HTN, dyslipidemia, and obesity

Question 1

when to refer for hypertension and dyslipidemia

Answer 1

1. no formal diagnosis
2. no visit to PCP in last year
3. nonadherence to medications
4. perception that Rx medications are ineffective
5. use of dietary supplements without PCP knowledge
6. concurrent medication

Question 2

medications that can worsen HTN

Answer 2

amphetamines, decongestants, erythropoietin, estrogen derivatives, nicotine, NSAIDs, corticosteroids, venlafaxine

Question 3

lifestyle habits that can worsen HTN

Answer 3

increased caffeine, sodium, alcohol intake, decreased physical activity, and tobacco use

Question 4

DASH diet reduces systolic by

Answer 4

8-14 mmHg

Question 5

reducing weight reduces systolic by

Answer 5

5-20 mmHg

Question 6

increase in physical activity reduces systolic by

Answer 6

4-9 mmHg

Question 7

reduce intake of dietary sodium reduces systolic by

Answer 7

2-8 mmHg

Question 8

consuming alcohol in moderation reduces systolic by

Answer 8

2-4 mmHg

Question 9

non pharm treatment for pts w dyslipidemia

Answer 9

exercise, diet, smoking cessation, and limiting alcohol consumption

Question 10

who should not be doing home cholesterol tests

Answer 10

excessive bleeding from a finger stick can occur in patients who have coagulation disorders or use anticoagulants, do not recommend for pt who have health insurance or see PCP annually

Question 11

who benefits from home cholesterol tests

Answer 11

more beneficial for those who don’t have insurance, those who don’t see PCP annually, or who have high cost or no lab coverage

Question 12

fish oil MOA

Answer 12

reduce intestinal absorption of cholesterol and inhibit VLDL –> reduction of TG synthesis in liver –> reduce concentration of TG

Question 13

fish oil therapeutic uses

Answer 13

lower TG levels (25-50%), hyperlipidemia, CAD, HTN, and inflammatory conditions

Question 14

dosing of fish oil

Answer 14

1-2g per day, for TG lowering 2-4g per day

Question 15

common AE of fish oil

Answer 15

fishy smell, fishy burps, and/or upset stomach

Question 16

doses of fish oil up to ______ considered safe in patients with anticoags

Answer 16

3g/day

Question 17

therapeutic use of red yeast rice

Answer 17

mainly lowers LDL with some effect on TG, improves indigestion and blood circulation

Question 18

MOA of red yeast rice

Answer 18

composed of monacolins which inhibit HMGCoA reductase

Question 19

dosing of red yeast rice

Answer 19

1.2 to 2.4g/day in two divided doses with food

Question 20

ADE of red yeast rice

Answer 20

allergic reactions, headache, and GI upset

Question 21

red yeast rice may cause

Answer 21

elevated liver enzymes or rhabdomyolysis similar to statins

Question 22

alcohol > 2 drinks/day and red yeast rice

Answer 22

increased risk of hepatotoxicity

Question 23

pregnancy and red yeast rice

Answer 23

category X

Question 24

therapeutic uses for niacin

Answer 24

dyslipidemia, hypertriglyceridemia

Question 25

MOA of niacin

Answer 25

inhibits mobilization of FFA from fat tissue to the liver --> reduce VLDL --> reduction in LDL and TG levels and increase HDL levels

Question 26

dosing of niacin

Answer 26

1-3 g/day typically divided; start at lower dose and titrate

Question 27

side effects of niacin

Answer 27

Flushing (IR > ER > SR) hyperglycemia (SR > ER > IR) hepatotoxicity (SR > ER > IR) GI symptoms

Question 28

contraindications of niacin

Answer 28

liver disease, active peptic ulcer

Question 29

co-enzyme Q10 therapeutic use

Answer 29

heart failure, cardiomyopathy, HTN, antioxidant, statin-related myopathy

Question 30

MOA of Q10

Answer 30

involved in many energy production functions. also involved with regeneration of antioxidants such as vitamin E, stabilizes membranes and may have vasodilator and inotropic effects

Question 31

typical dosage of coQ10

Answer 31

100mg dosed 1-3 times daily

Question 32

side effects of coQ10

Answer 32

nausea, GI upset, headache

Question 33

BMI | < 18.5

Answer 33

underweight

Question 34

BMI | 18.5-24.9

Answer 34

normal

Question 35

BMI | 25.0-29.9

Answer 35

overweight

Question 36

BMI | 30.0-34.9

Answer 36

class I obesity

Question 37

BMI | 35.0-39.9

Answer 37

class II obesity

Question 38

BMI | 40 or higher

Answer 38

class III obesity

Question 39

exclusions for obesity

Answer 39

1. BMI 40 or higher 2. pregnancy or breast-feeding 3. < 18 y/o OR > 65 y/o 4. CV disease, diabetes, hypertension, dyslipidemia 5. eating disorders

Question 40

non pharm treatment for obesity

Answer 40

caloric restriction, dietary changes, altered proportions of food groups/diets, commercial weight loss-programs, exercise

Question 41

alli moa

Answer 41

reversible lipase inhibitor | - inhibits 25% absorption of dietary fat intake

Question 42

alli dosage

Answer 42

60 mg capsule > 18 y/o (take one capsule TID)

Question 43

alli ADE

Answer 43

flatulence with oily spotting/leakage, oily diarrhea, fecal urgency

Question 44

MVI and alli

Answer 44

one time daily at bedtime or at least 2 hours AFTER alli

Question 45

alli contraindications

Answer 45

1. organ transplant OR taking cyclosporine 2. pregnant or breast feeding 3. chronic malabsorption syndrome 4. cholestasis

Question 46

stimulants, energy boosters, thermogenic aids

Answer 46

increase basal metabolism, increase energy, counteract fatigue (bitter orange, caffeine)

Question 47

fat and carb modulators

Answer 47

alter fat or carbohydrate metabolism, resulting in decreased body mass and increased lean muscle mass (green tea, chromium, carcinia)

Question 48

appetite suppressants and satiety promoters

Answer 48

reduce caloric intake by suppressing appetite or promoting satiety (guar gum, glucomannan, psyllium)

Question 49

fat absorption blockers

Answer 49

block intestinal absorption of dietary fats | chitosan, green coffee, raspberry ketones

Question 50

cortisol blockers

Answer 50

block stress-induced release of cortisol to avoid cortisol-induced increased appetite and fat storage (beta-sitosterol, phosphatidylserine, theanine)

Question 51

carbohydrate absorption blockers

Answer 51

block intestinal absorption of dietary carbohydrates | kidney bean extract, mung bean extract

Question 52

laxatives

Answer 52

promote weight loss by increasing fecal loss | cascara Sagrada, psyllium

Question 53

Diuretics

Answer 53

promote weight loss by increasing urination and fluid loss | dandelion, caffeine