Cholesterol Meds

Question 1

Cholesterol lab value

Answer 1

150-200 mg/dL

Question 2

Triglyceride lab value

Answer 2

40-150 mg/dL

Question 3

LDL lab value

Answer 3

<100 mg/dL

Question 4

HDL lab value

Answer 4

> 60 mg/dL

Question 5

HDL

Answer 5

• high-density lipoprotein
• “good”
• removes cholesterol from blood & transports to liver for elimination

Question 6

LDL

Answer 6

• low-density lipoprotein
• “bad”
• contains a higher percent of cholesterol

Question 7

VLDL

Answer 7

• Very low-density lipoproteins
• “very bad”
• contains mostly triglycerides & less cholesterol

triglyceride accumulation can cause pancreatitis

Question 8

Chylomicrons

Answer 8

• mostly triglycerides
• transports fatty acids and cholesterol to liver

Question 9

ApoB-100

Answer 9

• contains VLDLs and LDLs
• better indicator of CAD than LDL alone

Question 10

Nonpharmacologic cholesterol control

Answer 10

• reduce saturated (trans) fats & cholesterol in diet
• reduce total fat intake to 30% or less of caloric intake
• reduce cholesterol to 300mg/day or less
• exercise
• smoking cessation

Question 11

What foods should be avoided for cholesterol reduction

Answer 11

• hydrogenated oils
• packaged foods
• sugary foods
• processed meats
• alcohol
• conventional dairy products
• refined grain products

Question 12

Types of antilipidemics

Answer 12

• Bile-acid sequestrants
• Fibrates
• Nicotinic acid
• Cholesterol absorption inhibitors
• HMG-CoA reductase inhibitors (Statins)

Question 13

Bile-acid sequestrants

Answer 13

• reduce LDL cholesterol by binding with bile acids in intestine and eliminating them with GI waste
• good for those w/o gallbladder & can prevent gallstones
• can cause deficiency in fat soluble vitamins (D, E, K)
• causes GI upset/side effects
• take with plenty of water to ensure full dose enters GI tract
• closely monitor PT/INR if taken w/ warfarin

cholestyramine, colestipol

Question 14

Fibrates

Answer 14

• reduces triglycerides and VLDLs (more effective on these than LDLs)
• good for those with rapid weight loss (adipose destruction –> increased trigs, VLDLs)
• contraindicated w/ anticoags –> highly protein bound
• monitor for bleeding (GI, gums, etc.)
• monitor PT/INR more frequently w/ warfarin

fenofibrate, gemfibrozil

Question 15

Nicotinic acid

Answer 15

• very effective against LDL, VLDL
• large doses required
• causes GI distress, heat/flushing, hepatic dysfunction, hyperglycemia, hyperuricemia

Niacin

monitor for gout/kidney stones (uric acid)

Question 16

Cholesterol absorption inhibitor

Answer 16

• acts on cells in small intestine to inhibit cholesterol absorption and decrease serum cholesterol
• must be combined with a statin for optimal effects
• doesn’t affect liver on own, but does w/ statin
• causes GI distress, headaches

ezetimibe

Question 17

Statins

Answer 17

• inhibits HMG CoA reductase enzyme in cholesterol synthesis in liver –> decreases LDLs, increases HDLs
• stopping can cause rebound effect & triple risk of MI
• ideally taken HS d/t nocturnal cholesterol synthesis in liver
• causes GI distress, muscle cramps (esp in legs), fatigue, cataracts, liver impairment (RUQ pain), rhabdomyolysis (& subsequent kidney issues), myopathy
• get yearly liver and eye check-ups
• cannot take w/ grapefruit

Question 18

Homocysteine

Answer 18

• 4-17 mmol/L (fasting)
• high levels indicative of CVD, stroke, Alzheimer’s risk
• may promote blood clotting, can damage lining of blood vessels –> may necessitate antiplatelets
• lowered by vitamin B6, B12, folic acid

Question 19

High sensitivity C-reactive protein

Answer 19

• made in liver d/t tissue damage
• detects inflammatory process d/t atherosclerotic plaque buildup, esp in coronary arteries
• high levels indicative of CVD
• 0.175 mg/L
• low risk <1, moderate 1-3, high >3

can indicate sepsis

Question 20

Complementary therapies

Answer 20

• black cohosh (natural estrogen) may increase liver enzymes
• cranberries may interact with simvastatin