Cardio Exam 2

Helpfulness: 0
Set Details Share
created 2 months ago by Austin_Millwood
14 views
updated 6 weeks ago by Austin_Millwood
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

What are the 3 parameters that control BP?

  1. HR (Heart Rate)
  2. SV (Stroke Volume)
  3. SVR (Systemic Vascular Resistance)
2

Primary HTN is also known as what?

Essential hypertension

3

What is the cause of primary HTN?

Unknown cause

4

Which HTN type is caused from other known disease stets or pathology?

Secondary

5

List some causes of secondary HTN:

  • Chronic kidney disease (renal system)
  • Renovascular disease (renal system)
  • Obstructive sleep apnea
  • Primary aldosteronism (endocrine)
  • Cushing’s syndrome (endocrine)
  • Pheochromocytoma (endocrine)
  • Coarctation of the aorta
  • Thyroid or parathyroid disease
  • Drug-induced or drug-related
6

List some common Rx drugs that can contribute to HTN:

  • Adrenal steroids
  • Amphetamines
  • Anti-vascular, endothelial, growth factor agents
  • Estrogens
  • Calcineurin inhibitors
  • Decongestants (OTC)
  • Erythropoietin stimulating agents
  • NSAIDs, COX 2 inhibitors (OTC)
7

List some common street drugs that can contribute to HTN:

  • Cocaine
  • Anabolic steroids
  • Nicotine withdrawal
  • Narcotic withdrawal
8

List some natural products that can contribute to HTN:

  • Ephedra alkaloids (ma-huang)
  • Licorice
  • St. John’s Wort
9

What should be recommended for aches and pains for patients with HTN?

Tylenol

10

Is baby aspirin (81 mg) safe for patients with HTN?

Yes

11

Why is HTN known as the "silent disease"?

Most patients don't have symptoms or know they have it

12

High BP can affect target organs. List the 5 organs and the effects HTN can have on them?

  • Heart (most common)
    • LVH
    • Heart Failure
    • CHD
  • Eyes
    • Retinopathy
  • Brain
    • Stroke or TIA
  • Kidney
    • ESRD
  • Peripheral Artery Disease
13

True or False: Cardiovascular Mortality Risk Doubles with Each 20/10 mm Hg BP Increment

True

14

List some CV risk factors:

  • Age (>55 in men, >65 in women)
  • Hypertension
  • Diabetes
  • Dyslipidemia
  • Microalbuminuria or GFR <60 mL/min
  • Family history of premature CVD (<55 in men, <65 in women)
  • Obesity
  • Physical inactivity
  • Tobacco use
15

What is the major benefit of lowering BP?

Slowing progression of target organ damage

16

How is BP diagnosed?

  • Avg. of 2 or more BP measurements
  • On at least 2 separate office visits
17

What is a normal BP range?

<120/80

18

What is considered elevated BP?

120-129 / <80

19

What is the range for Stage 1 HTN?

130-139 / 80-89

20

What is the range for stage 2 HTN?

> or equal to 140 / > or equal to 90

21

True or False: Individuals with SBP and DBP in 2 categories should be designated to the higher BP category.

True

22

True or False: Reducing BP to desired goal means that target-organ damage will not occur.

False; does not mean

23

What is considered the "desired goal" for BP?

<130/80

24

Which HTN medications are first-line for non-blacks?

  • Thiazide-type diuretics
  • Calcium channel blockers (CCB)
  • ACE inhibitors (ACEIs)
  • Angiotensin receptor blockers (ARBs)
25

Which HTN medications are first-line for blacks?

  • thiazide-type diuretics
  • calcium channel blocker
26

What is the drug class of HCTZ?

thiazide-type diuretics

27

What is the brand name of hydrochlorothiazide (HCTZ)?

Microzide

28

What is the dosing of HCTZ?

12.5-25 mg daily

29

List some common adverse events of thiazide-type diuretics:

  • ↓ in Na +, K+, Mg +
  • ↑ in Ca+2, uric acid, glucose, lipids
  • Sexual dysfunction, photosensitivity
30

Patients that are taking thiazide diuretics that complain of having muscle cramps or fatigue may be experiencing what?

hypokalemia (due to loss of K+)

31

What should be monitored prior to putting a patient on a thiazide diuretic?

