Dyslipidemia

Question 1

Dyslipidemia consists of one or all 3 of the following:

Answer 1

increased LDL, decreased HDL, increased triglycerides

Question 2

What are the 2 sources of cholesterol in the body

Answer 2

exogenous (dietary) and endogenous (genetics/hereditary) - main source of cholesterol

Question 3

Excess LDL becomes cytotoxic and initiates:

Answer 3

atherosclerosis and CV disease

Question 4

LDL is known as:

HDL is known as:

Answer 4

bad or lousy cholesterol - transports cholesterol to peripheral cells
good or helper cholesterol - transports cholesterol to liver and kidneys for removal from body

Question 5

Goal of LDL:
Goal of HDL:
Goal of total chol:
Goal of triglycerides:

Answer 5

< 100
40-60
< 200
< 150

Question 6

Primary cause of hyperlipidemia:

Secondary causes:

Answer 6

genetics

diet, DM, hypothyroidism, CRF, alcoholism, medications

Question 7

Treatment decisions for hyperlipidemia are based on what 2 things?

Answer 7

1) CHD risk assessment, 2) Risk factor status

Question 8

CHD risk factors include:

Answer 8

smoking, HTN, low HDL cholesterol (< 40), family hx of CHD, age (men > 45, women > 55)

Question 9

CHD risk:
Multiple (2+) risk factors:
0-1 risk factor:

Answer 9

< 100
< 130
< 160

Question 10

Therapeutic lifestyle changes is the cornerstone in LDL-lowering therapy include:

Answer 10

TLC diet, stay away from saturated fats like whole fat dairy products, fast food, donuts/cookies, processed meats (bologna, salami, pepperoni)
plants sterols and fiber lower LDL
wt reduction, increased activity

Question 11

CAGE questionnaire includes:

Answer 11

C - cheese (diary fats)
A - animal fats (hamburger, ground meat, bologna, salami, sausage, fried foods)
G - got it away from home (fast food)
E - eat extra amts of (candy, pastries, pies, doughnuts, cookies

Question 12

Drug therapy for hyperlipidemia:

Answer 12

1) start on statin (HMG CoA Reductase Inhibitors)
2) consider higher dose of statin or add a bile acid sequestrant or nicotinic acid
- monitor response every 6 weeks

Question 13

When increasing the dose of a statin, you also increase risk for s/e:

Answer 13

rhabdomyolysis (breakdown of muscle fibers that can be toxic to kidneys, causing renal failure)

Question 14

For hyperlipidemia, always use therapeutic lifestyle changes first, like ___ and ___.

Answer 14

diet, exercise

Question 15

For elevated LDL, use a ___. ___ is the gold standard.

Answer 15

statin, crestor

Question 16

For elevated triglycerides, use a ___, like ___ or ___.

Answer 16

fibrate/fibric acid, tricor or cholestyramine

Question 17

For decreased HDL levels, use a ___, like ___.

Answer 17

nicotinic acid, niacin

Question 18

Which level is the primary target of cholesterol lowering therapy? First priority to to decrease ___ level, unless triglycerides are > ___, then treat triglycerides FIRST.

Answer 18

LDL, LDL, 500

Question 19

Framingham risk scoring adds up totals of:

Answer 19

age, total cholesterol, smoking status, HDL level, syst. b/p

Question 20

A lipoprotein analysis/fasting lipid profile includes drawing:

Answer 20

total cholesterol, LDL, HDL, and total triglycerides

Question 21

Drug classifications for the tx of dyslipidemia include: ___. The purpose of all tx’s is to decrease ___ level and raise ___ level.

Answer 21

HMG CoA reductase inhibitors (statins), bile acid sequestrants, nicotinic acid, fibric acids, LDL, HDL

Question 22

HMC CoA reductase inhibitors bind and inhibit HMG CoA reductase to decrease the amount of ___ cholesterol.

Answer 22

endogenous

Question 23

All tx’s for dyslipidemia may cause ___ and eventually lead to ___.

Answer 23

myopathy, rhabdomyolysis

Question 24

Statins include: ___.

They work best at what time of day?

Answer 24

lovastatin (mevacor), pravastatin (pravachol), simvastatin (zocor), atorvastatin (lipitor), rosuvastatin (crestor)
evening/bedtime

Question 25

Bile acid sequestrants are ___ or ___ line meds when statins are unsuccessful. They stimulate the ___ to decrease the amount of cholesterol.

Answer 25

second, third, liver

Question 26

Important to instruct to take other meds either 1 hr before or 4hrs after a ___ ___ ___ b/c it binds in the gut. These are also contraindicated in pt’s w/elevated ___ b/c it ___ triglyceride level.

Answer 26

bile acid sequestrant, triglycerides, raises

Question 27

Bile acid sequestrants cause ___, so take ___ ___ while on it and maintain a high-___ diet.

Answer 27

constipation, stool softener, fiber

Question 28

Bile acid sequestrants include:

Answer 28

cholestyramine (questran), colesevelam (welchol)

Question 29

Nicotinic acid, like ___ works to slow production of ___.

Answer 29

nyacin, VLDL

Question 30

A common s/e of nyacin is ___, so important to take ___ 30 mins prior to taking med. Need to regularly monitor ___.

Answer 30

flushing d/t vasodilation, ASA, LFT’s

Question 31

Fibric acids/fibrates are highly protein bound and can displace meds like ___, making it more available in blood stream and increases ___ effects.

Answer 31

warfarin, anticoagulatory

Question 32

Fibric acids include:

Answer 32

gemfibrozil (lopid), fenofibrate (tricor)

Question 33

Cholesterol absorption inhibitors include: ___. This is used if pt has not met LDL goal after trying a ___ first.

Answer 33

esetimibe (zetia), statin

Question 34

Fish oils/omega-3’s protect against ___ and decrease ___ ___. Helpful tips to decrease fishy taste:

Answer 34

HD, platelet aggregation, place capsules in freezer, take w/food, spread doses apart

Question 35

A triglyceride level > 500 puts the pt at risk for ___.

Answer 35

pancreatitis