NAPLEX: Cardiovascular Disease With Answers

Statin + ezetimibe - Ezetimibe + Atorvastatin= Liptruzet + Simvastatin= Vytorin Statin + niacin - Niacin + lovastatin = Advicor + Simvastatin = Simcor Renal adjustment of statin and fenofibrate - Lova, Simva, Rosu= CrCl 30: use lower starting dose Prava= CrCl 60: use lower starting dose Fenofibrate= lower dose if CrCl 30-80 mL/min LDL, TG lowering effect - Statin: lower LDL 20-55%, TG 10-30%, raise HDL 5-15% Ezetimibe: lower LDL 18-23%, TG 5-10%, raise HDL 3% BIle acid binding resin: lowers LDL 10-30%, no change or raise TG ~5%, raise HDL 3-5% Fibrates: lower LDL 5-20%, TG 20-50%, raise HDL 15% Niacin: lower LDL 5-25%, TG 20-50%, raise HDL 15-35% Fish oil: lower TG up to 45%, raise HDL 9%, can raise LDL DDI with statin - Do NOT use colchicine or gemfibrozil with statin - NOT use pivastatin (Livalo) with cyclosporine Max dose with verapamil, diltiazem, dronedarone - Simva: 10mg /day Lova: 20 mg/day Max dose with amiadarone - Simva: 20 mg/day Lova: 40 mg/day ACC/AHA recommendation for bile acid sequestrant - *do NOT recommend when TG 300 mg/dL Cholestyramine (Questran), Colesevelam (Welchol), Colestipol (Colestid) hepatotoxicity - Niacin Lomitapide (Juxtapid) - REMS program Mipomersen (Kynamro) - REMS program Cholesterol lowering agent available as inejctable - Alirocumab (Praluent)- q2wk Evolocumab (Repatha)- q month or q2wk Mipomersen (Kynamro)-q1wk Lovaza - 1) can be tried as an alt to fenofibrate to lower TG 2) Should be used in addition to low-fat diet 3) can increase LDL level 4) If use OTC fish oil, will need to double the amount to get similar TG lowering effect as RX ones 5) Max dose is 2 cap BID 6) Indication: to lower TG in pts with TG500 as adjunct to diet Drugs that affect lipid profile - Cyclosporine, amiodarone, prednisone, beta-blocker