  • renal function
    • (CrCL < 30 mL/min) is contraindicated = will not be effective in lowering BP
32

Thiazide diuretics can lead to an increase in what?

uric acid (this can lead to gout)

33

True or False: Doses of HCTZ or other thiazide diuretics over 25 mg are proven more effective in lowering BP.

False; are not proven

34

What is the brand name of benazepril?

Lotensin

35

What is the brand name of enalapril?

Vasotec

36

What is the brand name of lisinopril?

  • Prinivil
  • Zestril
37

What is the dosing of lisinopril?

10-40 mg daily

38

What is the brand name of ramipril?

Altace

39

What are common adverse events of ACE inhibitors?

  • Hypotension
  • Increased K+ (hyperkalemia)
  • Increased SCr
40

True or False: Any increase up to 30% from baseline in SCr still considered to be normal response for ACE inhibitors.

True

41

What is the dry cough associated with ACE inhibitors caused from?

increase bradykinin levels

42

If a patient has the non-productive dry cough on an ACE-I then what HTN medicine should the patient be switched to?

ARB

43

What is a severe side effect of an ACE inhibitor that requires immediate medical attention and discontinuation of the medicine?

angioedema (allergic rxn causing swelling of nose, throat, mouth = closing of throat/difficulty breathing)

44

Which HTN medication classes are contraindicated in pregnancy (absolutely cannot be used)?

  • ACE-Is
  • ARBs
  • DRIs
  • Most BBs
45

List some ARBs:

  • Losartan
  • Olmesartan
  • Valsartan
46

What is the brand name of losartan?

Cozaar

47

What is the brand name of olmesartan?

Benicar

48

What is the brand name of valsartan?

diovan

49

What is the dosing of losartan?

50-100 mg in 1-2 doses daily

50

True or False: Patients with a history of angioedema can take ARBs do to them not being fully contraindicated so Pt. can take, but must be monitored more closely.

True

51

What are the side effects of ARBs?

Same as ACE-Is

52

What are the two types of calcium channel blockers?

  • DHP
  • Non-DHP
53

DHP CCBs target what (mostly)?

vascular smooth muscles

54

Non-DHP targets what (mostly)?

cardiac muscles

55

List some DHP CCBs:

  • Amlodipine
  • Nifedipine long acting
56

What is the brand name of amlodipine?

Norvasc

57

What is the dosing of amlodipine?

2.5-10 mg daily

58

What is the brand name of Nifedipine long acting?

  • Adalat CC
  • Procardia XL
59

DHP CCBs have vasodilatory side effects. What does this mean?

  • HA/flushing
  • Peripheral (ankle) edema = most common SE
60

What are the monitoring parameters for DHP CCBs?

  • HR
  • BP
61

What drug interactions are associated with DHP CCBs?

  • CYP 3A4 inhibitors and inducers
62

What are some drugs that belong to the Non-DHP CCB class?

  • Diltiazem
  • Verapamil
63

What are some common adverse events associated with Non-DHP?

  • Bradycardia (<60 beats/min) --> bc works on coronary arteries
  • Dizziness, peripheral edema
  • Constipation (specifically just for Verapamil)
64

Non-DHP CCBs should NOT be used with patients that have what?

systolic heart failure

65

Patients cannot take Non-DHP CCBs and BBs due to what?

It can produce heart block

66

What is a common side effect of Non-DHP CCBs?

Constipation

67

What drug can be used to treat constipation for patients taking Non-DHP CCBs?

Bulk-forming laxatives (e.g. Psyllium/MetaMucil)

68

Instead of recommending patients to take bulk-forming laxatives for their constipation, what is a good counseling point?

increasing diet with fiber

69

Which HTN drugs are considered additional therapies?

  • Beta blockers
  • Direct Renin inhibitor
  • Arterial vasodilators
  • Aldosterone receptor antagonists
  • Alpha1 blockers
  • Central alpha2 agonists
70

Which alternative therapies for HTN should be considered after trying 1st line options?

  • Beta blockers
  • Aldosterone receptor antagonists
71

Beta blockers primarily lower BP how?

By lowering HR

72

List some cardioselective BBs:

  • Atenolol
  • Bisoprolol
  • Metoprolol tartrate
  • Metoprolol succinate
  • Nebivolol
73

What is the brand name of atenolol?

Tenormin

74

What is the brand name of bisoprolol?

Zebeta

75

What is the brand name of Metoprolol tartrate?

