dyslipidemia

Question 1

for how long does a patient need to fast for a lipid panel?

Answer 1

9-12 hours

Question 2

normal range for LDL

Answer 2

<100 optimal

100-129 near or above optimal

Question 3

good range for HDL?

Answer 3

> =40 , >=60 high

Question 4

normal TG level?

Answer 4

<150

Question 5

normal TC level

Answer 5

<200

Question 6

Friedewasl equation for LDL

Answer 6

LDL= TC - HDL - TG/5 but cannot use the forumula if TGs are > 400

Question 7

what are hte CHD risk equivalents?

Answer 7

abdominal aortic aneurysm
CAD (MI, ANgina) 
aortic artery disease
peripheral arterial disease 
diabetes  
10 year framingham risk of >20%

Question 8

major risk factors for CHD? (one point each)

Answer 8

1. men >= 45, Women >=55
2. cigarette smoking
3. > = 140/90 or on HTN meds
4. HDL< 40
5. First degree male relative with premature CHD < 55 yo, female relative < 65 yo
   negative risk factor if HDL >= 60mg/dl

Question 9

what lifestyle modifications to do for Therapeutic lifestyle changes?

Answer 9

a. Reduced intake of saturated fat (< 25

e. stop smoking

Question 10

which is the drug of choice for lowering LDL?

Answer 10

statins

Question 11

what is the drug of choice for inc HDL?

Answer 11

niacin, fenofibrates

Question 12

DOC lowering TG

Answer 12

Fenofibrates or fish oils

Question 13

when should you stop cholesterol lowering medications?

Answer 13

when the AST or the ALD become >3 times the upper limit of normal
Normal AST 10-35 unitls/ L
ALT 6-40 units/L

Question 14

what is the MOA of Statins

Answer 14

inhibit HMG-CoA reductase which stops conversion of HMG-CoA to mevalonate, which is the rate limiting step in cholesterol synthesis

Question 15

brand name of pravastatin

Answer 15

pravachol

Question 16

contraindications of statins?

Answer 16

active liver disease (ie unexplained elevations in liver enzymes)
pregnancy
breast feeding
taking strong cyp3A4 inhibitors

Question 17

what must you do if a patient has symptoms of muscle damage?

Answer 17

should be seen right away and get a CPK checked

may have statin tstopped or changed

Question 18

factors that increase risk of myopathy?

Answer 18

higher doses & used of fibrates
age > 65
renal impairment
untreated hypothyroidism

Question 19

main side effects of statins

Answer 19

myalgias, arthralgias, myopathy
inc CPK, rhabdomyolysi
cognitive impairment (mem loss confsuion)
inc blood glucose, inc a1c 
inc LFTs

Question 20

what Labs should you get if patient is starting statins?

Answer 20

LFts at baseline

Question 21

pregnancy category for statins?

Answer 21

X

Question 22

which statins can you take any time of the day?

Answer 22

crestor
lipitor
livalo
pravachol

Question 23

when should you take simvastatin?

Answer 23

take at bedtime because that is when hormones are made

Question 24

when should you lower doses for statins in renal impairment?

Answer 24

if clcr < 30ml/min
except lescol if <60ml/min
no dose adjustment for lipitor

Question 25

which two statins have the most first pass CYP3A4 metabolism?

Answer 25

simvastatin and lovastatin

Question 26

what is the dose of simvastatin that should not be used and why?

Answer 26

simvastatin 8mg /day dues to increased risk of myopathy

Question 27

with which medications should you not exceed simvastatin 10mg?

Answer 27

verapamil diltaizem dronadarone

Question 28

with which medications should you not exceed simvastatin 20mg ?

Answer 28

amiodarone amlodipine ranolazine

Question 29

which medications are contraindicated with atorvastatin?

Answer 29

tipranavir plus ritonavir telaprevir cyclosporine

Question 30

which medications are contraindicated with simvastatin and lovastatin (most common)

Answer 30

HIV protease inhibitors cyclosporine erytrhomycin itraconazole/posa/keto/voriconazole

Question 31

signs and symptoms of liver damage?

Answer 31

``` brown or dark colored urine pale stools tirnedess yellow eyes yellow skin ```

Question 32

MOA of ezetemibe?

Answer 32

inhibits cholesterol abosorption in the small intestines

Question 33

ezetemibe effect on cholesterol types

Answer 33

dec LDL 18-23% inc HDL 1-3 % dec TG 8-10%

Question 34

side effects ezetemibe?

Answer 34

diarrhea arthralgias/myalgias pain in extermities URTIs

Question 35

DDI ezetimibe

Answer 35

cyclosporine (inc c level) | bile acid binding resins dec zetia sep by 4-6 hrs

Question 36

moa of bile acid binding resins?

Answer 36

bind bile acids and form a complex that is excreted in the feces. SO the body has to make more blie acids which dec LDL

Question 37

BABR effect on cholesterol types?

Answer 37

dec LDL 10-30% inc HDL 3-5 % no change or inc in TG! 5%

Question 38

contraindications for colesevelam ?

Answer 38

bowel obstruciton TG > 500mg/dl hisytory of hypertriglyceridemia induced pancreatitis

Question 39

side effects of BABR?

Answer 39

``` constipation (reduce dose or laxative ) dyspepsia abdomina pain crapmping , gas , bloating * less GI side effects with Welchol) ```

Question 40

pregnancy category of welchol

Answer 40

B

Question 41

pregnancy category of colestipol and cholestyramine?

Answer 41

C

Question 42

which drugs should be taken 4 hours before welchol?

Answer 42

pheytoin levothyroxine glyburide oral contraceptives E+P

Question 43

how do you separate Niaspan from BABRs?

Answer 43

take niaspan 4-6 hours later

Question 44

for questran or colestipol, when should you take all other meds?

Answer 44

all others can be taken 1 hour before BABRs or 4-6 hours after BABRs

Question 45

which vitamins can you potentially be deficient with BABRs?

Answer 45

ADEK the fat soluble type

Question 46

what is the MOA of Fibrates?

Answer 46

PPAR alpah activation which leads to decreased levels of VLDL. This causes a decrease in TGs and an increase in HDL

Question 47

fibrates effect on types of cholesterol?

Answer 47

TG lowering 20-50% ince HDL 15% dec LDL 5-20% unless TG are high in which in that case LDL will actuall increcase

Question 48

when are fibrrates contraindicated?

Answer 48

severe liver disease severe renal disease gallbladder disease nursing modther

Question 49

side effects of fibrates?

Answer 49

increase LFTs incerase CPK, myopathy abdomina pain, dyspepsia, constipation hypothyroidism

Question 50

pregnancy category of fibrates?

Answer 50

C

Question 51

which is the only fenofibarre that has the indication to be used with a statin?

Answer 51

Trilipix

Question 52

which is the only fibrate you need to take twice daily?

Answer 52

Lopid takes twice daily 30 minutes before breakfast and dinner

Question 53

which fibrates brands require you take with food?

Answer 53

Fenoglide lofibra lipofen once daily with food

Question 54

what is the MOA of niacin

Answer 54

decrease the rate of synthesis of VLDL (which decreases TG) and LDL. May also increase removal of TG by chylomicrons

Question 55

what are the three formulations of Niacin?

Answer 55

Niacor OTC immediate release Niaspan Extended release niacin Slo-niacin Sustained Release

Question 56

Are the niacin formulations interchangeable?

Answer 56

no

Question 57

what effect of niacin on different cholesterol types?

Answer 57

dec LDL 5-25% inc HDL 15-35% dec TG 20-50%