Dyslipidemia

Question 1

cholesterol is synthesized by ___

Answer 1

liver

Question 2

additional cholesterol comes from __

Answer 2

diet

Question 3

cholesterol has a ___ structure

Answer 3

membrane

Question 4

cholesterol is a precursor to ___

Answer 4

steroid hormones

Question 5

lipid categories

Answer 5

endogenous and dietary cholesterol

triglycerides

Question 6

total - c =

Answer 6

LDL-c + HDL-c + VLDL - c

Question 7

LDL

Answer 7

low density lipoproteins – bad

Question 8

HDL

Answer 8

high density lipoproteins – good

Question 9

triglyceride categories:

Answer 9

vldl-c

Question 10

optimal LDL

Answer 10

<100

Question 11

high LDL

Answer 11

160-189

Question 12

causes of secondary dyslipidemia

Answer 12

diabetes
hypothyroid
obstructive liver disease
chronic renal failure
drugs

Question 13

TLC diet to lower LDL

Answer 13

reduced intake of cholesterol raising nutrients

LDL lowering therapeutic options

Question 14

major features of TLC that lower LDL

Answer 14

TLC diet
weight reduction
increased physical activity

Question 15

most commonly prescribed drugs from high cholesterol

Answer 15

HmG CoA reductase inhibitors (statins)

Question 16

major side effects of statins

Answer 16

myopathy (increased CK)

increased liver enzymes (increased AST/ALT)

Question 17

absolute contraindications to statins

Answer 17

liver disease

Question 18

relative contraindication to statins

Answer 18

use with certain drugs

Question 19

statins demonstrated ___

Answer 19

therapeutic benefits: 
reduce coronary events
reduce CHD
reduce coronary procedures
reduce stroke
reduce mortality

Question 20

MOA of statins

Answer 20

block rate - limiting step in cholesterol synthesis

Question 21

statin induced myopathy

Answer 21

serum CK >10x ULN with unexplained muscle weakness

Question 22

statin induced rhabdomyalsis

Answer 22

serum CK >40x ULN w/ unexplained muscle pain or wekness

Question 23

patients tend to present with statin induced myopathy within the first ___

Answer 23

12 mo

Question 24

highest risk of statin induced myopathy

Answer 24

high dose simvastatin (zocor)

Question 25

statin induced myopathy is due to ___

Answer 25

metabolism by cyp3a4

Question 26

if patient's experience SEs w/ statin, try ___

Answer 26

a different statin

Question 27

HMG CoA Reductase Inhibitors

Answer 27

atorvastatin | rosuvastatin

Question 28

cost of pitavastatin

Answer 28

295 -- not available generically anymore

Question 29

rosuvastatin (Crestor) lowers LDL by

Answer 29

63%

Question 30

atorvastatin decreases LDL by ___

Answer 30

57%

Question 31

simvastatin decreases LDL by ___

Answer 31

46%

Question 32

high dose simvastatin

Answer 32

80mg

Question 33

low dose simvastatin

Answer 33

40mg

Question 34

high dose simvastatin users are at risk for

Answer 34

myopathy and rhabdo

Question 35

low dose simvastatin users are at risk for

Answer 35

myopathy but not rhabdo

Question 36

restricting dosing fo simvastatin:

Answer 36

80mg dose

Question 37

use of 80mg dose of simvastatin should be restricted to patients who:

Answer 37

have bene taking it for >12mo without s/s of toxic effect son muscles

Question 38

patients on 80mg dose without AE but need to take a c/I drug should ___

Answer 38

switch to a noter statin

Question 39

patents who's LDL-C cannot be reached on 40mg dose should be switched to statin with ___