Lopressor

76

What is the dosing of metoprolol tartrate?

100-400 mg in 2 doses

77

What is the brand name of metoprolol succinate?

Toprol XL

78

What is the dosing of metoprolol succinate?

50-200 mg daily

79

What is a non-selective BB?

Propranolol

80

What is the brand name of propranolol?

Inderal

81

What are some mixed alpha/beta blockers?

  • Carvedilol
  • Labetalol
82

What is the brand name of carvedilol?

Coreg

83

What is the dosing of carvedilol?

12.5-50 mg in 2 doses

84

What is the brand name of labetalol?

  • Normodyne
  • Trandate
85

Which BBs are primarily eliminated through the kidneys and therefore would require dose adjustments for patients that may have any kind of kidney impairment?

  • Atenolol
  • Nadolol
86

Which BB is primarily eliminated through hepatic enzymes and therefore would require dose adjustments for patients that may have any kind of hepatic impairment?

Carvedilol

87

What are some common adverse events of beta blockers?

  • bradycardia (consider lower dose if this occurs)
  • orthostatic hypotension (counsel to take time when switching positions)
88

Should beta blocker therapy be initiated in patients with bradycardia (HR <60 beats/min)?

No

89

Beta blockers are contraindicated in pregnancy when?

2nd and 3rd trimesters

90

Which beta blocker is NOT contraindicated in pregnancy?

labetalol

91

Why shouldn't beta blockers be discontinued abruptly?

Can cause rebound HTN (can lead to sudden death) --> need to taper

92

What is the drug class of spironolactone?

Aldosterone antagonists

93

What is the brand name of spironolactone?

Aldactone

94

What is the dosing of spironolactone?

25-50 mg in 1-2 doses

95

What is a common side effect of aldosterone antagonists?

dose-dependent hyperkalemia

96

What is dose-dependent hyperkalemia?

The higher the dose of the drug --> the higher the risk for hyperkalemia

97

What are some common side effects of aldosterone antagonists?

  • Gynecomastia
  • Menstrual irregularities
98

True or False: Gynecomastia and menstrual irregularities are considered reversible side effects of aldosterone antagonists.

True

99

Aldosterone antagonists are contraindicated in patients with a SCr level less than what?

30 mL/min

100

Can ACE-Is and ARBs be used simultaneously?

NO!

101

True or False: Patients can be put on aldosterone antagonists in addition to an ACE inhibitor or ARB.

True

102

Patients taking aldosterone antagonists have a contraindication if their potassium (K+) levels are greater than what?

> 5.5 mEq/L

103

A patient with a potassium (K+) concentration >5.5 mEq/L and taking an aldosterone antagonist can develop too much K+ in the body and therefore the patient can develop what?

cardiac arrythmia (this could be fatal)

104

List some less common therapies used for HTN:

  • Direct Renin Inhibitor
  • Alpha1 Blockers
  • Arterial Vasodilators
  • Central Alpha2 Agonists
105

What is an example of a direct renin inhibitor (DRI)?

Aliskiren (Tekturna)

106

What are the adverse events, monitoring parameters, contraindications, drug interactions, and counseling points for DRIs?

Same as ARBs

107

List some examples of Alpha1 blockers:

  • Doxazosin
  • Terazosin
108

What is the brand name of doxazosin?

Cardura

109

What is the brand name of terazosin?

Hytrin

110

Patients that are prescribed Alpha1 blockers as initial therapy for HTN also have what disorder?

BPH

111

List some examples of Direct Arterial Vasodilators:

  • Hydralazine (Apresoline)
  • Minoxidil (Loniten)
112

Before adding a direct arterial vasodilator as therapy, a patient must be on something for what?

  • lowering HR (BB/Non-DHP CCB)
  • fluid retention (thiazide diuretics)
113

Why should a patient be on something to lower HR as well as something for fluid retention prior to starting a direct arterial vasodilator?

reflex tachycardia

114

List some examples of Central Alpha2 Agonists:

  • Clonidine
  • Methyldopa
115

What are common adverse events of central alpha2 agonists?

  • orthostatic hypotension
  • dizziness
  • anti-cholinergic effects (Clonidine)
116

Which central alpha2 agonist is used for pregnancy-induced HTN?

Methyldopa

117

Why should central alpha2 agonists not be discontinued abruptly?

