10/29

Question 1

people in the US w high cholesterol

Answer 1

men age 45-54: 20.8%
women age 55-64: 30.5%
all women: 16.9%

Question 2

lipoprotein abnormalities can contribute to…

Answer 2

increased risk of coronary, cerebrovascular and peripheral arterial disease
-major risk factor for CHD

Question 3

pathogenesis of atherosclerosis

Answer 3

endothelial injury -> inflammatory response -> macrophage infiltration -> platelet adhesion -> smooth muscle cell proliferation -> extracellular matrix accumulation

Question 4

secondary causes of dyslipidemia

Answer 4

elevated LDL: hypothyroidism, nephrotic syndrome, cholestasis, anorexia, thiazides, cyclosporine, tegrtol
reduced LDL: severe liver disease, malabsorption, mal nutrition, hyperthyroidism, niacin toxicity
elevated HDL: alcohol, exercise, exposure to chlorinated hydrocarbons, estrogen
reduced HDL: smoking, T2DM, obesity, malnutrition, steroids, BB

Question 5

symptoms of dyslipidemia

Answer 5

largely asymptomatic
depending on severity and duration of disease:
-chest pain, palpations, sweating, anxiety, SOB, loss of consciousness, difficulty w speech or movement, abdominal pain, sudden death

Question 6

signs of dyslipidemia

Answer 6

pancreatitis, eruptive xanthomas, peripheral polyneuropathy, inc BP, waist >40 in men or >35 in women, BMI > 30kg/m2

Question 7

lab parameters associated w dyslipidemia

Answer 7

inc: non-HDL-C, TC, LDL-C (amount of cholesterol in LDL), TG, Apo-B, CRP, LDL-P (number of LDL particles)
dec: HDL

Question 8

non-HDL-C =

Answer 8

TC-HDL

Question 9

ApoB, LDL-P, and non-HDL-C

Answer 9

all valid in non-fasting sample and w elevated TG levels

all more predictive of CVD risk than LDL-C alone

Question 10

FLP includes

Answer 10

TC, TG, HDL-C, LDL-C

Question 11

friedewald equation

Answer 11

used to estimate LDL from FLP
LDL calc not valid when TG > 400 mg/dL
LDL = TC - HDL - TG/5

Question 12

non-fasting FLP

Answer 12

TC and HDL

Question 13

lifestyle management

Answer 13

DASH diet, USDA food pattern, AHA diet: vegetables, fruits, whole grains, low fat dairy, poultry, fish, legumes, non-tropical vegetable oils and nuts, limit sweets and red meats
reduce percent of calories from saturated and trans fat: 5-6% calories from sat fat
lower NA intake: less than 2400 mg
moderate intensity exercise 3-4x/week for 40 min/session

Question 14

TC/HDL

Answer 14

goal: less than 5:1 (or 3-3.5:1)

Question 15

soluble fiber will ___

Answer 15

decreased LDL

-oat bran, petins or gums, psyllium products

Question 16

recommended dietary intake

Answer 16

total fat: 25-35% of calories
saturated fat: less than 7-10% total calories
carbs: 50-60% total calories
cholesterol: less than 200 mg/day
fiber: 20-30 grams/day
plant sterols: 2 grams/day
protein: 15% of total calories

Question 17

effects of pharmacologic agents on serum LDL

Answer 17

statins: reduce 20-60%
BARs: reduce 15-30%
niacin: reduce 10-25%
cholesterol absorption inhibitor: reduce 17%

Question 18

effects of pharmacologic agents of serum TGs

Answer 18

gemfibrozil: reduce 35-50%
fenofibrate: reduce 41-53%
omega 3 fatty acids: reduce 23-45%

Question 19

HMG-CoA reductase inhibitors

Answer 19

lovastatin, pravastatin, pitavastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin

Question 20

statins: important consideration

Answer 20

usually well tolerated, DC if LFTs 3x upper limit of normal, myopathy, rhabdomyolysis, watch for muscle pain and darkened urine, avoid large quantities of grapefruit juice, PREGNANCY CATEGORY X

Question 21

statins can cause ___ and ___

Answer 21

hyperglycemia and cognitive decline

Question 22

statin monitoring

Answer 22

FLP: baseline, 4-12 weeks after initiation, every 3-12 months as indicated
consider: baseline CK in pts with increased risk of muscle events, CK while on therapy of patients with muscle symptoms, hepatic function in individual w s/sx of hepatatoxicity

Question 23

BARs

Answer 23

bile acid resins

cholestyramine, colestipol, colesevelam

Question 24

BARs overview

Answer 24

decrease LDLs and cholesterol
disadvantages: may increase TGs, need to take other meds 1 hour before or 4 hours after
GI SE
AE: impaired absorption of ADEK, hypernatremia, hyperchloremia, GI obstruction

Question 25

BARs interactions

Answer 25

may decrease effect of: acetaminophen, TZDs, OCs, CSs, ezetimibe, fibrates, thiazide diuretics, warfarin, digoxin

Question 26

niacin

Answer 26

OTC
PG mediated flushing and itching: administer ASA 30 minutes before niacin, take close to meals, avoid alcohol and hot drinks, start w low dose and titrate, inc LFTs, hyperuricemia and hyperglycemia, may inc levels of statins