Answer 39

less risk of myopathy

Question 40

gemfibrozil is c/I w/ ___

Answer 40

simvastatin

Question 41

when taking amiodarone, verapamil or diltiazem, do not ___

Answer 41

exceed 10mg simvastatin daily

Question 42

if taking amlodipine, ranolazine, do not ___

Answer 42

exceed 20mg simvastatin daily

Question 43

if drinking grapefruit juice, do not

Answer 43

ingest > 1 quart daily if taking simvastatin

Question 44

____ on statins is not a reason to sotp

Answer 44

elevated transaminases

Question 45

statin side effects are often ___

Answer 45

agent specific, not always class specific

Question 46

if unexplained myalgia on statin w/o CK elevation, ___

Answer 46

try a different statin

Question 47

await follow up of ___

Answer 47

simvastatin relabeling

Question 48

very few patients receive ___

Answer 48

new scripts for simvastatin

Question 49

MOA of bile acid sequestrates (BAS)

Answer 49

bind dietary cholesterol

Question 50

major actions of BAS

Answer 50

reduces LDL by 20-25% raises HDL by 3-5% may increase TG

Question 51

side effects w/ BAS

Answer 51

GI distress/constipation, diarrhea, bloating | decreased absorption of other drugs

Question 52

contraindications to BAS

Answer 52

``` severe hepatic impairment raised TG (especially >400mg/dl) ```

Question 53

BAS

Answer 53

cholestyramine cholestipol coleseyelam

Question 54

generic cost of 30 day supply of coleseyelam

Answer 54

$561

Question 55

BAS is typically add on therapy to ___

Answer 55

max dose statin

Question 56

major actions of niacin

Answer 56

lowers LDL 5-25% raises HDL 15-35% lowers TG 10-50%

Question 57

s/e of niacin

Answer 57

flushing

Question 58

flushing with niacin is minimized by:

Answer 58

pretreatment with aspirin or NSAIDS 30-60 minutes prior to ingestion

Question 59

niacin is currently used as ___

Answer 59

add on therapy (not monotherapy) if used at all

Question 60

niacin did not reduce incidence of ___

Answer 60

primary composite endpoint

Question 61

unexpected increase in ___ in niacin patients

Answer 61

stroke

Question 62

use niacin for ____

Answer 62

statin intolerant patients

Question 63

niacin did not reduce risk of ___ but did increase risk of ___

Answer 63

major CV cents / serious adverse effects

Question 64

niacin is ___

Answer 64

little used

Question 65

fibric acids decrease TG and VLDL C by

Answer 65

25-50%

Question 66

fibric acids may lower LDL by ___ w/ normal TG

Answer 66

5-20%

Question 67

fibric acids may raise LDL with ___

Answer 67

high TG

Question 68

fibric acids may raise HDLC by

Answer 68

10-20%

Question 69

fibric acids

Answer 69

gemfibrozil | fenofibrate

Question 70

cholesterol absorption inhibitor

Answer 70

ezetimibe (zetia)

Question 71

new class of cholesterol absorption inhibitor inhibits ___

Answer 71

intestinal absorption of cholesterol

Question 72

ezetimibe lowers LDL by ___

Answer 72

20-25%

Question 73

ezetimibe combined with a statin:

Answer 73

increases effect of statin by 10-15% w/o s/e

Question 74

Vytorin =

Answer 74

ezetimibe + simvastatin

Question 75

MOA of monoclonal antibodies

Answer 75

bind to pro protein converts subtilizing/kexin (PCSK9) receptors

Question 76

addition to statins, monoclonal antibodies reduce LDL by

Answer 76

50-60%

Question 77

monoclonal antibodies are given by ____

Answer 77

SC injetion q 2-4 wks

Question 78

when should you give monoclonal AB?

Answer 78

add on to max dose statin

Question 79

bempedoic acid is not ___

Answer 79

FDA approved yet

Question 80

MOA of bemepdoic acid

Answer 80

inhibits ATP citrate lyase (key enzymes cholesterol synth)

Question 81

dosing of bempedoic acid

Answer 81

180 mg PO DAILY

Question 82

BPDA results:

Answer 82

``` LDL decrease Non-HDL decrease TC decrease apolipoprotein B decrease high sensitivity CRP decrease ```