It directly acts on the heart (just like non-DHP and BB)

118

What is the first step for deciding appropriate HTN therapy for patients with diabetes?

Looking at their race first (whether they are black or non-black)

119

What are appropriate HTN therapies for black patients with diabetes?

  • Thiazide-type diuretics
  • CCB
120

What are appropriate HTN therapies for non-black patients with diabetes?

  • Thiazide-type diuretic
  • CCB
  • ACEi
  • ARB
121

What should be examined when choosing appropriate HTN therapy for patients with chronic kidney disease?

Whether the patient has proteinuria (spilling protein over into urine)

122

What are some appropriate HTN therapies for patients with chronic kidney disease that has proteinuria?

  • ACEI
  • ARB
123

What are some appropriate HTN therapies for patients with chronic kidney disease that has does not have proteinuria?

  • Thiazide-type diuretic
  • CCB
  • ACEI or ARB
124

After initiating HTN drug therapy, BP should be re-checked when?

4 weeks

125

If the BP is under control (BP goal is reached) after the 4 weeks of therapy, what is the plan?

continue treatment and monitoring

126

If the BP goal is not reached after 4 weeks of therapy what is the next step?

  • Reinforce medication & lifestyle adherence
  • Select a drug treatment titration strategy
127

What are the drug treatment titration strategies?

  • Maximize 1st medication before adding 2nd medication
    • Apply this strategy to majority of patients
  • Add 2nd medication before reaching maximum dose of 1st medication
    • Consider this strategy if patient experiences ADR with the 1st medication
  • Start with 2 medication classes separately or as fixed-dose combination
    • Use this strategy in patients with Stage 2 HTN
128

List the types of HTN during pregnancy:

  • Chronic HTN
  • Gestational HTN
  • Preeclampsia
  • Preeclampsia superimposed on chronic HTN
129

Pre-existing hypertension or developing it before 20 weeks of gestation refers to what?

Chronic HTN

130

Hypertension + proteinuria developing after 20 weeks of gestation refers to what?

Preeclampsia

131

Hypertension without proteinuria developing after 20 weeks of gestation refers to what?

Gestational HTN

132

True or False: Preeclampsia during pregnancy is an emergency situation.

True

133

What is the "drug of choice" for HTN in pregnancy?

Methyldopa

134

True or False: Methyldopa has no AE in unborn child or development.

True

135

True or False: Methyldopa has no AE in the mother.

False; does have AE

136

Which drug is beginning to become preferred in pregnancy HTN, because it does not have a lot of side effects?

Labetalol

137

What is the only CCB not contraindicated in pregnancy?

Nifedipine

138

Which HTN medications are contraindicated in pregnancy?

  • ACEIs
  • ARBs
  • DRIs
  • Almost all BBs (Labetalol exception)
  • CCBs (Nifedipine exception)
139

List the special circumstances of hypertensive urgency:

  • BP > 180/120 mm Hg
  • No target-organ damage
  • Not life-threatening
  • GOAL of therapy: ↓ BP over days
  • Treatment: Oral therapy
140

List the special circumstances of hypertensive emergency:

  • BP > 180/120 mm Hg
  • Target-organ damage
  • Life-threatening
  • GOAL of therapy: ↓ BP now
  • Treatment: IV therapy
141

What are some outcomes of target-organ damage in the heart?

  • Acute coronary syndrome
  • Acute left ventricular failure with pulmonary edema
  • Dissecting aortic aneurysm
142

What are some outcomes of target-organ damage in the brain?

  • Encephalopathy
  • Intracranial hemorrhage
  • Stroke or TIA
143

What are some outcomes of target-organ damage renally?

Acute kidney failure

144

What are some outcomes of target-organ damage associated with pregnancy-related complications?

  • Eclampsia
  • Severe hypertension
145

List some treatment of hypertensive urgencies:

  • Adjusting oral maintenance therapy
    • Adding new anti-hypertensive
    • ↑ dose of current medications
  • AVOID use of immediate-release nifedipine (SL or PO), SL captopril, and high dose PO agents
  • Re-evaluate within 7 days
146

List some treatments of hypertensive emergencies:

  • Therapy should be provided in a hospital or emergency room setting
    • Intra-articular BP monitoring
  • Goals of therapy
    • Initial target
      • 25% reduction in SBP within the 1st hour
  • Subsequent target
    • Goal: < 160/100-110 mm Hg within next 2-6 hours
  • Further reductions to goal targets can be attempted after 24-48 hours
147

What 3 drugs are used in hypertensive crisis?

