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Questions and Answers
A 62-year-old male with a history of hypertension and type 2 diabetes mellitus has an LDL-C level of 170 mg/dL despite lifestyle modifications. His 10-year ASCVD risk score is calculated to be 12%. According to the guidelines, what is the most appropriate initial treatment?
A 62-year-old male with a history of hypertension and type 2 diabetes mellitus has an LDL-C level of 170 mg/dL despite lifestyle modifications. His 10-year ASCVD risk score is calculated to be 12%. According to the guidelines, what is the most appropriate initial treatment?
- Ezetimibe monotherapy
- Moderate-intensity statin therapy
- Bile acid sequestrant
- High-intensity statin therapy (correct)
Which of the following is the primary mechanism of action of HMG-CoA reductase inhibitors (statins)?
Which of the following is the primary mechanism of action of HMG-CoA reductase inhibitors (statins)?
- Increasing the excretion of bile acids
- Inhibiting the synthesis of cholesterol in the liver (correct)
- Increasing the expression of LDL receptors
- Inhibiting the absorption of cholesterol in the small intestine
A 58-year-old female is started on atorvastatin for hyperlipidemia. Which laboratory value is most important to check before initiating statin therapy?
A 58-year-old female is started on atorvastatin for hyperlipidemia. Which laboratory value is most important to check before initiating statin therapy?
- Thyroid-stimulating hormone (TSH)
- Vitamin D level
- Creatine kinase (CK)
- Liver function tests (LFTs) (correct)
Which of the following statins is considered a high-intensity statin at commonly prescribed doses?
Which of the following statins is considered a high-intensity statin at commonly prescribed doses?
A patient on warfarin is prescribed gemfibrozil for hypertriglyceridemia. What potential interaction should the healthcare provider monitor for?
A patient on warfarin is prescribed gemfibrozil for hypertriglyceridemia. What potential interaction should the healthcare provider monitor for?
Which of the following is a common side effect of niacin, and what strategy can be used to mitigate it?
Which of the following is a common side effect of niacin, and what strategy can be used to mitigate it?
A 45-year-old patient with a history of premature coronary artery disease (CAD) presents with an LDL-C level of 180 mg/dL despite being on a moderate-intensity statin. What is the next best step in management?
A 45-year-old patient with a history of premature coronary artery disease (CAD) presents with an LDL-C level of 180 mg/dL despite being on a moderate-intensity statin. What is the next best step in management?
Which lipid-lowering agent is most effective at lowering triglyceride levels?
Which lipid-lowering agent is most effective at lowering triglyceride levels?
Which of the following is a contraindication to the use of HMG-CoA reductase inhibitors (statins)?
Which of the following is a contraindication to the use of HMG-CoA reductase inhibitors (statins)?
A patient taking simvastatin reports muscle pain and weakness. What is the most appropriate initial action?
A patient taking simvastatin reports muscle pain and weakness. What is the most appropriate initial action?
Which of the following best describes the action of omega-3 fatty acids in managing hypertriglyceridemia?
Which of the following best describes the action of omega-3 fatty acids in managing hypertriglyceridemia?
A patient with severe hypertriglyceridemia (TG > 500 mg/dL) is started on fenofibrate. What potential adverse effect should the patient be educated about?
A patient with severe hypertriglyceridemia (TG > 500 mg/dL) is started on fenofibrate. What potential adverse effect should the patient be educated about?
Which of the following lipid-lowering medications is a prodrug?
Which of the following lipid-lowering medications is a prodrug?
A 68-year-old patient with known coronary artery disease (CAD) has an LDL-C level of 85 mg/dL despite being on a high-intensity statin. According to current guidelines, what should be considered?
A 68-year-old patient with known coronary artery disease (CAD) has an LDL-C level of 85 mg/dL despite being on a high-intensity statin. According to current guidelines, what should be considered?
Which of the following laboratory values should be monitored in patients taking niacin?
Which of the following laboratory values should be monitored in patients taking niacin?
Which of the following patients would be the best candidate for bile acid sequestrants?
Which of the following patients would be the best candidate for bile acid sequestrants?
