Slide set 5

Question 1

Major lipids transported by lipoproteins

Answer 1

Cholesterol and Triglycerides

Question 2

Major Lipoproteins

Answer 2

LDL, VLDL, HDL, Chylomicrons

Question 3

Dyslipidemia defined as

Answer 3

Abnormal circulating lipid levels

Question 4

Primary Dyslipidemia is a result of

Answer 4

Genetics

Question 5

Secondary Dyslipidemia is a result of

Answer 5

Lifestyle, DM, renal/thyroid DZ

Question 6

Familial hypercholesterolemia mutation is at the

Answer 6

LDL receptor gene

Question 7

Familial hypercholesterolemia is

Answer 7

Elevated cholesterol and premature CAD

Question 8

Familial hypercholesterolemia pts may have what common S/S

Answer 8

Xanthomatous tendons FamHx hypercholesterolemia Elevated LDL in childhood

Question 9

Familial Combined Hyperlipidemia is

Answer 9

Elevated LDL, Triglycerides and early CAD

Question 10

Another name for HDL is

Answer 10

Apo-A1 lipoprotein

Question 11

Another name for LDL is

Answer 11

Apo-B100 lipoprotein

Question 12

Another name for Chylomicrons is

Answer 12

Apo-B-48 lipoprotein

Question 13

Cholesterol screening recommendation is

Answer 13

Fasting lipid screening every 5 years >20yo

Question 14

Calculate ASCVD risk when

Answer 14

Every 4-6y for those 40-75yo w/out DM/ASCVD and LDL 70-189 - not on statin

Question 15

Predisposing statin Cis are

Answer 15

Multiple comorbidites Impaired Renal/Hepatic fx Hx of statin intolerance - muscle D/Os Unexplained ALT elevations >3x upper NL Taking drugs affecting statin metabolism >75yo

Question 16

Cholesterol lab test contains

Answer 16

Total chol and HDL

Question 17

What are the 4 statin benefit groups?

Answer 17

1.Pts with clinical ASCVD 2.Pts with primary elevations of LDL >190 3.Pts 40-75yo with DM and LDL 70-190 4.Pts 40-75yo with LDL 70-190 and >7.5%

Question 18

ASCVD is defined as athersosclerotic origin of (3)

Answer 18

Acute coronary syndrome (MI, any angina) Revascularization Peripheral artery disease Stroke/TIA

Question 19

What are the high intensity statins/doses

Answer 19

Atorvastatin 40-80mg Rosuvastatin 20mg

Question 20

What are the low intensity statins/doses

Answer 20

Pravastatin 10-20mg Lovastatin 20mg

Question 21

High intenstiy statin is expected to lower LDL by how much

Answer 21

> 50%

Question 22

Mod intenstiy statin is expected to lower LDL by how much

Answer 22

30-50%

Question 23

S/S of statin use

Answer 23

Pain, Tenderness, stiffness, cramping, weakness, fatigue

Question 24

If pt has severe muscle S/S then

Answer 24

DC statin and perform a Rhabdomyolysis workup

Question 25

Rhabdomyolysis workup consist of

Answer 25

CK, Creatininte, and UA for myoglobinuria

Question 26

If pt has mild-mod muscle S/S then

Answer 26

DC and eval for hypothyroidism, renal-hepatic function, Vit-D deficency, primary muscle disease

Question 27

If pt's mild-mod muscle S/S resolve and no other CI can be determined whats next for statin therapy

Answer 27

Start pt back on SAME statin at the original or lower dose and monitor. If S/S reoccur DC current statin and start low dose of another statin

Question 28

Can drugs such as estrogen replacement affect cardiovascular risk?

Answer 28

Yes (as a secondary cause)

Question 29

Treatment of hypertryglyceridemia

Answer 29

<200 - lifestyle 200-500 - lifestyle and txt of DZ process >500 - req Rx txt to avoid pancreatitis

Question 30

Meds to lower TG levels are

Answer 30

Fibrates, Nicotinic Acid, Omega 3's

Question 31

What fibrates are used to lower TG levels?

Answer 31

Fenofibrates and Gemfibrozil

Question 32

How much can Omega 3s reduce TG levels

Answer 32

>3gm per day can lower TG by 50%

Question 33

What is metabolic syndrome

Answer 33

3 or more risk factors indicating health issues

Question 34

TXT of metabolic syndrome

Answer 34

Lifestyle DM II prevention CV risk reduction Tob cessation Prevent/TXT HTN

Question 35

90% of the time the HCP fails the patient in treating CV risks by

Answer 35

Wrong drug/dose Pt required combo TXT Patient is noncompliant due to Ses

Question 36

Other drug choices for dyslipidemia

Answer 36

HMG-CoA reductase inhibitors Bile Acid-Binding agents Cholesterol Absorption inhibitors Niacin Fibrates

Question 37

What is another name for Statins

Answer 37

HMG-CoA reductase inhibitors

Question 38

MOA of HMG-CoA reductase inhibitors

Answer 38

Compete for HMG-CoA enz preventing cholesterol synthesis

Question 39

MOA of Bile Acid-Binding agents

Answer 39

POS charged agent binds NEG charged bile acids preventing reabsorption

Question 40

Bile Acid-Binding agents reduces what

Answer 40

LDL (difficult SEs however)

Question 41

MOA of Cholesterol Absorption inhibitors

Answer 41

Inhibitor of cholesterol uptake in the small intestines and causes reduced Chylomicron production

Question 42

Cholesterol Absorption inhibitors reduces what

Answer 42

LDL (works best in combo with statin)

Question 43

Niacin MOA allow for what to happen

Answer 43

Increased HDL, inhibits fatty acid release

Question 44

MOA of fibrates

Answer 44

Affects peroxisome proliferator receptor

Question 45

Fibrates will cause what to happen

Answer 45

Lower triglycerides and elevate HDL

Question 46

Ezetimbe is an example of what class of drug

Answer 46

Cholesterol Absorption inhibitors

Question 47

What factors are used to determine metabolic syndrome (5)

Answer 47

Obesity at waist Triglycerides level >150 HDL cholesterol level BP >130/85 Fasting glucose >110

Question 48

What are the waist circumferance criteria for M/F to determine metabolic syndrome?

Answer 48

M->40 in and F->35in

Question 49

What are the HDL criteria for M/F to determine metabolic syndrome?

Answer 49

M-<40 and F-<50

Question 50

What does ASCVD stand for

Answer 50

Atherosclerotic Cardiovascular DZ

Question 51

Before starting statin therapy what labs should be run

Answer 51

Fasting Lipid ALT CK 2ndry issues ( >500TG, >190LDL, >ALT 3xNL)

Question 52

What 3 statin benefit groups receive moderate intensty statins

Answer 52

Hx of clinical ASCVD and is >75yo DM 40-75yo with LDL 70-189 and <7.5% 40-75yo with LDL 70-189 and >7.5%

Question 53

What 3 statin groups receive high intensity statins

Answer 53

Hx of clinical ASCVD and is <75yo LDL >190 DM 40-75yo with LDL 70-189 and >7.5%