10 - Dyslipidemia

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Last updated 9:18 PM on 6/9/26

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39 Terms

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High intensity statins and

When to switch to them

<img src="https://assets.knowt.com/user-attachments/fc17d13a-2d81-4988-9ce5-f0cba94eb3b7.png" data-width="25%" data-align="center" alt="knowt flashcard image"><img src="https://assets.knowt.com/user-attachments/e49bbdb0-c4ea-4353-9208-89a589257243.png" data-width="50%" data-align="center" alt="knowt flashcard image"><p></p>

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LDL, HDL, Triglycerides Normal Levels

<img src="https://assets.knowt.com/user-attachments/3adcab2a-e1a0-4522-ab6d-6001562b00d0.png" data-width="25%" data-align="center" alt="knowt flashcard image"><p></p>

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When to use high vs moderate intensity statin

High intensity statin

Clinical ASCVD (MI, stroke/TIA, PAD) → LDL goal <70 (goal in high risk)
Familial hypercholesterolemia, LDL >190 → LDL goal <100 (goal in healthy patients)
Add ezetimibe and PCSK9 inhibitor for adjunct if goal not met

Moderate intensity statin

Age 40-75 with DM and LDL >70 (high intensity if also have risk enhancing factors or LDL >190)
10 year ASCVD risk of at least 7.5%

If uncertain check coronary artery calcium (CAC) scores

scores of 0: delay statin except if major risk factors
score of 1-99: favors statins especially if >55 yo
score of 100: statins indcated

<p><strong>High </strong>intensity statin</p><ul><li><p>Clinical <strong>ASCVD </strong>(MI, stroke/TIA, PAD) → LDL goal <strong><70 </strong>(goal in high risk)</p></li><li><p><strong>Familial hypercholesterolemia</strong>, LDL <strong>>190</strong> <strong>→ </strong>LDL goal <strong><100 </strong>(goal in healthy patients)</p></li><li><p>Add ezetimibe and PCSK9 inhibitor for adjunct if goal not met</p></li></ul><p><strong>Moderate </strong>intensity statin</p><ul><li><p>Age 40-75 with <strong>DM </strong>and LDL <strong>>70 </strong>(high intensity if also have <strong>risk enhancing factors </strong>or <strong>LDL >190</strong>)</p></li><li><p>10 year <strong>ASCVD risk </strong>of <strong>at least 7.5%</strong></p></li></ul><p>If uncertain check coronary artery calcium (<strong>CAC</strong>) scores</p><ul><li><p>scores of <strong>0</strong>: <strong>delay </strong>statin except if major risk factors</p></li><li><p>score of <strong>1-99</strong>: <strong>favors </strong>statins especially if <strong>>55 yo</strong></p></li><li><p>score of <strong>100</strong>: statins <strong>indcated</strong></p></li></ul><p></p>

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Stroke risk enhancing factors → may need primary prevention statin therapy

emphnasis on Hs-C

<img src="https://assets.knowt.com/user-attachments/b9306d37-c379-464a-8eb3-161c113db575.png" data-width="50%" data-align="center" alt="knowt flashcard image"><p>emphnasis on <strong>Hs-C</strong></p>

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Equation

Total cholesterol

Non-HDL Cholesterol (goal)

Cholesterol / HDL ratio

<img src="https://assets.knowt.com/user-attachments/bab75c7e-e9af-458a-9a61-e9e2ed351aaf.png" data-width="50%" data-align="center" alt="knowt flashcard image"><p></p>

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NCEP III Risk Factor for CHD

Age (male >45, female >55)

Gender: male > female

Family hx

Smoking

HDL <40 mg/dL

HTN

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Drugs that increase cholesterol

PAS on the BLT

Protease inhibitors

Antipsychotics

SGLT2 inhibitors

Loop

Thiazides

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Statin equivalency 38% LDL reduction

Pete and Rose Attract Similar Love Potions Frequently

<img src="https://assets.knowt.com/user-attachments/56f99979-aae7-46fd-afb8-42b15ce6f82f.png" data-width="50%" data-align="center" alt="knowt flashcard image"><p><strong>P</strong>ete and <strong>R</strong>ose <strong>A</strong>ttract <strong>S</strong>imilar <strong>L</strong>ove <strong>P</strong>otions <strong>F</strong>requently</p>

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Statin (general)

Side effect, CI, Comments

decreases hsCRP → reduce inflammation

Emphasis on myopathy

If severe muscle symptoms → DC use, evaluate CPK
increase myopathy with fibric acid agent or niacin
Muscle toxicity increased with: Daptomycin, Zidovudine, Raltegravir, Colchicine