A patient with a history of ASCVD has been on maximally tolerated statin therapy for several years, achieving a 40% reduction in LDL-C. His LDL-C remains above target. Which of the following would be the most appropriate next step?
A patient with a history of ASCVD has been on maximally tolerated statin therapy for several years, achieving a 40% reduction in LDL-C. His LDL-C remains above target. Which of the following would be the most appropriate next step?
A patient is started on cholestyramine. To avoid drug interactions, when should other medications be administered?
A patient is started on cholestyramine. To avoid drug interactions, when should other medications be administered?
Which of the following patients with hyperlipidemia would be LEAST likely to benefit from statin therapy?
Which of the following patients with hyperlipidemia would be LEAST likely to benefit from statin therapy?
Which of the following is a risk factor for myopathy and rhabdomyolysis in patients taking statins?
Which of the following is a risk factor for myopathy and rhabdomyolysis in patients taking statins?
A 70-year-old patient has an LDL-C level of 150 mg/dL and is started on simvastatin 20 mg daily. After 6 weeks, LDL-C is 120 mg/dL. What is the next appropriate step?
A 70-year-old patient has an LDL-C level of 150 mg/dL and is started on simvastatin 20 mg daily. After 6 weeks, LDL-C is 120 mg/dL. What is the next appropriate step?
A 55-year-old male with a history of hypertension and a 10-year ASCVD risk of 8% has an LDL-C of 140 mg/dL. Which of the following is the MOST appropriate recommendation, according to current guidelines?
A 55-year-old male with a history of hypertension and a 10-year ASCVD risk of 8% has an LDL-C of 140 mg/dL. Which of the following is the MOST appropriate recommendation, according to current guidelines?
Which of the following is a potential benefit of using a cholesterol absorption inhibitor like ezetimibe in addition to a statin?
Which of the following is a potential benefit of using a cholesterol absorption inhibitor like ezetimibe in addition to a statin?
Which of the following is considered a risk-enhancing factor that may favor the initiation of statin therapy in individuals with borderline to intermediate ASCVD risk?
Which of the following is considered a risk-enhancing factor that may favor the initiation of statin therapy in individuals with borderline to intermediate ASCVD risk?
Which of the following statins is a prodrug that requires hydrolysis to its active form?
Which of the following statins is a prodrug that requires hydrolysis to its active form?
Which of the following medications is most effective for lowering LDL cholesterol?
Which of the following medications is most effective for lowering LDL cholesterol?
A patient with severe hypertriglyceridemia (TG > 500 mg/dL) should be started on which therapy?
A patient with severe hypertriglyceridemia (TG > 500 mg/dL) should be started on which therapy?
Which of the following statin doses is considered high-intensity?
Which of the following statin doses is considered high-intensity?
A 55-year-old patient with an ASCVD score of 10% and no history of cardiovascular disease should be started on which therapy?
A 55-year-old patient with an ASCVD score of 10% and no history of cardiovascular disease should be started on which therapy?
A patient taking niacin reports significant flushing. What can help reduce this side effect?
A patient taking niacin reports significant flushing. What can help reduce this side effect?
Which drug class is the most effective at increasing HDL levels?
Which drug class is the most effective at increasing HDL levels?
A 45-year-old with diabetes and an ASCVD score of 6% should be started on which therapy?
A 45-year-old with diabetes and an ASCVD score of 6% should be started on which therapy?
Which of the following side effects is most concerning in a patient taking a statin?
Which of the following side effects is most concerning in a patient taking a statin?
Which lab should be checked prior to initiating statin therapy?
Which lab should be checked prior to initiating statin therapy?
A patient on maximally tolerated statin therapy still has high LDL. What is the next step?
A patient on maximally tolerated statin therapy still has high LDL. What is the next step?
Which lab test is the most important to monitor for statin-induced myopathy?
Which lab test is the most important to monitor for statin-induced myopathy?
Which of the following lipid-lowering drugs increases the anticoagulant effect of warfarin?
Which of the following lipid-lowering drugs increases the anticoagulant effect of warfarin?
Which lipid-lowering medication is contraindicated in pregnancy?
Which lipid-lowering medication is contraindicated in pregnancy?
