Dyslipidemia Flashcards
What is the rate limiting step of the formation of cholesterol?
The conversion of β -hydroxyl-β -methylglutaryl
coenzyme A (HMG-CoA) to mevalonic acid
Which lipids that serve as an important source of stored energy in adipose tissue?
Triglycerides
What is the most common type of heart disease in the U.S?
Coronary artery disease
True or false: HDL-C is inversely related to CHD risk
False
What test is often used to diagnose dyslipidemia?
Fasting lipid panel
What is the Friedewald equation? What is it used for?
. LDL = TC – HDL – (TG/5)
. Calculate LDL
What is the main protein component of LDL?
Apo B
In what population should FLPs be routinely checked?
a. 20-50
b. 30-50
c. 20+
d. 30+
c. 20+
How often should a FLP be taken?
At least once every 5 years
True or false: The Framingham 10 year CHD risk tool is a fully comprehensive tool currently used to assess ASCVD risk
False. Currently the 10 year ASCVD risk tool, which is more comprehensive than the Framingham
Which of the following is an appropriate goal of dyslipidemia therapy?
a. Raise TC and lower LDL
b. Raise TC and LDL
c. Lower TC and raise LDL
d. Lower TC and LDL
d. Lower TC and LDL
Select all treatments that are currently more recommended according to current guidelines?
▪HMG-CoA Reductase Inhibitors (Statins)
▪Cholesterol Absorption Inhibitor
▪Niacin
▪Apo B Antisense Oligonucleotides
▪Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors
▪Microsomal Triglyceride Protein Inhibitors
▪HMG-CoA Reductase Inhibitors (Statins)
▪Cholesterol Absorption Inhibitor
▪Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors
Which HMG-CoA reductase inhibitors are prodrugs?
Lovastatin and simvastatin
What is the most common adverse effect of HMG-CoA reductase inhibitors?
Myalgia (muscle pain)
Which statin drug and at what dose is highly associated with rhabdomyolysis?
Simvastatin 80mg
Which of the following HMG-CoA reductase inhibitors is the most lipophilic?
a. Fluvastatin
b. Lovastatin
c. Pravastatin
d. Rosuvastatin
b. Lovastatin
What is the recommended course of action for unexplained severe muscle symptoms or fatigue developing during statin therapy?
Promptly discontinue the statin
What is the recommended course of action for mild to moderate muscle symptoms developing during statin therapy?
Discontinue the statin until the symptoms can be evaluated. Consider alternative statin
Moderate intensity statins reduce LDL by about what percent?
30-49%
Low intensity statins reduce LDL by about what percent?
< 30%
High intensity statins reduce LDL by about what percent?
Greater than or equal to 50%
Which statins and at what dose are classified as high intensity?
. Atorvastatin 40, 80mg
. Rosuvastatin 20, 40mg
What is the rule of 6?
Every doubling of statin dose develops, on average, a further 6% reduction in LDL cholesterol. For this reason ACC/AHA guidelines recommend starting statin therapy at max tolerated dose
True or false: Dyslipidemias play an important role in the pathogenesis of ASCVD
True
Dyslipidemia is defined as…
▪ Elevated total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, or triglycerides
▪ Low high-density lipoprotein (HDL) cholesterol
▪ A combination of these abnormalities
Blockage in the arteries that supply the heart or brain may result in what?
Heart attack or stroke
For every 1% increase in blood cholesterol levels, there is a _____ increase in the risk of ASCVD
1-2%
When can the Friedewald equation not be used to calculate LDL?
If TG levels are >400mg/dL
Ezetimibe MOA
Selectively inhibits the absorption of cholesterol on the brush border of the small intestine
Contraindications of bile acid sequestrants
. Triglycerides >300mg/dL
. Hypertriglyceridemia induced pancreatitis
Welchol drug classification and MOA
Bile acid sequestrant. Anion exchange resins that bind bile acid in the intestinal lumen, forming a complex that is excreted in the feces
True or false: Gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis
True
Vascepa drug classification and MOA
Omega 3 fatty acid. MOA is unknown, but this class is thought to reduce synthesis of TGs
Repatha drug classification and MOA
PCSK9 inhibitor. Binds to and inhibits PCSK9, binding to LDL receptors preventing the degradation of the receptors and promoting clearance of circulating LDL
Nexletol drug classification and MOA
Bempedoic acid. ACL inhibitor that inhibits cholesterol synthesis in the liver
How many statin benefit groups are there?
4
What is the immediate secondary prevention plan for individuals with clinical ASCVD?
High intensity statin