Lab monitoring

Lipid panel: baseline → 4-12 weeks → 3-12 months
CPK: Don’t routine monitor, only if patient has symptoms of myopathy
LFT: baseline → only as indicated

<img src="https://assets.knowt.com/user-attachments/9e12040d-aa36-4776-aa50-e0a5a5958277.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p><strong>decreases hsCRP </strong>→ reduce inflammation</p><p>Emphasis on <strong>myopathy</strong></p><ul><li><p>If <strong>severe </strong>muscle symptoms → DC use, evaluate <strong>CPK</strong></p></li><li><p>increase <strong>myopathy </strong>with <strong>fibric acid </strong>agent or <strong>niacin</strong></p></li><li><p><strong>Muscle toxicity increased </strong>with: <strong>D</strong>aptomycin, <strong>Z</strong>idovudine, <strong>R</strong>altegravir, <strong>C</strong>olchicine</p></li></ul><p>-</p><p>Lab monitoring</p><ul><li><p>Lipid panel: baseline → 4-12 weeks → 3-12 months </p></li><li><p>CPK: Don’t routine monitor, only if patient has symptoms of myopathy</p></li><li><p>LFT: baseline → only as indicated </p></li></ul><p></p>

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Livalo

Pitavastatin (Livalo)

Dose…Comment

know max dose with/without renal issues

rifampin INCREASES pitavastatin (usu CYP inducer, but inhibits via non-CYP pathways)

<p><strong>Pitava</strong>statin (<strong>Liv</strong>alo)</p><p><em>Dose…Comment</em></p><img src="https://assets.knowt.com/user-attachments/bd5b47a6-80d1-48f9-957e-04a0e63b1d9e.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p>know <strong>max dose </strong>with/without renal issues</p><p><strong>rifampin INCREASES pitavastatin </strong>(usu CYP inducer, but inhibits via non-CYP pathways)</p>

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Zypitamag (→ generic)

Mg2+ Salt of Pitavastatin (Zypitamag)

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Cyclosporine DDI with Statins

CI in Pitavastatin, Atorvastatin, Simvastatin, Lovastatin

Capped with…

Rosuvastatin (max 5 mg/day)
Pravastatin (max 20 mg/day)
Fluvastatin (max 20 mg/day)

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Crestor

Rosuvastatin (Crestor)

Dose…Comment

know max dosing

emphasis on hs-CRP part

<p><strong>Rosuv</strong>astatin (<strong>Crest</strong>or)</p><p><em>Dose…Comment</em></p><img src="https://assets.knowt.com/user-attachments/93c1d850-f22e-4c9b-95ae-81fbcf0c9540.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p>know <strong>max dosing</strong></p><p>emphasis on <strong>hs-CRP </strong>part</p>

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Roszet (→ generic)

Roszet (rosuvastatin + ezetimibe)

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Lipitor

Atorvastatin (Lipitor)

Dose…Comment

doesnt increase warfarin bleeding effect or need dose adjust if CrCl<30

<p><strong>Atorva</strong>statin <strong>(Lipi</strong>tor)</p><p><em>Dose…Comment</em></p><img src="https://assets.knowt.com/user-attachments/2ca6be70-9ef5-4fd8-99b7-7fa8f73eecc8.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p>doesnt increase warfarin bleeding effect or need dose adjust if CrCl<30</p>

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Caduet (→ generic)

Caduet (amlodipine + atorvastatin)

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Zocor

Simvastatin (Zocor)

Dose…Comment

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Vytorin (→ generic)

Vytorin (ezetimibe + simvastatin)

max dose of ezetimibe is 10 mg (first # of Rx)

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Simvastatin Drug Interactions

<img src="https://assets.knowt.com/user-attachments/8a6e29b6-ff42-4cb3-bd51-c6cc3964d1d1.png" data-width="50%" data-align="center" alt="knowt flashcard image"><img src="https://assets.knowt.com/user-attachments/c01221c5-45b9-4036-8d2c-eae0f0b73ced.png" data-width="50%" data-align="center" alt="knowt flashcard image"><p></p>

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Mevacor (generic)

Altopreve

Lovastatin (Mevacor, Altopreve)

Mevacor: IR with evening meal

Altopreve: ER take any time

Max dose: 80 mg/day

Red yeast rice → structurally identical to lovastatin → may increase toxic effects when paired with statins

<p><strong>Lovas</strong>tatin (<strong>Meva</strong>cor, <strong>Altop</strong>reve)</p><p>-</p><p><strong>Meva</strong>cor: <strong>IR </strong>with <strong>evening meal</strong></p><p><strong>Altop</strong>reve: <strong>ER </strong>take any time</p><p><strong>Max </strong>dose: <strong>80 </strong>mg/day</p><p><strong>Red yeast rice</strong> → <strong>structurally identical to lovastatin </strong>→ may increase toxic effects when paired with statins</p>