Which of the following patients should be started on high-intensity statin therapy?
Which of the following patients should be started on high-intensity statin therapy?
Which medication is most effective at lowering LDL cholesterol?
Which medication is most effective at lowering LDL cholesterol?
Which statement about omega-3 fatty acids is correct?
Which statement about omega-3 fatty acids is correct?
Which of the following is a known adverse effect of statins?
Which of the following is a known adverse effect of statins?
Which of the following is NOT a major risk factor for hyperlipidemia?
Which of the following is NOT a major risk factor for hyperlipidemia?
Which lipid-lowering agent can increase the effect of warfarin, increasing the risk of bleeding?
Which lipid-lowering agent can increase the effect of warfarin, increasing the risk of bleeding?
Which lipid-lowering medication is absolutely contraindicated in pregnancy?
Which lipid-lowering medication is absolutely contraindicated in pregnancy?
A patient on a high-intensity statin still has an elevated LDL. What is the preferred add-on therapy?
A patient on a high-intensity statin still has an elevated LDL. What is the preferred add-on therapy?
Which of the following medications is most effective for lowering triglycerides?
Which of the following medications is most effective for lowering triglycerides?
Which statement about PCSK9 inhibitors is correct?
Which statement about PCSK9 inhibitors is correct?
What is the mechanism of action of ezetimibe?
What is the mechanism of action of ezetimibe?
Flashcards
What lipid levels indicate hyperlipidemia?
What lipid levels indicate hyperlipidemia?
High LDL, total cholesterol, and low HDL.
Name the risk factors for hyperlipidemia
Name the risk factors for hyperlipidemia
Smoking, HTN, obesity, DM, CKD, and advanced age.
What are the two main hyperlipidemia treatments?
What are the two main hyperlipidemia treatments?
Lifestyle modifications and pharmacotherapy.
ASCVD patients treatment
ASCVD patients treatment
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Treatment for very high-risk ASCVD
Treatment for very high-risk ASCVD
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Treatment for LDL-C ≥190 mg/dL
Treatment for LDL-C ≥190 mg/dL
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Treatment for diabetics with LDL-C ≥70 mg/dL?
Treatment for diabetics with LDL-C ≥70 mg/dL?
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What are the two high-intensity statins?
What are the two high-intensity statins?
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How do statins work?
How do statins work?
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In very high-risk ASCVD when should nonstatins be added
In very high-risk ASCVD when should nonstatins be added
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What the the dose of atorvastatin to be high intensity?
What the the dose of atorvastatin to be high intensity?
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What the the dose of rosuvastatin to be high intensity?
What the the dose of rosuvastatin to be high intensity?
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What are major statin side effects to monitor?
What are major statin side effects to monitor?
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Which lab value needs to be checked when starting statins?
Which lab value needs to be checked when starting statins?
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What to check with statin-associated muscle symptoms?
What to check with statin-associated muscle symptoms?
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Which statins are prodrugs?
Which statins are prodrugs?
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Which statin lowers LDL the most?
Which statin lowers LDL the most?
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How does niacin work?
How does niacin work?
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What are common side effects of Niacin?
What are common side effects of Niacin?
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How do you reduce niacin-induced flushing?
How do you reduce niacin-induced flushing?
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What lipid does fibrates affect the most?
What lipid does fibrates affect the most?
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What are drug interactions with fibrates?
What are drug interactions with fibrates?
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Omega-3 fatty acids action to treat?
Omega-3 fatty acids action to treat?
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How do bile acid sequestrants like cholestyramine work?
How do bile acid sequestrants like cholestyramine work?
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Bile acid sequestrants side effects
Bile acid sequestrants side effects
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What is a prodrug?
What is a prodrug?
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How to reduce niacin flushing?
How to reduce niacin flushing?
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What baseline labs are needed when starting statins?
What baseline labs are needed when starting statins?
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How does ezetimibe work?
How does ezetimibe work?
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Cholestyramine counseling important to remember?
Cholestyramine counseling important to remember?
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PCSK9 inhibitor effect on LDL
PCSK9 inhibitor effect on LDL
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What statin use is contraindicated in pregnancy?
What statin use is contraindicated in pregnancy?