  • Sodium nitroprusside
  • Nicardipine
  • Labetalol
148

Why is it important to make sure that a patient is not exacerbating abnormal renal function prior to administering sodium nitroprusside in a hypertensive emergency?

Sodium nitroprusside gets metabolized to cyanide and if not being cleared by the kidneys can lead to cyanide toxicity

149

What must be made sure that the patient is not experiencing prior to administering labetalol or nicardipine in a hypertensive emergency?

Acute heart failure

150

What is preeclampsia superimposed on chronic hypertension?

A pregnant patient with chronic HTN that develops preeclampsia during pregnancy.

151

What is the formula for calculating LDL?

LDL = TC-HDL-TG/5

152

What should someone's TG levels be in order to be able to use the TG formula?

<400

153

If TG levels are greater than 400, then what has to be done?

Directly measure the LDL (cannot use formula)

154

List some non-pharmacological therapies for dyslipidemia:

  • Therapeutic Lifestyle Changes (TLC)
    • Reduce intake of saturated fats and cholesterol
    • Increase fiber intake
    • Reduce weight
    • Increase physical activity
155

What is the brand name of rosuvastatin?

Crestor

156

What is the brand name of atorvastatin?

Lipitor

157

What is the brand name of simvastatin?

Zocor

158

What is the brand name of Pitavastatin?

Livalo

159

What is the brand name of Pravastatin?

Pravachol

160

What is the brand name of lovastatin?

Mevacor

161

What is the brand name of Fluvastatin?

Lescol

162

What is the main function of statins?

Lowering LDL

163

What are some notable side effects of statins?

  • Myalgia (muscle pain) --> can lead to rhabdomyolysis
  • Increased LFTs
  • Increased blood glucose levels
164

How long after a patient is started on a statin should the lipid panel be re-checked?

6 weeks

165

What are some monitoring parameters of statin use?

  • Lipid panel
  • +/- LFTs
  • +/- CK (Creatinine kinase) —> mostly in patients with myalgia
166

Which drugs can interact with statins and increase the risk of myalgia?

  • fibrates
  • niacin
167

What are some counseling points for statins?

  • unexplained weakness/muscle pain
  • coca-cola colored urine
168

Are statins safe to use in pregnancy?

No

169

True or False: Lower potency statins have lower risk of myalgia

True

170

When should lower potency statins be taken?

At bedtime

171

List some statins that do not have to be taken at bedtime due to a higher potency (longer half-life):

  • Atorvastatin
  • Rosuvastatin
172

Which statins are primarily metabolized by CYP3A4 and therefore should be monitored closely in relation to drugs that induce or inhibit CYP3A4?

  • Atorvastatin
  • Simvastatin
  • Lovastatin
173

List some notable CYP3A4 inhibitors that are contraindicated with the statins that are mainly metabolized by CYP3A4:

  • Dilitazem, Verapamil
  • Amiodarone
  • Grapefruit juice (a quart)
174

Which drug is also a CYP2C9 inhibitor and therefore can interact with some statins?

Amiodarone

175

What is the current maximum dose of Simvastatin per current guidelines?

40 mg

176

Simvastatin 80 mg is limited to patients under which circumstances?

  • that have been taking this dose for >12 consecutive months
  • without evidence of myopathy
  • not currently taking or beginning to take a simvastatin dose-limiting or contraindicated interacting medication
177

What is the brand name of gemfibrozil?

Lopid

178

What is the brand name of fenofibrate?

Tricor

179

Gemfibrozil and Fenofibrate belong to which drug class?

Fibrates

180

Gemfibrozil and Fenofibrate a cleared how?

renally (monitor CrCL --> low CrCL would require the discontinuation of the drug or a lowered dosage)

181

What is the dosing of Gemfibrozil?

BID

182

What is the dosing of Fenofibrate?

QD

183

Fibrates are primarily utilized for what?

Lowering TG

184

If TG levels are extremely high (>500) then fibrates can cause an increase in what?

LDL (add a Statin therapy to help)

185

What are some monitoring parameters of fibrates?

  • Lipid panel, SCr, LFTs
  • +/- CK
186

Gemfibrozil is contraindicated with which statin?

Simvastatin

187

What are some counseling points of fibrates?

