CDCES Flashcards - Lipid-Lowering Medications

Vocabulary practice flashcards covering lipid-lowering medications, dosing intensities, clinical targets, side effects, and management guidelines based on the CDCES review notes.

High-Intensity Statins

Atorvastatin and rosuvastatin; these are the only statins capable of reaching high intensity, whereas all other statins max out at moderate intensity.

Atorvastatin (Lipitor) Dosing

Dosed at $40\text{--}80\,\text{mg}$ for high intensity and $10\text{--}20\,\text{mg}$ for moderate intensity.

Rosuvastatin (Crestor) Dosing

Dosed at $20\text{--}40\,\text{mg}$ for high intensity and $5\text{--}10\,\text{mg}$ for moderate intensity.

Statin Counseling Points and Side Effects

Administer at night, watch for muscle pain or weakness, monitor for raised glucose, and avoid grapefruit juice due to drug interactions; statins raise HDL by $5\text{--}15\%$ and modestly lower triglycerides.

Statin Therapy: Age 40–75 with Diabetes and No ASCVD

Initiate a moderate-intensity statin; escalate to high-intensity if risk factors are present (hypertension, smoking, CKD, BMI $30+$, albuminuria, or family history).

LDL Goal: Age 40–75 with Diabetes and No ASCVD

Target LDL under $70\,\text{mg/dL}$ and at least a $50\%$ reduction; add ezetimibe or a PCSK9 inhibitor if the goal is not met.

Statin Regimen and LDL Goal: Established ASCVD

High-intensity statin plus lifestyle modifications with an LDL goal under $55\,\text{mg/dL}$ and at least a $50\%$ reduction; add ezetimibe or a PCSK9 inhibitor if the goal is not achieved on the maximum tolerated statin dose.

Statin Therapy: Ages 20–39 with Diabetes

Statin initiation is only recommended if additional ASCVD risk factors are present.

Statin Add-On Therapy

Ezetimibe (commonly added first) or a PCSK9 inhibitor, used when a patient fails to reach their LDL goal on the maximum-tolerated statin dose.

Ezetimibe (Zetia)

A lipid medication dosed at $10\,\text{mg}$ daily that lowers LDL by $15\text{--}20\%$; it is usually added to a statin (rarely used alone) and has potential side effects of headache and rash.

Bile Acid Sequestrants Administration and Side Effects

Must be taken apart from other medications because they bind drugs and block absorption; common side effects include constipation and bloating.

Colesevelam (Welchol)

A bile acid sequestrant available in tablet form only that provides a dual benefit for diabetes by lowering LDL and lowering A1C by about $0.5\%$.

Cholestyramine (Questran)

A bile acid sequestrant formulated as a powder only that lowers LDL by $15\text{--}30\%$ but may raise triglyceride levels.

PCSK9 Inhibitors (Praluent, Repatha)

Lipid-lowering medications administered via subcutaneous injection every $2$ or $4$ weeks; associated with injection site reactions and no significant drug interactions.

PCSK9 Inhibitor Indications and Monitoring

Add-on therapy used when statins with or without ezetimibe fail to achieve target goals, or in cases of statin intolerance; check lipid panels at baseline, $4\text{--}12$ weeks after initiation, and every $3\text{--}12$ months thereafter.

Statin-Intolerant Alternatives

Bempedoic acid or PCSK9 inhibitors.

Plant Stanol Products (Benecol vs. Take Control)

Well-tolerated dietary options: Benecol requires $3$ servings per day to achieve a $14\%$ LDL reduction, while Take Control requires $2$ servings per day for a $17\%$ LDL reduction.

Pediatric Statin Initiation Criteria

Age $10+$ AND LDL over $130\,\text{mg/dL}$ persisting after $6$ months of lifestyle and Medical Nutrition Therapy (MNT); target LDL on a statin is under $100\,\text{mg/dL}$.

Pediatric Lipid Goals and Screening

Target levels are LDL under $100\,\text{mg/dL}$, HDL over $35\,\text{mg/dL}$, and triglycerides under $150\,\text{mg/dL}$; fasting lipid screening occurs at diabetes diagnosis once glucose is controlled, with yearly rechecks if elevated.

Pediatric Severe Hypertriglyceridemia Treatment

Indicated for fasting triglycerides over $400\,\text{mg/dL}$ (or nonfasting over $1{,}000\,\text{mg/dL}$); treatment involves optimizing blood glucose and starting a fibrate, targeting fasting triglycerides under $400\,\text{mg/dL}$.

Preconception Medication Discontinuation

Statins and ACE inhibitors or ARBs (e.g., atorvastatin and lisinopril) should be discontinued prior to conception as part of preconception planning, employing shared decision-making for statins.

Postpartum Follow-Up after GDM

Recommended follow-up includes a lipid profile and blood pressure monitoring, along with breastfeeding encouragement, healthy weight support, and preconception counseling.

Statin Therapy: Age 75+ with Diabetes

Continue current statin therapy or initiate a moderate-intensity statin if starting new, using shared decision-making to balance risks and benefits.

Statin Guidance: Older Adults with Complex or Poor Health

Consider the likely benefit unless contraindicated or not tolerated; guidance softens to evaluate individual benefit rather than mandating an outright stop.

Cognitive Benefits of Statins in Older Adults

Statins, combined with blood pressure control, are noted to help reduce the risk of dementia and cognitive decline depending on life expectancy.

Clinical Role of Bile Acid Sequestrants

Used as an add-on or alternative for statin intolerance rather than first-line therapy; they should be avoided when baseline triglycerides are elevated because they can raise triglyceride levels.