Guidelines
MI
Stable Angina
Arterial revascularization
Stroke
TIA
PAD
What are the 4 statin benefit groups?
Clinical ASCVD
LDL > 190
Diabetes age 40-75 with LDL 70-189
Age 40-75 with 10-year ASCVD > 7.5%
What labs should be monitored when initiating statin therapy?
LFTs at baseline
Lipid panel
ASA 81 mg daily
simvastatin 20 mg daily
multivitamin daily
lisinopril 10mg daily
Are there any issues with his new Rx?
rosuvastatin: 20 and 40 mg
Age (20-79)
Race
Total Cholesterol
HDL
Systolic BP
HTN treatment status
Diabetes
Smoking status
A 26 year old female with an LDL of 250 mg/dL presents to the pharmacy with a script for atorvastatin 20 mg. What concerns should you have?
Is the patient pregnant?
Is the patient nursing?
Is the patient using effective contraception?
Does the patient know the risks of statin therapy and pregnancy?
A patient recently had to discontinue the use of simvastatin 20 mg due to complaints of muscle pain. It has been 3 weeks since discontinuation and her pain has resolved. She is still indicated and would benefit from statin use. Her PCP is unsure what the best course of action is. What is recommended?
Re-challenge simvastatin at the same or lower dose to establish whether or not the statin was the true cause of the muscle pain. If the pain resumes d/c the statin and when symptoms resolve try a new statin at a low dose.
colestipol (Colestid)
colesevelam (Welchol)
In a patient without diabetes, when is it recommended to take low-dose ASA for primary prevention?
Age 50-59
10-year ASCVD risk >10%
No bleeding risk
Life expectancy >10 years
Willing to take ASA for >10 years
What is the first line treatment option for severe or very severe elevated triglyceride levels?
Fibric acid derivatives (gemfibrozil, fenofibrate)
Dietary modification
A 78 year old patient without clinical ASCVD presents to the clinic without a history of statin use. Should a statin be initiated in this patient?
No, starting therapy for primary prevention in patients >75 years of age is not supported unless the benefit outweighs the risk.
Which of the following is an injectable medication?Vascepa
Lopid
Repatha
Livalo
Repatha (evolocumab)
At what age should men and women be screened for lipid disorders?
Men >35: strong recommendation
Men >20 at increased risk: recommended
Women >45 at increased risk: Strong recommendation
Women >20 at increased risk: recommended
- Increased risk: diabetes, history of heart disease, family history (before 50 in men and before 60 in women), tobacco use, HTN, obesity
What is the renal dose adjustment for rosuvastatin if a patient has a CrCl <30 mL/min?
5 mg once daily, NTE 10 mg once daily
A 35 year old patient receives hemodialysis for their CKD. She has a new diagnosis of hyperlipidemia. The PCP prescribes her atorvastatin 10mg. Should this medication be dispensed to the patient?
No. Statin or statin/ezetimibe combo only should only be used if the patient was already receiving them prior to dialysis initiation.
How would you explain the MOA of alirocumab to a patient?
This medication helps your body to naturally remove more LDL (bad cholesterol) from your blood.
Per the 2010 Endocrine Society Guidelines, which hypertriglyceridemia classifications are considered to be manageable with lifestyle modifications alone?
Mild
Moderate
Symptomatic peripheral artery disease (PAD)
Ischemic stroke
A diabetic patient has a 10-year ASVD risk if >10%. What are some of the risk factors to consider when deciding whether to initiate low-dose ASA for primary prevention?
Smoking
Hypertension
Dyslipidemia
FH of premature CVD
Albuminuria
A patient presents to the pharmacy with a new Rx for Welchol. Based on the patient’s medication list, how should the patient be instructed to take his new medication?
Curent Medications:
ASA 81 mg daily
glipizide 5 mg with breakfast
metformin 1000 mg BID
lisinopril 20 mg daily
multivitamin daily