Mukherjee_Interventional Cardiology Board Review, 4e

69

7 Antiarrhythmics, Inotropes, Sedatives, and Lipid-Lowering Agents

7.17 A 71-year-old man with diabetes mellitus and a his tory of revascularization for peripheral artery dis ease (PAD) was initiated on ezetimibe 10 mg/day 4 months ago in addition to atorvastatin 80 mg/ day. His low-density lipoprotein cholesterol (LDL C) today is 82 mg/dL. Which one of the following is best to optimize this patient’s medical regimen? A. Maintain current therapy B. Add bempedoic acid C. Change to rosuvastatin 40 mg/day D. Add evolocumab 7.18 A patient presents to the clinic following triple vessel coronary artery bypass graft (CABG) sur gery 2 months ago. She was discharged on ro suvastatin 5 mg 3 times per week due to her previous history of partial statin intolerance. Her LDL-C obtained in the office is 99 mg/dL. She is not interested in self-administering in jectables or increasing her dose or frequency of rosuvastatin. Which of the following is most ap propriate to initiate to achieve her LDL-C target of < 55 mg/dL? A. Bempedoic acid B. Alirocumab 7.19 A 55-year-old man presents with questions re garding cardiovascular risk reduction after his friend died of a heart attack. He has hypertension and reports his mother had a heart attack at the age of 60 years. His 10-year atherosclerotic car diovascular disease (ASCVD) risk is 7.3%. Which of the following steps is most appropriate? A. Obtain biomarkers or a coronary artery cal cium score 7.20 A 48-year-old woman with type 2 diabetes mel litus (for 10 years) presents to the clinic for follow-up. Current medications include lisinopril 10 mg/day, HCTZ 25 mg/day, and atorvastatin 10 mg/day. Her 10-year ASCVD risk is estimated at 7.5% and plasma LDL-C is measured at 110 mg/ dL. Which of the following is most appropriate to reduce her risk of ASCVD events? A. Continue current therapy B. Increase atorvastatin to 40 mg C. Add ezetimibe 10 mg D. Add aspirin 81 mg B. Initiate atorvastatin 40 mg C. Initiate simvastatin 20 mg D. Initiate ezetimibe 10 mg C. Inclisiran D. Ezetimibe

7.21 A 49-year-old male presents to the clinic for a routine follow-up of stable ischemic heart disease. The patient has a history of non–ST segment elevation acute coronary syndrome (NSTE-ACS) with a DES placement to the right coronary artery (4 months ago), type 2 diabetes mellitus, and hypertension. Current medications include aspirin 81 mg daily, carvedilol 12.5 mg twice daily, losartan 25 mg daily, metformin 500 mg twice daily, prasugrel 10 mg daily, and rosu vastatin 40 mg daily. A fasting lipid panel reveals total cholesterol 135 mg/dL, high-density lipo protein cholesterol (HDL-C) 44 mg/dL, LDL-C 51 mg/dL, and triglycerides 202 mg/dL. Relevant laboratory parameters include an aspartate ami notransferase (AST) 29 IU/L, alanine transami nase (ALT) 26 IU/L, and hemoglobin A1C 6.8%. Which change to pharmacologic therapy is most appropriate? A. Change rosuvastatin 40 mg daily to atorvas tatin 80 mg daily B. Add ezetimibe C. Add evolocumab D. Add icosapent ethyl 7.22 A 66-year-old man presents to the clinic follow ing his recent STEMI 2 months ago (DES to right coronary artery). Other relevant PMH includes diabetes mellitus and hypertension. Current med ications include aspirin 81 mg daily, ticagrelor 90 mg twice daily, metoprolol tartrate 25 mg twice daily, metformin 1,000 mg twice daily, lisinopril 20 mg daily, and rosuvastatin 20 mg daily. At the time of his acute coronary syndrome (ACS), he was not receiving statin therapy and his plasma LDL-C was reported as 155 mg/dL. In clinic today, a fasting lipid panel reports his LDL is 70 mg/dL. Which of the following is the most appropriate next step? A. No changes, repeat lipid panel in 12 months B. Add ezetimibe C. Add evolocumab D. Change rosuvastatin to atorvastatin 7.23 A 57-year-old female is admitted to the hospi tal with unstable angina. Her PMH includes a two-vessel CABG, PAD with a stent to the right common iliac artery, hypertension, type 2 dia betes mellitus, and gout. Current medications include allopurinol 200 mg daily, aspirin 81 mg daily, atorvastatin 80 mg daily, clopidogrel 75 mg daily, heparin 12 units/kg/h IV continuous infu sion, liraglutide 1.2 mg SQ (subcutaneous) daily,

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.