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Lovastatin Drug Interactions

Note that the max dose of simvastatin is half that of lovastatin in the same meds

<img src="https://assets.knowt.com/user-attachments/7795671a-0175-4a62-bff2-a2c2125fa136.png" data-width="50%" data-align="center" alt="knowt flashcard image"><p>Note that the max <strong>dose of simvastatin is half that of lovastatin </strong>in the same meds</p><img src="https://assets.knowt.com/user-attachments/bd80e9fb-5eea-4f7c-ade0-0fb3243fa024.png" data-width="50%" data-align="center" alt="knowt flashcard image"><p></p>

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Pravachol

Pravastatin (Pravachol)

Dose…Comment

can switch to pravastatin if worried about DDI

<p><strong>Pravas</strong>tatin (<strong>Prava</strong>chol)</p><p><em>Dose…Comment</em></p><img src="https://assets.knowt.com/user-attachments/37f258b1-c944-40ed-b8dc-99e806cefc58.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p><em>can switch to pravastatin if worried about DDI</em></p>

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Lescol, Lescol XL

Fluvastatin (Lescol, Lescol XL)

just know QHS max dose

comes as IR caps and ER tabs → do not open IR caps

dont need to dose adjust if CrCl<30

<p><strong>Fluvas</strong>tatin (<strong>Lesc</strong>ol, Lescol XL)</p><img src="https://assets.knowt.com/user-attachments/379fd4a6-6b9d-490a-80f8-9f0cc3b9af38.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p>just know <strong>QHS max dose</strong></p><p>comes as <strong>IR caps </strong>and <strong>ER tabs </strong>→ <strong>do not open </strong>IR caps</p><p>dont need to dose adjust if CrCl<30</p>

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Statins metabolized by CYP3A4

SAL

Simvastatin

Atorvastatin

Lovastatin

<p><strong><u>SAL</u></strong></p><p><strong>S</strong>imvastatin</p><p><strong>A</strong>torvastatin</p><p><strong>L</strong>ovastatin</p><img src="https://assets.knowt.com/user-attachments/4354ac17-5e35-412e-9ea4-e3a8a9a8e2a6.png" data-width="50%" data-align="center" alt="knowt flashcard image"><p></p>

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Statins metabolized by CYP2C9

Fluvastatin

Rosuvastatin

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Statins taken at night

FLoS at night

Fluvastatin
Lovastatin
Simvastatin
(all IR formulations)

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Zetia

Ezetimibe (Zetia)

Max 10 mg

Cholesterol absorption inhibitor

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Bile acid sequestrants (general)

Side effect, CI, Comments

Bile acid sequestrants decreases LDL → formation of bile acid requires uptake of LDL BUT also increases TG

Shouldnt use in patients with TG >300.

DC use if TG >400

Packet formulations → patients can feel when they pass stool → not preferred

Impairs drug absorption some meds like of Digoxin, Levothyroxine, Warfarin, Thiazides, OCP, TCA

Cholestyramine (powder)

Colestipol (powder, tabs)

Colesevelam (tabs) → can be used as adjunct in T2DM (improved A1C)

<img src="https://assets.knowt.com/user-attachments/5bbbeff0-ded9-452d-a4f5-025a8e7e73ee.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p>Bile acid sequestrants <strong>decreases LDL </strong>→ <strong>formation of bile acid </strong>requires uptake of LDL BUT also <strong>increases TG</strong></p><p><strong>Shouldnt use </strong>in patients with <strong>TG >300</strong>.</p><p><strong>DC use </strong>if <strong>TG >400</strong></p><p>-</p><p><strong>Packet </strong>formulations → patients can feel when they pass stool → <strong>not preferred</strong></p><p><strong>Impairs drug absorption </strong>some meds like of <strong>D</strong>igoxin, <strong>L</strong>evothyroxine, <strong>W</strong>arfarin, <strong>T</strong>hiazides, <strong>O</strong>CP, <strong>T</strong>CA</p><p>-</p><p><strong>Cholesty</strong>ramine (powder)</p><p><strong>Colest</strong>ipol (powder, tabs)</p><p><strong>Colese</strong>velam (tabs) → can be used as <strong>adjunct in T2DM </strong>(improved A1C)</p>

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Questran

Cholestyramine (Questran)

<p><strong>Cholest</strong>yramine (<strong>Ques</strong>tran)</p>

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Colestid

Colestipol (Colestid)

<p><strong>Colest</strong>ipol (<strong>Colest</strong>id)</p>

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Welchol

Colesevelam (Welchol)

