Dyslipidemia

Question 1

On physical exam what are six signs of HLD?

Answer 1

1. Xanthelasma
2. Circumferential arcus
3. PVD
4. Thickened achilles
5. HTN
6. DM

Question 2

What is the desired, borderline and high TC level?

Answer 2

1. Desirable under 200
2. Borderline 200-239
3. High is over 240

Question 3

What is the optimal, near optimal, borderline high, high, and very high levels for LDL?

Answer 3

1. Optimal is under 100
2. Near optimal is 100-129
3. Borderline high is 130-159
4. High is 160-189
   5 Very high is over 190

Question 4

Of our diet, what elevates HDLs?

Answer 4

Alcohol saturated fats and weight loss

Question 5

Of our diet, what lowers HDLs?

Answer 5

Low fat diet, sugar, excess calories, excess polyunsaturated fats.

Question 6

Of our diet, what elevates LDLs?

Answer 6

saturated fat, trans fatty aids and dietary cholesterol

Question 7

Of our diet, what lowers LDL?

Answer 7

MUFAs, complex carbs and soy

Question 8

Of our diet what elevates TC?

Answer 8

Saturated fats and transfatty acids

Question 9

Of our diet what decreases TC?

Answer 9

Substituting MUFAs and complex carbs for saturated fats, soy

Question 10

Of our diet what increases TG?

Answer 10

alcohol, sugar, high carb diet, excess calories

Question 11

Of our diet, what decreases TG?

Answer 11

weight loss and fish oil

Question 12

What is the dietary recommendation for saturated fats, polyunsaturated fats, monounsaturated fats and total fat?

Answer 12

1. Saturated <7% of total calories
2. Poly up to 10% of calories
3. Mono up to 20% of calories
4. Total fat 25-35% of calories

Question 13

What is the dietary recommendation for carbs, fiber, protein and cholesterol?

Answer 13

1. Carbs 50-60% of calories
2. Fiber 20-30grams/day
3. Protein 15% of calories
4. Cholesterol <200mg/day

Question 14

What are the four main categories established for statin therapy for secondary prevention of ASCVD?

Answer 14

1. Clinical ASCVD (or intervention)
2. LDL > 190
3. DM
4. Equal or more than 7.5 estimated 10-year ASCVD risk

Question 15

The dosage of statin therapy depends on what two factors?

Answer 15

1. Which category

2. Ability to tolerate treatment

Question 16

Moderate intensity statin therapy is composed of what and achieves what?

Answer 16

1. 40 Atorvastatin

2. Approx 30-50% reduction in LDL

Question 17

High intensity statin therapy includes what and achieves what?

Answer 17

1. Atorvastatin 80 or 20 rosuvastatin

2. Approx over 50% reduction in LDL

Question 18

Statin therapy in general reduces the risk of ASCVD across the spectrum for all those with LDL >

Answer 18

70

Question 19

Explain MOA of statin and name some agents.

Answer 19

Inhibit the rate-limiting enzyme in the formation of cholesterol. Effect is to decrease LDL and TG while increasing HDL.

Agents include anything that ends in statin.

Question 20

When a person is under 75 and has clinical ASCVD what kind of statin therapy should they receive?

Answer 20

High intensity

Question 21

Over 75 or with contraindications to high-intensity therapy with ASCVD should receive?

Answer 21

Moderate intensity

Question 22

What are four considerations for statin therapy for primary hyperlipidemia (without CVD)?

Answer 22

1. Patients with LDL over or equal to 190
2. Reduction of LDL by 39mg/dl reduces ASCVD by approx 20%.
3. May require additional use of non-statin lipid lowering agents to achieve acceptable lipid reduction.
4. Assess need for addressing elevated TG.

Question 23

With diabetes when should someone get high intensity therapy?

Answer 23

When 10yr ASCVD risk over 7.5

Question 24

What medication works by reducing the production of VLDLs, which reduces LDLs, reduce TGs and increases HDLs?

Answer 24

Nicotinic acid

Question 25

What medication reduces the synthesis and increases the breakdown of VLDLs, effect is to reduce LDLs, decrease TG and increase HDLs?

Answer 25

Fibric acid derivatives including gemfibrozil, fenofibrate, clofibrate.

Question 26

Which medication works by inhibiting cholesterol and phytosterol absorption from the brush border of the intestines?

Answer 26

Ezetimibe (zetia)

remember, no effect on absorption of fat soluble vitamins (ADEK), no effect on CYP450, only intended for COMBO use with statin.

Question 27

When statins are given with ezetimibe what kind of a reduction do we see in LDL?

Answer 27

approx 25%

Question 28

When statins are given with bile acid sequestrants what kind of a reduction do we see in LDL?

Answer 28

8-16%

Question 29

What three considerations must be made with combination therapy fibric acid derivatives and statins?

Answer 29

1. Primarily assist in decreasing TG
2. Increased risk of myopathies
3. Contraindicated with severe hepatic disease

Question 30

What do we see with statins and niacin?

Answer 30

Increased risk of hepatic dysfunction

Question 31

With lovastatin and simvastatin what kind of significant drug interactions do we see?

Answer 31

Issues with antifungals, antibiotics, gemfibrozil and grapefruit juice.

Question 32

Myopathies are a side effect of statins which ones can it occur with and who is at risk?

Answer 32

1. Can occur with any statin

2. Age over 80, small body frame and failty, impaired renal or hepatic system and alcohol abuse.

Question 33

Which drug interactions with statins cause myopathies?

Answer 33

Niacin, gemfibrozil, cyclosporin, HIV protease inhibitors, verapamil and amiodarone.

Question 34

What drugs should be avoided in pregnant and nursing women? What drug should they be on?

Answer 34

Avoid: Statins, ezetimibe, niacin and fibric acid derivatives.
Should be on: Bile acid-binding resins are the only lipid lowering medication safe for use in prego