  • Unexplained muscle pain/weakness
  • Coca-cola colored urine
188

Which fibrate can be taken without regard to meals?

Fenofibrate

189

Which fibrate should be taken with food or 30 minutes prior to eating?

Gemfibrozil

190

What is the brand name of extended-release niacin?

Niaspan

191

Niacin is primarily used in the management of what?

TGs

192

What are some notable adverse events associated with niacin?

  • Flushing
  • HA
  • Uric acid level increase
  • Hyperglycemia
193

What are the monitoring parameters associated with niacin?

  • Lipid panel
  • LFTs
  • Glucose
  • Uric acid
194

What are some drug interactions associated with niacin?

  • ethanol
  • statins
195

List some counseling points related to niacin:

  • ASA 325mg PO 30 minutes prior to niacin to ↓ flushing symptoms
  • Take with high fiber meals to ↓ flushing
  • Flushing ↓ with sustained use
  • Avoid alcohol and hot beverages
  • May elevate BG
  • May notice empty shell in your stool
196

What is the brand name of cholestyramine?

Questran

197

What is the brand name of Colestipol?

Colestid

198

What is the brand name of colesevelam?

Welchol

199

Cholestyramine, Colestipol, and Colesevelam all belong to which drug class?

Bile acid sequestrants

200

Bile acid sequestrants are primarily utilized for what?

lowering LDL

201

Bile acid sequestrants have what common side effects?

GI SE

202

What is recommended to avoid drug interactions when a patient is taking a bile acid sequestrant?

Space dosing

203

True or False: Bile acid sequestrants should be taken with food to avoid GI upset.

True

204

List some notable clinical pearls associated with bile acid sequestrants:

  • Absolute contraindications: TG>400
  • Supplementation of vitamins A, D, E, and K, folic acid, and iron may be required with high-dose, long-term therapy
  • Increase dose monthly
205

What is the brand name of Ezetimibe?

Zetia

206

What is the dosing of Zetia?

10 mg PO QD

207

What is the primary role of ezetimibe (Zetia)?

lowering LDL

208

True or False: Zetia is a pretty clean drug, so there aren't as many side effects to worry about.

True

209

True or False: Zetia must be taken with meals.

False; can be taken without regard to meals

210

What is the brand name of Omega 3 fatty acids?

Lovaza

211

Omega 3 fatty acids (Lovaza) primarily lowers what?

TGs

212

What are some common AE of omega 3 fatty acids (Lovaza)?

  • Dyspepsia
  • belching
  • fishy smell/breath
213

True or False: Dyspepsia associated with omega 3 fatty acids goes away over time.

True

214

True or False: Omega 3 fatty acids can be taken without regard to meals.

True

215

List some herbals used for dyslipidemia:

  • Cod liver oil
  • Policosonal
  • Plant Stanols and Sterols- Sitostanol
216

Which herbal is equal to a statin and truly works for dyslipidemia?

Red Yeast Rice

217

Red Yeast Rice has the same MOA as which drug?

Lovastatin

218

What is an inherited disorder of lipoprotein metabolism caused mainly by mutations in the LDL-receptor (LDL-R) gene?

Familial Hypercholesterolemia (FH)

219

Which disorder is being described below?

  • 1 in 160,000-300,000 patients
  • Inherit 2 defective alleles

Homozygous FH

220

Which disorder is being described below?

  • 1 in 200 patients
  • Inherit 1 defective allele

Heterozygous FH

221

For people with Homozygous FH they have LDL levels that are what?

High (>500)

222

People with HeFH have LDL levels at which range?

300-500

223

What is the clinical presentation of FH?

  • Corneal arcus and xanthelasma
  • extensor tendon xanthomas
  • Achilles tendon xanthomas
224

When are the clinical presentations of FH usually seen?

When LDL levels are >500

225

True or False: There are several diagnostic criteria for FH and they are all different.

True

226

What is the brand name of Mipomersen?

Kynamro

227

Mipomersen (Kynamro) is used for what?

HoFH

228

What is the efficacy rate of Mipomersen (Kynamro)?

  • decreases LDL by 25%
229

True or False: Mipomersen (Kynamro) is part of the REMS program because of hepatotoxicity.

True

230

What is the brand name of Lomitapide?

Juxtapid

231

What is Lomitapide (Juxtapid) used for?

