholesterol is not able to be formed
18What are high intensity statins indicated for?
patients with:
CAD, stroke PAD
DM and multiple risk factors
LDL greater than 190
19What are some options for high intensity statins?
Atorvastatin taken at 40 or 80 mg/d or rosuvastatin taken at 20 or 40 mg/d
20What are some contraindications for statins
hypersensitivity
active liver disease
muscle disorder
pregnancy
breastfeeding
21What can statin associated myopathy progress to
rhabdomylolysis
22How would you managed statin induced rhabdomylolysis?
d/c statin for 2-4 weeks and start them on a low dose statin once symptoms have resolved
23What happens when statins interact with other lipid lowering agents like fibrates and nicotinic acid?
increase risk of myalgias
24What is a group of drugs statin should not interact with
Cytochrome P450 inhibitors (HIV/HCV protease inhibitors, macrolides, azole antifungals, cyclosporines)
25What is a drug statins should not interact with?
warfarin
26What should you be cautious with in asian populations when prescribing simvastatin?
increased myopathy risk so want to prescribe less than 20 mg/d
27What is beneficial about atorvastatin and rosuvastatin?
patients can take it any time of day with or without food
28When are PCSK 9 inhibitors indicated?
as an add on therapy for patients who have LDL > 70 despite maximally tolerated treatment with statins and ezetimibe and patients who are very high risk for atherosclerotic cardiovascular
29What is the contraindication for ezetimibe?
do not want to coadminister with a statin during active liver dz
30What is the MOA for niacin?
it inhibits lipolysis and fatty acid release in adipose tissue through blockage of hormone sensitive lipase and decrease hepatic VLDL synthesis
31When is niacin indicated?
high LDL cholesterol and lipoprotein despite statin and ezetimibe therapy (or if statins are CI)
32What can be used to treat AE like flushing in patients taking niacin?
pre treatment 30-60 min prior with aspirin or ibuprofen
33Which group of medications is most effective in lowering triglycerides?
fibrates
34What are some examples of fibrates?
bezafibrate
fenofibrate
gemfibrozil
35What is the MOA for fibrates?
activation of the peroxisome proliferator activated receptor alpha causes an increase in lipoprotein lipase activity which lead to more rapid degradation of LDL and triglycerides and induction of HDL synthesis
36What are some AE you can expect to see with fibrates?
dyspepsia, myopathy, increase in LFTs, mild decrease in Hct/Hb and WBCs
37Fibrates are an enhancer or inhibitor of the cytochrome P450 system? How does this effect its interaction with other drugs?
it is an inhibitor so it enhances the effect of other drugs
38What is a DDI you should be aware of for fibrates?
statins
39What are some contraindications for fibrates?
gall bladder disease and renal insufficiency/liver failure
40What are some examples of bile acid resins?
cholestyramine, colestipol, colesevelam
41What is the MOA for bile acid resins?
ion exchange resin bind bile acids in the intestine which interrupts the enterohepatic circulation causing an increase in bile acid excretion this lowers the cholesterol pool and promotes synthesis of LDL receptors (decreasing unbound LDL)
42When are bile acid resins indicated?
combo treatments w/ statins for hypercholesterolemia, digitoxin overdose, pruritus associated with elevated bile acid levels, bile acid diarrhea
43AE of bile acid resins?
GI- nausea, abdominal bloating and cramping
increase LFTs
myalgia
44CI of bile acid resins?
hypertriglyceridemia
hypertriglyceridemia induced pancreatitis
bowel obstruction
45DDI of bile acid resins?
reduces absorption of warfarin, digoxin and fat soluble vitamins
46What are some AE of statins?
GI symptoms, h/a, increased LFTs, myalgia or myopathy
47When is Lovastatin IR taken? How many doses?
divided into 1-2 doses, one taken with evening meal
48When is Lovastatin ER taken?
daily at bedtime
49When is simvastatin taken?
in the evening
50Alirocumab and Evolocumab are..?
PCSK 9 inhibitors
51What is the MOA for PCSK 9 inhibitors?
binds to PCSK 9 to inhibit it
PCSK 9 bind to the LDL receptor and when it is taken into the liver cell it causes both the receptor and LDL to be destroyed by lysosomes which means the receptor cannot be recycled and help reduce LDL from the blood stream
52What effect does ezetimibe have on HDL and triglycerides?
slight increase or no effect on HDL
slight decrease or no effect on triglycerides
53What are some contraindications for niacin?
liver failure, gout, hemorrhage, gastric ulcer, cardiovascular instability
54What should niacin be taken with?
food
55What are some AE of niacin?
flushing
pruritus
hyperglycemia
hyperuricemia
patesthesias
GI upset
increase LFTs
56MOA of Omega 3 Fatty acids?
decreases transportation of free fatty acids and inhibits triglyceride-synthesizing enzymes causing a slight increase in HDL and LDL and decreases triglycerides
57What is icosanpent ethyl indicated for?
treatment of hypertriglyceridemia as an adjunct to diet
58When is icosapent ethyl taken?
daily with food
59AE Of icosapent ethyl?
arthralgia