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Which lipid lowering drug interacts with warfarin?
Which lipid lowering drug interacts with warfarin?
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Study Notes
Prodrugs
- Simvastatin and lovastatin are statin prodrugs needing activation through hydrolysis.
Best Drug for Hyperlipidemia & Hypertriglyceridemia
- High-intensity statins like rosuvastatin and atorvastatin are most effective for lowering LDL.
Hypertriglyceridemia Treatment
- Omega-3 fatty acids significantly lower triglycerides (25-30%) and serve as an adjunct for severe hypertriglyceridemia (TG > 500 mg/dL).
Statin Intensity Levels
- High-intensity statin doses include atorvastatin 40-80 mg and rosuvastatin 20-40 mg.
Algorithm Based on Age/Risk
- Initiate moderate-intensity statin therapy for a 55-year-old patient with a 10% ASCVD score and no history of cardiovascular disease.
- ASCVD risk ≥ 7.5% but < 20% warrants a moderate-intensity statin.
Flushing and How to Reduce It
- Aspirin 30 minutes before niacin helps reduce prostaglandin-mediated flushing.
Benefits of Each Drug Class
- Niacin is the most effective drug class at increasing HDL levels (15-35%).
ASCVD Score & Best Drug Choice
- Diabetic patients aged 40-75 years should be started on at least moderate-intensity statins regardless of ASCVD score.
Side Effects of Statins
- Muscle pain with elevated creatine kinase is a concerning symptom with statin use due to myopathy and rhabdomyolysis risk, which should be monitored.
Monitoring When Starting Statins
- Check liver function tests (LFTs) before starting statin therapy to assess for underlying liver disease.
Add-On Therapy for Patients Already on Statins
- Add ezetimibe for patients on maximally tolerated statin therapy with persistently high LDL.
- Ezetimibe is the preferred add-on when LDL remains elevated.
Most Important Lab Monitoring
- Monitor creatine kinase (CK) levels in patients with muscle complaints while on statins because it can indicate Statin-induced myopathy.
Warfarin Interactions
- Gemfibrozil increases INR when used with warfarin, increasing bleeding risk.
Drugs Contraindicated in Pregnancy
- Statins (like atorvastatin) are teratogenic and contraindicated in pregnancy.
Statin Benefit Groups
- Patients with ASCVD risk ≥ 20% warrant high-intensity statin therapy.
Which Drug Lowers LDL the Most?
- High-intensity statins, like rosuvastatin and atorvastatin, lower LDL the most.
High-Intensity Statin Doses
- High-intensity statins include atorvastatin 40 mg.
Omega-3 Fatty Acids
- Omega-3 fatty acids primarily lower triglycerides and are used as an adjunct in severe hypertriglyceridemia.
Side Effects of Statins
- Statins can cause elevated liver enzymes, requiring LFT monitoring before initiation.
What to Check If a Certain Side Effect Occurs
- Check creatine kinase levels in patients on atorvastatin presenting with muscle pain and weakness to assess for myopathy or rhabdomyolysis.
What to Do When Starting an Agent
- Baseline LFTs are required before starting statins to assess liver function.
Risk Factors for Hyperlipidemia
- Hypothyroidism can contribute to lipid abnormalities but is not a primary risk factor for hyperlipidemia.
Warfarin Interactions
- Gemfibrozil increases INR when used with warfarin, leading to a higher bleeding risk.
Contraindicated in Pregnancy
- Statins are contraindicated in pregnancy due to teratogenic effects.
What to Add When LDL Remains High on Statins
- Ezetimibe is commonly added to statins when additional LDL lowering is needed.
Fibrates and Triglycerides
- Fibrates such as fenofibrate are the most effective at lowering triglycerides.
Bile Acid Sequestrants
- Bile acid sequestrants impair drug absorption and should be taken separately from other medications.
PCSK9 Inhibitors
- PCSK9 inhibitors significantly lower LDL and are used in statin-intolerant patients or those needing additional LDL lowering.
- PCSK9 inhibitors lower LDL by 50-70%.
Cholesterol Absorption Inhibitors
- Ezetimibe blocks cholesterol absorption, reducing LDL.
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