HoFH

232

What is the efficacy rate of lomitapide (Juxtapid)?

decreases LDL by 50%

233

Lomitapide (Juxtapid) is a part of the REMS program why?

hepatotoxicity

234

True or False: Lomitapide (Juxtapid) is safe for use in pregnancy.

False; is contraindicated in pregnancy

235

What is the brand name of Alirocumab?

Praluent

236

What is the brand name of Evolocumab?

Repatha

237

Alirocumab (Praluent) and Evolocumab (Repatha) belong to which drug class?

PCSK9 inhibitors

238

What are uses for Alirocumab (Praluent)?

  • HeFH
  • Dyslipidemia (add-on therapy)
239

Alirocumab (Praluent) is mainly used to lower what?

LDL

240

What are common adverse events associated with Alirocumab?

  • Hypersensitivity
  • injection-site reactions
  • influenza
241

What is an absolute contraindication associated with Alirocumab?

Previous allergic reaction

242

What are the main things to consider with PCKS9 inhibitors in regards to administration?

  • Injections are refrigerated
  • Allow drug to come to room temp before injection to reduce stinging.
243

What are the indications for Evolocumab?

  • HeFH
  • Dyslipidemia
  • HoFH (additional indication)
244

What is the efficacy of Evolocumab?

Lowers LDL and TG (mainly LDL)

245

What are some notable adverse events associated with Evolocumab?

  • Hypersensitivity
  • injection-site reactions
  • nasopharyngitis
246

What are the 5 ASCVD conditions?

  • MI
  • Stroke
  • TIA
  • Peripheral Arterial Disease (PAD)
  • Angina (stable or unstable)
247

List the statin benefit groups associated with the ACC/AHA guidelines:

  • Individuals with clinical ASCVD (Secondary prevention)
  • Individuals 40 to 75 years of age with LDL ≥ 190 mg/ dL
  • Individuals 40 to 75 years of age with LDL 70-189 mg/ dL and diabetes
  • Individuals 40 to 75 years of age with LDL 70-189 mg/ dL but without clinical ASCVD or diabetes
248

Normal LDL is considered what?

less than 100

249

Individuals with clinical ASCVD need to be put on what?

High intensity statins

250

Individuals 40 to 75 years of age + diabetes + LDL 70-189 mg/dL who do not smoke or have high blood pressure who are aged 40-49 should be treated with a what?

Moderate intensity statin

251

Individuals 40 to 75 years of age + LDL ≥ 190 mg/dL need to be administered what?

High intensity statins

252

Individuals 40 to 75 years of age + diabetes + LDL 70-189 mg/dL who do not smoke or have high blood pressure who are aged 50-75 should be treated with a what?

High intensity statin

253

Individuals 40 to 75 years of age + diabetes + LDL 70-189 mg/dL who do smoke or have high blood pressure should be treated with a what?

High intensity statin

254

Individuals 40 to 75 years of age (without clinical ASCVD or diabetes) + LDL 70-189 mg/dL who have a 10-year ASCVD risk between 7.5-19.9% should be treated with a what?

moderate intensity statin

255

Individuals 40 to 75 years of age (without clinical ASCVD or diabetes) + LDL 70-189 mg/dL who have a 10-year ASCVD risk greater than 20% should be treated with a what?

high intensity statin

256

What are the 4 treatment options associated with high intensity statins?

  • Atorvastatin 40
  • Atorvastatin 80
  • Rosuvastatin 20
  • Rosuvastatin 40
257

A high intensity statin is supposed to decrease LDL levels by what percent?

> or equal to 50%

258

If a patient with clinical ASCVD is started on a high intensity statin and does not achieve a greater than 50% drop in LDL levels, what is the next course of action?

increasing to the highest dose of a high intensity statin

259

If a patient with clinical ASCVD started on a high intensity statin has a decrease of LDL ≥ 50% , but has an LDL level ≥ 70 mg/dL, what is the course of action?

Add Ezetimibe

260

If a patient with clinical ASCVD on a high-intensity statin and Ezetimibe has an LDL still ≥ 70 mg/dL what is the course of action?

Add PCSK9 inhibitor

261

For individuals with ASCVD, what is the LDL target level?

