Dislipidemia

Question 1

What are three of cholesterols important roles in the body

Answer 1

Its part of our cell walls
Its a precursor in hormone synthesis (steroids, glucocorticoids, mineral corticoids, sex hormones, etc.)
It’s used to produce bile acids

Question 2

Bile acid function

Answer 2

helps to break down fats (lipids) including fat soluble vitamins

Question 3

Describe the synthesis and pathway for use of bile acids (describe enterohepatic recycling)

Answer 3

Produced in the liver as bile acids, then travel through bile ducts to the intestines along with free cholesterol and waste products, then converted from bile acids to bile salts in the intestine, then are recycled by returning back to the liver.

Question 4

what is atherosclerosis

Answer 4

When the vessels have plaque from a buildup of cholesterol, fats, and other substances on the inner walls of arteries.

Question 5

List different types of atherosclerotic cardiovascular disesases

Answer 5

Stroke/Transient ischemic attack, Myocardial infarction, angina, peripheral arterial disease

Question 6

What are the different components of cholesterol?

Answer 6

Non-HDL cholesterol (LDL, intermediate density, and VLDL, chylomicron, lipoprotein-a) - these are bad lipoproteins that contribute to atherosclerosis

HDL - good lipoproteins that carry cholesterol from blood to liver for removal from body

Total cholesterol - HDL = Non-HDL cholesterol

Question 7

Which meds should be taken 4 hours prior to colesevelam

Answer 7

levothyroxine***, cyclosporine, glimepiride, glipizide, olmesartan, phenytoin, oral contraceptives with ethinyl estradiol or norethindrone

Question 8

True or false: colesevelam causes metformin levels to decrease

Answer 8

False: colesevelam causes metformin levels to increase

Question 9

Multivitamin taken at separate time may be needed to supplement patients on bile acid sequestrants. Which vitamins have decreased absorption with these drugs

Answer 9

Fat KADE, folic acid, iron

Question 10

What TG levels are associated with atherosclerosis

Answer 10

TG>500 mg/dL

Question 11

Drugs that increase LDL AND TG

Answer 11

Diuretics
Efavirenz
Steroids
Immunosuppressants (cyclosporine, tacrolimus)
Atypical antipsychotics
Protease inhibitors
Retinoids

We dont always DC drugs, sometimes we just need to monitor (ex: tacrolimus)

Question 12

Drugs that increase LDL alone

Answer 12

Fish oils (except Vascepa)
Anabolic steroids
Fibrates
Thiazolidinones
Progestin
SGLT2 inhibitors

Question 13

Drugs at increase TG alone

Answer 13

IV lipid emulsions
Propofol
Bile acid sequestrants (~5%)
Estrogen
Tamoxifen
Clevidipine
Beta blockers

These drugs can make TG so high that they put the patient at risk for having pancreatitis

Question 14

Conditions that can increase TG

Answer 14

Nephrotic syndrome, DM, Hypothyroidism, obesity, alcoholism, smoking, poor diet

Pregnancy, PCOS, anorexia

Question 15

what is the frieldwald equation and how is it used

Answer 15

It is an equation that allows us to see what the LDL value is when its not given
LDL= TC - HDL - (TG/5)

THIS EQUATION ONLY WORKS IF THE TG ARE < 400 mg/dL

Question 16

primary vs secondary dyslipidemia

Answer 16

Primary is genetic cause (heterozygous vs homozygous familial hypercholestrolemia
Secondary is acquired and usually due to life style factors but also medical conditions like diabetes and hypothyroidism

Question 17

High risk dyslipidemia that must be treated TG: ____ and LDL: _____

Answer 17

TG >/=400
LDL >/= 190

Question 18

Describe how we use the ranges for cholestrol levels in practice

Answer 18

They are no longer seen as goals, but moreso indicators of effective therapy

Question 19

ensure that the patient has fasted for _____ hours before they get their lipid panel

Answer 19

9-12 hours

Question 20

desired non-HDL level

Answer 20

< 130

Question 21

Desired LDL level

Answer 21

< 100

> 190 is extremely high and must be treated to avoid pancreatitis

Question 22

Desired HDL

Answer 22

> /= 40 in men and and >/= 50 in women

Question 23

Desired TG

Answer 23

< 150
> 500 is extremely high and should be treated immediately to avoid pancreatitis

Question 24

What natural products can someone take if they want to reduce their TGs

Answer 24

Red yeast rice is not recommended though it has low amounts of naturally occurring HMG CoA reductase inhibitors, we don’t know what else is in it. We can suggest plant stanols, sterols, fiberous foods especially help, OTC fish oils (Rx can be recommended), Garlic can help too minimally