<p><strong>Colese</strong>velam (<strong>Welch</strong>ol)</p>

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Vitamin B3, Niacor

Slo-Niacin (OTC)

Niaspan

Regular release: Vitamin B3, Niacor

SR: Slo-Niacin

ER: Niaspan

OTC: Slo-Niacin, Niacin-50

Dosing: just know with food and max doses

Emphasis on side effects (GI, flushing, 3 H’s) → IR has less hepatotoxicity than SR

<p><strong>Regular </strong>release: Vitamin B3, Nia<strong>cor</strong></p><p><strong>SR: Slo</strong>-Niacin</p><p><strong>ER</strong>: Nia<strong>span</strong></p><p>-</p><p><strong>OTC</strong>: <strong>Slo</strong>-Niacin, Niacin-<strong>50</strong></p><img src="https://assets.knowt.com/user-attachments/3ba7a6b2-9fff-46e2-9b8c-3c0cef0ff213.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p>Dosing: just know <strong>with food and max doses</strong></p><p>Emphasis on <strong>side effects </strong>(GI, flushing, 3 H’s) → <strong>IR has less hepatotoxicity than SR</strong></p>

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Lopid

Lipofen

Antara

Trilipix

Tricor

Gemfibrozil (Lopid)

just know before meals

May increase LDL

Metabolized through liver and kidney

ADE: cholelithiasis (DC if gallstones found)

<p><strong>Gemfib</strong>rozil (<strong>Lop</strong>id)</p><img src="https://assets.knowt.com/user-attachments/c33e1521-9e7e-45b7-aa28-793f175403b3.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p>just know <strong>before meals</strong></p><p>May <strong>increase LDL</strong></p><p>Metabolized through <strong>liver and kidney </strong></p><p>ADE: <strong>cholelithiasis </strong>(DC if gallstones found)</p>

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Lovaza, Epanova, Omtryg, Vascepa

only if really high TG >500

Lovaza, Epanova, Omtryg all EPA/DHA combos

VascEPA → EPA does NOT increase LDL like DHA or EPA/DHA combos but less effective in decreasing TG

Omtryg and VascEPA take with food

<img src="https://assets.knowt.com/user-attachments/2cb0d316-7a43-40f8-b21f-187300266c01.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p>only if really high <strong>TG >500</strong></p><p><strong>Lov</strong>aza, <strong>Epan</strong>ova, <strong>Omt</strong>ryg all <strong>EPA/DHA combos</strong></p><p>Vasc<strong>EPA</strong> → <strong>EPA does NOT increase LDL </strong>like DHA or EPA/DHA combos but <strong>less effective in decreasing TG</strong></p><p><strong>Omt</strong>ryg and Vasc<strong>EPA </strong>take <strong>with food</strong></p>

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Praluent

Repatha SureClick, Repatha Pushtronex System

Alirocumab (Praluent)

Evolocumab (Repatha)

just know SC and frequency

PCSK9 inhibitors prevent break down of LDL receptors → less LDL removed from the blood

Repatha SureClick (Q2 weeks), Repatha Pushtronex System (once monthly)

<p><strong>Alirocu</strong>mab (<strong>Pralu</strong>ent)</p><p><strong>Evolocu</strong>mab (<strong>Repa</strong>tha)</p><img src="https://assets.knowt.com/user-attachments/364b82fb-3438-4648-a0f0-68858a62ba2c.png" data-width="100%" data-align="center" alt="knowt flashcard image"><p>just know <strong>SC and frequency</strong></p><p>PCSK9 inhibitors prevent break down of LDL receptors → <strong>less LDL removed </strong>from the blood</p><p>Repatha <strong>SureClick </strong>(<strong>Q2 weeks</strong>), Repatha <strong>Pushtronex </strong>System (once <strong>monthly</strong>)</p>

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Nexletol

Bempedoic (Nexletol)

works before statins

<p><strong>Bempe</strong>doic (<strong>Nexl</strong>etol)</p><img src="https://assets.knowt.com/user-attachments/af69ccff-c844-4a1a-ad25-fa473a0a824e.png" data-width="75%" data-align="center" alt="knowt flashcard image"><p>works <strong>before statins</strong></p>

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Nexlizet

Bempedoic acid + ezetimibe

Nexlizet = Bempedoic acid (Nexletol) + Eztimibe

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Meds that increase uric acid

ABCDE-T

Aspirin, Alcohol

B3 (niacin), Bempedoic acid

Calcineurin inhibitors (tacrolimus, cyclosporine), Chemo agents

Diuretics (loops, thiazides)

Ethambutol and Pyrazinamide

Ticagrelor, Teriparatide

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Liptruzet

Atorvastatin + Ezetimibe