dyslipidemia

Question 1

who should be screened for HLD

Answer 1

men and women >40yo

younger adults >18yo if they have CAD risk factors

Question 2

what are the risk factors for CAD

Answer 2

DM
tobacco use, HTN
family hx of CVD before 50yo in male relatives and before 60yo in females
familial hyperlipidemia

Question 3

very high risk for HLD criteria

Answer 3

established CAD, atherosclerotic cerebrovascular disease , aortic aneurysm or peripheral arterial disease
DM + CKD
familial hypercholesterolemia

Question 4

high risk for HLD criteria

Answer 4

moderate to severe CKD (eGFR <60ml/min)
DM without established CAD, atherosclerotic cerebrovascular disease , aortic aneurysm or peripheral arterial disease or CKD

Question 5

what is the LDL target for very high risk group

Answer 5

<2.1

Question 6

what is the LDL targets for high risk group

Answer 6

<2.6

Question 7

what is the LDL targets for intermediate risk group

Answer 7

<3.4

Question 8

what is the LDL targets for the low risk group

Answer 8

< 4.1

Question 9

MOA of statins

Answer 9

catalyses the rate limiting step in hepatic intracellular cholesterol synthesis.
inhibition indirectly causes increased cellular uptake of LDL molecules and lower the intravascular circulating LDL concentration effectively

Question 10

ADR of statins

Answer 10

GI (after food)
hepatotoxicity (counsel jaundice)
muscle breakdown (counsel unexplained muscle pain)

Question 11

statins contraindications

Answer 11

active liver disease

alcoholism

Question 12

statins preggo?

Answer 12

no

Question 13

statins BF

Answer 13

no

Question 14

which are the 3 statins that must be at night

Answer 14

fluva, lova, simva

Question 15

which are the 3 statins that can be given anytime

Answer 15

prava, atorva, rosuva

Question 16

low intensity LDL reduction options (4)

Answer 16

silva 10
prava 10-20
lova 20
fluva 20-40

Question 17

moderate intensity statin therapy (high risk patients) (6)

Answer 17

atorva 10-20
rosuva 5-10
simva 20-40
prava 40-80
lova 40 
fluva 80 (40bd)

Question 18

high intensity (very high risk patients) (2)

Answer 18

atorva 80

rosuva 20-40

Question 19

name the cholesterol absorption inhibitor

Answer 19

ezetimibe 10mg

Question 20

Use of ezetimibe

Answer 20

lower LDL

Question 21

how does ezetimibe work

Answer 21

selectively block absorption of dietary and biliary cholesterol through intestinal wall `

Question 22

dosing of ezetimibe

Answer 22

10 OD with or without food

Question 23

ADR of ezetimibe

Answer 23

diarrhoea

Question 24

DDI of ezetimibe

Answer 24

2h hours before or 4 hours after cholestyramine

Question 25

ezetimibe preggo

Answer 25

ok (c)

Question 26

name 2 fabric acids

Answer 26

gemfibrozil | fenofibrate

Question 27

what are fabric acids used for

Answer 27

lower TG

Question 28

is fenofibrate or gemfibrozil more effective in lowering LDL

Answer 28

fenofibrate

Question 29

gemfibrozil dosing

Answer 29

600mg bd | 30 min before food

Question 30

fenofibrate dosing

Answer 30

100mg ads or 300om with food maintenance 100mg bd, max 100mg ads

Question 31

gemfibrozil and fenofibrate conversion

Answer 31

gemfibrozil 1200 mg = fenofibrate 300mg

Question 32

ADR of fibric acids (5)

Answer 32

nausea, dyspepsia, stomach pain, rash, liver enzyme elevation

Question 33

contraindications for fabric acids

Answer 33

``` pre-exisiting gallbladder disease hepatic dysfunction severe renal disease - CrCl<50 - no fenofibrate if CrCl <30ml/min - low dose if CrCl 30-59 ```

Question 34

how does warfarin affect fibric acid

Answer 34

increase warfarin level, may need to decrease warfarin dose

Question 35

statin and fabric acid DDI

Answer 35

may increase risk of myopathy

Question 36

fibric acid preggo?

Answer 36

cat c

Question 37

name a bile acid sequestrate

Answer 37

cholestyramine

Question 38

cholestyramine MOA

Answer 38

resins bind to bile acid in intestines, exit body via feces, liver converts more cholesterol into bile acids --> lower cholesterol

Question 39

cholestyramine dosing

Answer 39

4g 1-2 times a day | max 24g/day

Question 40

ADR of cholestyramine

Answer 40

abdominal fullness, gas, constipation, bloating, nausea, dyspepsia take with at least 180ml of water to minimise constipation

Question 41

cholestyramine DDI

Answer 41

many DDI due to binding

Question 42

when to discontinue cholestyramine

Answer 42

TG > 4.5mmol/L

Question 43

nicotinic acid usage

Answer 43

increase HDL and decrease TG

Question 44

nicotinic acid ADR

Answer 44

flushing, pruritus titrate slowly and take with food aspirin 100-300mg 30-60 min prior to administration GI distress (titrate slowly and take with food) hepatotoxicity hyperuricemia hyperglycaemia

Question 45

contraindications of nicotinic acid

Answer 45

liver disease, active PUD | GERD, DM, gout

Question 46

DDI of nicotinic acid

Answer 46

statin adrenergic blocking agents antioxidants may interfere with HDL raising effects of niacin

Question 47

place in therapy for HLD for omega 3 FA

Answer 47

inhibit hepatic TF synthesis, Lowe TF | 2-4g of EPA+DHA