NURS 5434 Family 3- Final Exam
Questions and Answers | Fall 2025/26
Update | 100% Correct –UTA.
Moderate Intensity Statin <<< answers >>>
atorvastatin 10-20mg
rosuvastatin 5-10mg
simvastatin 20-40mg
pravastatin 40-80mg
reduces LDL 30-49%
Low intensity statin <<< answers >>>
simvastatin 10mg
pravastatin 10-20mg
reduces LDL <30%
when to add ezetimibe <<< answers >>>
- patients with clinical ASCVD who are already on maximum statin therapy and
LDL >70 or if need >50% drop
- patients with LDL >190 at baseline or with LDL>100 on max statin
why add ezetimibe first?
- well tolerated, inezpensive, lowers LDL 20-25%
when to add PCSK9 <<< answers >>>
- pts with clinical ASCVD at very high risk who are on max statin therapy and
ezetimibe but still have LDL >70
- pt with familial hypercholesterolemia (LDL>190) and still >100 on max statin and
ezetimibe
,PCSK9 Inhibitors <<< answers >>>
alirocumab, evolocumab
injectible and expensive
decrease LDL ~60%
saved for highest risk people
what counts as "very high risk ASCVD"<<< answers >>>
multiple major ASCVD events (MI, stroke, PAD) OR 1 major ASCVD event and
multiple high risk conditions like DM, HTN, smoking, CKD, age >65
recent ACS within last year, Hx MI or stroke, symptomatic PAD, ABI <8.5, previous
revascularization or amputation
Statin Side Effects <<< answers >>>
Most common - muscle aches, cramps, weakness
Rhabdomyolysis is rare - dark urine, marked CK elevation
Liver impact - statins can cause transient increase in ALT/AST, only monitor LFTs if
symptomatic
CAC Scoring <<< answers >>>
Coronary Calcium Screening
CT without contrast that measures the amount and location of calcified coronary
artery plaque (doesn't measure soft plaque which is the kind most likely to
rupture)
- provides strong evidence of risk
0 - no evidence of CAD
1-10 - minimal evidence
11-100 mild evidence, look at risk factors
101-400 moderate evidence of CAD
>400 extensive evidence of CAD
How to manage myalgias <<< answers >>>
,1. stop statin for 2-4 weeks to see if sx resolve
2. check CK, TSH, vitamin D, renal function
3. if sx resolve, start at lower dose or try different statin (pravastatin and
rosuvastatin are LESS lipophillic)
4. consider alternate day dosing
5. if intolerable despite trying 2-3 statins, consider ezetimibe or PCSK9 inhibitors if
high risk
Statin Follow Up <<< answers >>>
Repeat lipid testing in 4-12 weeks after to monitor adherence and biological
response
Then check every 3-12 months from there
CK and ALT not necessary unless symptomatic
Pediatric Lipid Screening <<< answers >>>
Age 9-11 and 17-21
Earlier screening if family hx of early ASCVD, diabetes, HTN, or obesity
Pediatric Statins <<< answers >>>
approved for >10 y.o if LDL >190 (or >160 with family hx or other risks)
Acceptable meds: pravastatin, simvastatin, atorvastatin, rosuvastatin
Fibrates <<< answers >>>
Fenofibrate (preferred)
Gemfibrozil
used to primarily lower triglycerides and modestly increase HDL
When do you use fibrates? <<< answers >>>
Hypertriglyceridemia (TG >500) - to reduce risk of pancreatitis
Mixed dyslipidemia with high TG and low HDL - to help raise HDL and lower TG
Fibrate side effects <<< answers >>>
myopathy
gallstones
, mild elevation in liver enzymes
mild elevation in creatinine
do NOT take Gemfibrozil with statin due to risk of rhabdomyolysis
When to start fibrate <<< answers >>>
TG >500-1000: to prevent pancreatitis
TG 200-499 with ASCVD risk already on statin: lifestyle changes first, then may
add fibrate if persistent high TG and very low HDL
TG elevated but goal is LDL lowering/ASCVD prevention: statin is first line, no
fibrate
Niacin <<< answers >>>
B vitamin that may raise HDL and lower triglycerides
New Onset Diabetes Mellitus <<< answers >>>
statins can increase the risk of NODM but only in patients who are ALREADY at
risk of DM
absolute risk is 0.2% per year
SAMS <<< answers >>>
muscle symptoms reported during statin therapy but not necessarily caused by
statin
myopathy<<< answers >>>
unexplained muscle pain or weakness when accompanied by CK > 10x normal
rhabdomylosis<<< answers >>>
severe form of myopathy with CK typically >140x normal and can cause
myoglobinuria and acute renal failure
5 criteria for metabolic syndrome<<< answers >>>
1. Waist circumference
- over 40 inches in men
Questions and Answers | Fall 2025/26
Update | 100% Correct –UTA.