<70 mg/dL

262

For individuals aged 40-75 years of age + LDL ≥ 190 mg/dL who are started on high intensity statin therapy who have not experienced a drop in LDL by less than 50%, what is the next course of action?

increase the high intensity statin to the highest dose

263

For individuals aged 40-75 years of age + LDL ≥ 190 mg/dL who are on the highest dose of a high intensity statin that have a 50% decrease in LDL, but who have an LDL level that remains ≥ 100 mg/dL, what is to be done?

Add ezetimibe

264

For individuals aged 40-75 years of age + LDL ≥ 190 mg/dL taking a high intensity statin and Ezetimibe who have an LDL ≥ 100 mg/dL what is to be done?

Add PCSK9 inhibtor

265

List the guidelines for Individuals 40-75 years of age + diabetes + LDL 70-189 mg/dL as well as individuals 40-75 years of age (without clinical ASCVD or diabetes) + LDL 70-189 mg/dL:

  • Moderate intensity statin = ↓ LDL by 30-49%
    • If ↓ in LDL < 30% = increase to the highest dose of a moderate intensity statin
      • If ↓ in LDL still < 30% = consider switching to high intensity statin
    • No recommendations on achieving target LDL levels
  • High intensity statin = ↓ LDL by ≥ 50%
    • If ↓ in LDL < 50% = increase to the highest dose of a high intensity statin
    • No recommendations on achieving target LDL levels
266

List some characteristics that predispose individuals to statin related adverse events:

  • >75 years of age
  • History of previous statin intolerance or muscle disorders
  • Unexplained ALT elevations >3 times ULN
  • Multiple or serious comorbidities, including impaired renal or hepatic function
  • Patient characteristics or concomitant use of drugs affecting statin metabolism
267

What are some additional characteristics predisposing individuals to statin adverse events?

  • History of hemorrhagic stroke
  • Asian ancestry
268

What is to be done if a patient is in fact pre-disposed to statin adverse events?

  • Moderate-intensity statin therapy should be used:
    • In individuals who have characteristics predisposing them to statin associated adverse events
      • +
    • High-intensity statin therapy would otherwise be recommended
269

After an initial lipid panel and follow-up lipid panel (after 4-12 weeks ~6 weeks) is performed, when should assessments be performed from there on out?

every 3-12 months

270

Decreasing a statin dose may be considered when 2 consecutive values of LDL levels are what?

< 40 mg/dL

271

Measuring LFTs is done by what panel?

ALT panel

272

An ALT panel should be repeated if what?

Patient shows signs of hepatotoxicity

273

List some signs/symptoms of hepatotoxicity:

  • Unusual fatigue or weakness
  • Loss of appetite
  • Abdominal pain
  • Dark colored urine
  • Yellowing of the skin or sclera
274

What should NOT be routinely measured in individuals receiving statin therapy?

Creatine Kinase

275

Baseline measurement of CK for patients on statin therapy is reasonable for individuals believed to be at an increased risk for adverse events based on:

  • A personal or family history of statin intolerance or muscle disease
  • Clinical presentation
  • Concomitant drug therapy that might increase the risk for myopathy
276

It is reasonable to measure CK for patients on statin therapy for individuals that have what?

muscle symptoms (myopathy/myalgia)

277

To avoid unnecessary distribution of statins, what should be obtained?

  • A history of prior or current muscle symptoms to establish a baseline before initiating statin therapy
278

If SEVERE muscle symptoms or fatigue develop during statin therapy occur, then what should be done?

  • Promptly discontinue therapy and address rhabdomyolysis by evaluating:
    • CK
    • Creatinine
    • Urinalysis for myoglobinuria
279

If MILD to MODERATE muscle symptoms or fatigue develop during statin therapy:

  • Discontinue statin until symptoms resolve.
  • If muscle symptoms resolve + if no contraindication exists, give the patient the original or a lower dose of the same statin to establish a causal relationship.
  • If patient has muscle pain again, discontinue the original statin.
  • Once muscle symptoms resolve, use a low dose of a different statin.
  • Once a low dose of a statin is tolerated, gradually increase the dose as tolerated
  • If, after 2 months without statin treatment, muscle symptoms or elevated CK levels do not resolve completely, consider other causes of muscle symptoms
    • If persistent muscle symptoms are determined to arise from a condition unrelated to statin therapy, or if the predisposing condition has been treated, resume statin therapy at the original dose
280

For patients that are completely statin intolerant, what should be used for treatment?

  • Zetia
  • PCSK9 inhibitors