NR 603 WEEK 3 QUIZ-All Possible Questions & Answers

Per 2013 ACC/AHA guidelines, which patient below would NOT benefit from statin therapy?

·                     - 42 yo male, LDL 162 mg/dL, 10 yr risk 4.9%

Which of the following patients should be on high-intensity statin therapy, if tolerated?

·                     58 yo male w/ NSTEMI
- 71 yo female w/ DM, HTN, 10 yr risk 11.5%
- 41 yo male w/ baseline LDL 206 mg/dL
- 64 yo female w/ history of CVA
- All of the above

For someone who is intolerant to higher doses of statins, has tried 2-3 statins...what do we recommend?

·                     There's no true guidelines on how many different statins to try before moving on to non-statin therapies, but generally should try 3-4 different statins that differ in metabolism, hydro/lipophilic...and consider alternate day dosing or twice a week dosing.

You have a patient with ASCVD but no comorbidities. Their LDL has gone down 30% from baseline and they are on maximally tolerated statin therapy. 
Is this patient appropriate for non-statin therapy and if so, what do you recommend?

·                     It is appropriate to consider non-statin therapy for this pt. b/c they have ASCVD. 
Since their LDL has gone down <50% (or if their LDL >70/non-HDL >100), they should be given ezetimibe 1st line. PCSK9 would be second line.

IG is a 47 yo male with CAD s/p MI 2015. He is currently prescribed atorvastatin 20 mg/day. Pt states he is unable to tolerate higher doses and refuses to try another statin. LDL 114 mg/dL. What is the next best step? 

·                     Alirocumab

YZ is a 67 yo female with DM and 10 year risk score 11.1%. She is currently prescribed atorvastatin 80 mg once daily with reported adherence. Current LDL-C 141 mg/dL. What is the next best step for cardiovascular risk reduction. 

·                     ezetimibe 10 mg once daily

TL is a 52 yo black male overbooked in your clinic today for evaluation of fasting labs per primary provider request. He is without complaints. 
Pertinent medications include amlodipine 10 mg/day and atorvastatin 20 mg/day
+ tobacco use, 3-4 beer/night    Labs: TC 302, HDL 21, TG 1167, direct LDL 152, SCr 1.1
BP 145/78, height 74 inches, weight 113.4 kg

Increase atorvastatin to 40 mg/day