420.2 📚 國考版醫垫國考 / PGY OSCE

420.2.0.1 📌 Cram Sheet

420.2.0.1.1 🔥 高 yield 15
  1. Lipoprotein 5: chylomicron / VLDL / IDL / LDL / HDL
  2. ApoB-48 (gut) / ApoB-100 (liver, VLDL/LDL)
  3. Statin = HMG-CoA reductase inhibitor 1st line
  4. High-intensity: atorva 40-80, rosuv 20-40
  5. LDL goals: ASCVD < 55 (ESC) / < 70 (AHA)
  6. Ezetimibe: NPC1L1; LDL ↓ ~ 25%
  7. PCSK9 inhibitor (alirocumab/evolocumab): Q2-4 wk SC, LDL ↓ ~ 60%
  8. Inclisiran: siRNA Q6 mo (22E)
  9. Bempedoic acid (CLEAR Outcomes 2023): for statin intolerant
  10. Icosapent ethyl (Vascepa) REDUCE-IT for TG + CV
  11. HoFH triple+: high-statin + ezetimibe + PCSK9 + lomitapide + evinacumab + apheresis
  12. Lp(a): independent ASCVD; once-in-lifetime measurement; olpasiran 22E
  13. Friedewald: LDL = TC − HDL − TG/5 (TG < 400)
  14. HeFH 1/250-500; tendon xanthoma pathognomonic
  15. Pregnancy + statin: 犁忌; use bile acid sequestrant
420.2.0.1.2 🔢 必背
項目 æ•žå­—
LDL ASCVD secondary < 55 (ESC) / < 70 (AHA)
LDL primary high-risk < 100
TG pancreatitis risk > 500-1000
Friedewald LDL valid TG < 400
HeFH LDL untreated 200-400
HoFH LDL untreated > 500
Atorva high-intensity 40-80 mg
Rosuv high-intensity 20-40 mg
Statin myalgia ~5%
Inclisiran dosing Q6 mo SC
Vascepa dose 4 g/d
ASCVD threshold ≥ 7.5% (statin)
ASCVD high > 20%

420.2.0.2 ⭐ 高 yield

420.2.0.2.1 Statin Intensity
Class Drugs
High (LDL ↓ ≥ 50%) Atorvastatin 40-80, rosuvastatin 20-40
Moderate (LDL ↓ 30-50%) Atorva 10-20, rosuv 5-10, simvastatin 20-40, pravastatin 40
Low (LDL ↓ < 30%) Simva 10, prava 10-20
420.2.0.2.2 Drug Quick by Target
Drug Target
Statin HMG-CoA reductase
Ezetimibe NPC1L1 (intestinal)
PCSK9 mAb (alirocumab, evolocumab) PCSK9
Inclisiran siRNA against PCSK9 mRNA
Bempedoic acid ATP-citrate lyase
Lomitapide MTP (HoFH)
Mipomersen ASO against ApoB (HoFH)
Evinacumab ANGPTL3 (HoFH)
Volanesorsen ASO against ApoC-III (LPLD)
Olpasiran siRNA against Lp(a) — phase 3
Niacin Multiple (LDL ↓, HDL ↑, TG ↓)
Fibrate PPARα (TG ↓, HDL ↑)
Omega-3 / Vascepa TG ↓
Bile acid sequestrant Bile acid binding
420.2.0.2.3 Familial Disorders Quick
Disorder Gene Feature
HeFH (1/250-500) LDLR, ApoB, PCSK9 GoF LDL 200-400, premature CAD, tendon xanthoma
HoFH (1/300K-1M) LDLR (rare PCSK9 GoF) LDL > 500, childhood CAD
Familial combined Polygenic TG ↑ + LDL ↑ + HDL ↓ + IR
Familial hyperTG Multiple TG > 500-1000, pancreatitis, eruptive xanthoma
Type III dysbetalipoproteinemia ApoE2/E2 Palmar xanthoma
LPLD LPL, ApoC-II TG > 1000, eruptive xanthoma, pancreatitis
Tangier ABCA1 HDL ↓, orange tonsils, peripheral neuropathy
Fish-eye (LCAT) LCAT Corneal opacity, low HDL
420.2.0.2.4 Trials
  • 4S, WOSCOPS, AFCAPS/TEXCAPS: statin original
  • IMPROVE-IT: ezetimibe added
  • FOURIER, ODYSSEY: PCSK9 alirocumab/evolocumab
  • ORION: inclisiran
  • CLEAR Outcomes: bempedoic acid
  • REDUCE-IT: icosapent ethyl
  • AIM-HIGH, HPS2-THRIVE: niacin negative
  • ACCORD-Lipid, FIELD: fibrate negative add-on
  • STRENGTH: omega-3 mixed (negative)
420.2.0.2.5 Secondary Causes Quick
  • Hypothyroidism (TSH)
  • DM (HbA1c)
  • Nephrotic syndrome
  • CKD
  • Cushing’s
  • Liver disease, biliary obstruction
  • Drug: glucocorticoid, antipsychotic (atypical), β-blocker, thiazide, OCP, retinoid, HIV PI
  • Pregnancy
  • Alcohol

420.2.0.3 🎯 自我檢枬

  1. Statin target? → HMG-CoA reductase
  2. Ezetimibe target? → NPC1L1
  3. PCSK9 inhibitor effect? → ↑ LDL-R recycling → ↓ LDL
  4. Inclisiran dosing? → Q6 mo SC
  5. Bempedoic acid for? → Statin intolerant
  6. Vascepa indication? → TG 135-499 + statin + CV risk
  7. HeFH prevalence? → 1/250-500
  8. HoFH treatment? → Statin + ezetimibe + PCSK9 + lomitapide + evinacumab + apheresis
  9. Tendon xanthoma? → FH pathognomonic
  10. Pregnancy + statin? → 犁忌
  11. Friedewald LDL TG cutoff? → < 400
  12. Niacin trials? → AIM-HIGH, HPS2-THRIVE (negative)
  13. ApoE2/E2 disease? → Type III dysbetalipoproteinemia
  14. Tangier disease? → ABCA1, HDL ↓, orange tonsils
  15. Lp(a) risk? → Independent ASCVD + AS

⚠ AI 草皿。