Moderate Intensity Statin <<< answers >>>
atorvastatin 10-20mg
rosuvastatin 5-10mg
simvastatin 20-40mg
pravastatin 40-80mg
reduces LDL 30-49%
Low intensity statin <<< answers >>>
simvastatin 10mg
pravastatin 10-20mg
reduces LDL <30%
when to add ezetimibe <<< answers >>>
- patients with clinical ASCVD who are already on maximum statin therapy and
LDL >70 or if need >50% drop
- patients with LDL >190 at baseline or with LDL>100 on max statin
why add ezetimibe first?
- well tolerated, inezpensive, lowers LDL 20-25%
when to add PCSK9 <<< answers >>>
- pts with clinical ASCVD at very high risk who are on max statin therapy and
ezetimibe but still have LDL >70
- pt with familial hypercholesterolemia (LDL>190) and still >100 on max statin and
ezetimibe
,PCSK9 Inhibitors <<< answers >>>
alirocumab, evolocumab
injectible and expensive
decrease LDL ~60%
saved for highest risk people
what counts as "very high risk ASCVD"<<< answers >>>
multiple major ASCVD events (MI, stroke, PAD) OR 1 major ASCVD event and
multiple high risk conditions like DM, HTN, smoking, CKD, age >65
recent ACS within last year, Hx MI or stroke, symptomatic PAD, ABI <8.5, previous
revascularization or amputation
Statin Side Effects <<< answers >>>
Most common - muscle aches, cramps, weakness
Rhabdomyolysis is rare - dark urine, marked CK elevation
Liver impact - statins can cause transient increase in ALT/AST, only monitor LFTs if
symptomatic
CAC Scoring <<< answers >>>
Coronary Calcium Screening
CT without contrast that measures the amount and location of calcified coronary
artery plaque (doesn't measure soft plaque which is the kind most likely to
rupture)
- provides strong evidence of risk
0 - no evidence of CAD
1-10 - minimal evidence
11-100 mild evidence, look at risk factors
101-400 moderate evidence of CAD
>400 extensive evidence of CAD
How to manage myalgias <<< answers >>>
,1. stop statin for 2-4 weeks to see if sx resolve
2. check CK, TSH, vitamin D, renal function
3. if sx resolve, start at lower dose or try different statin (pravastatin and
rosuvastatin are LESS lipophillic)
4. consider alternate day dosing
5. if intolerable despite trying 2-3 statins, consider ezetimibe or PCSK9 inhibitors if
high risk
Statin Follow Up <<< answers >>>
Repeat lipid testing in 4-12 weeks after to monitor adherence and biological
response
Then check every 3-12 months from there
CK and ALT not necessary unless symptomatic
Pediatric Lipid Screening <<< answers >>>
Age 9-11 and 17-21
Earlier screening if family hx of early ASCVD, diabetes, HTN, or obesity
Pediatric Statins <<< answers >>>
approved for >10 y.o if LDL >190 (or >160 with family hx or other risks)
Acceptable meds: pravastatin, simvastatin, atorvastatin, rosuvastatin
Fibrates <<< answers >>>
Fenofibrate (preferred)
Gemfibrozil
used to primarily lower triglycerides and modestly increase HDL
When do you use fibrates? <<< answers >>>
Hypertriglyceridemia (TG >500) - to reduce risk of pancreatitis
Mixed dyslipidemia with high TG and low HDL - to help raise HDL and lower TG
Fibrate side effects <<< answers >>>
myopathy
gallstones
, mild elevation in liver enzymes
mild elevation in creatinine
do NOT take Gemfibrozil with statin due to risk of rhabdomyolysis
When to start fibrate <<< answers >>>
TG >500-1000: to prevent pancreatitis
TG 200-499 with ASCVD risk already on statin: lifestyle changes first, then may
add fibrate if persistent high TG and very low HDL
TG elevated but goal is LDL lowering/ASCVD prevention: statin is first line, no
fibrate
Niacin <<< answers >>>
B vitamin that may raise HDL and lower triglycerides
New Onset Diabetes Mellitus <<< answers >>>
statins can increase the risk of NODM but only in patients who are ALREADY at
risk of DM
absolute risk is 0.2% per year
SAMS <<< answers >>>
muscle symptoms reported during statin therapy but not necessarily caused by
statin
myopathy<<< answers >>>
unexplained muscle pain or weakness when accompanied by CK > 10x normal
rhabdomylosis<<< answers >>>
severe form of myopathy with CK typically >140x normal and can cause
myoglobinuria and acute renal failure
5 criteria for metabolic syndrome<<< answers >>>
1. Waist circumference
- over 40 inches in men
