Statin Galore
Which 3 statins are substrates of isoenzyme CYP3A4?
Lovastatin, Simvastatin, Atorvastatin
Statins are safe to take during pregnancy
Fiction
The use of this hyperlipidemia medication is associated with hepatotoxicity, darkening of skin, and flush reactions.
Niacin
22 year old female without any comorbidities and an LDL-C of 62mg/dL
Don’t treat (would not benefit)
What options are there for patients who cannot tolerate taking their statin every day due to severe side effects?
Twice weekly dosing
Adding CoQ10, or vitamin D
Genetic testing on patient AB reveals a strong polymorphism of CYP2C9. Which two statins may you want to avoid?
Fluvastatin and Rosuvastatin
A healthy lifestyle and diet should be part of every initial treatment for hyperlipidemia.
Fact
This prescription medication is highly purified and concentrated EPA and DHA. Its effects on lowering risk of ASCVD is unknown.
Lovaza
54 year old female with history of myocardial infarction
Treat (secondary prevention)
What two medication classes can lower triglycerides up to 50%?
Fibrates and omega-3 fatty acids
Name two high intensity statins and include dosing.
Atorvastatin 40-80mg QD and Rosuvastatin 20-40mg QD
Moderate intensity statin therapy has shown to decrease LDL-C by >50%
Fiction (30-50%)
Name the class of medications whose adverse effects include gallstones and muscle related ADE.
Fibrates
34 year old female with type 1 diabetes mellitus and LDL-C of 154mg/dl
Treat (Primary prevention: Patients with diabetes between 40 and 75 years of age, and LDL-C between 70mg/dl and 189mg/dl) *bonus= moderate or maybe risk assessment for high intensity
Which medication can help raise HDL-C?
Niacin
Which statin eliminated primarily by renal route and not by a CYP450 isoenzyme?
Pravastatin
ASCVD Risk factors/enhancers include chronic kidney disease, metabolic syndrome, and inflammatory diseases such as RA and psoriasis
Fact
This OTC product is a long chain, highly unsaturated omega 3 fatty acids and has antithrombotic properties
Fish oil
50 year old male with no clinical ASCVD, and an LDL-C of 192mg/dL
Treat (primary prevention: patients with severe hypercholesterolemia defined as LDL-C >/= 190mg/dl) *bonus: high intensity
Why might we de-prescribe statins in the very elderly?
Decrease pill burden
Long term benefits are no longer worth continuing therapy
Which statins bioavailability increases with food?
Lovastatin
New-onset diabetes mellitus is a common side effect of statins and has significantly limited statin use
Fiction
Which two classes of medications would you consider adding if your patient is on a maximally tolerated statin and still not at your LDL-C goal?
PCSK9 or Ezetimibe
47 year old female with and ASCVD risk of 7%, a family history of premature ASCVD and an LDL-C of 84mg/dL
Treat (primary prevention: age 40-75 years old without DM and a 5-7.5% ASCVD risk=”borderline risk” Consider statin since patient has a risk enhancer present (FHx). *bonus: moderate intensity
Which statin does red yeast rice contain?
lovastatin