Exam 3: Lipid Lowering Agents

Question 1

Cholesterol is necessary for production of:

Answer 1

Cell membranes, bile acids, and steroid hormones

Question 2

Physical s/s of hyperlipidemia:

Answer 2

Xanthelasma 
Circumferential arcus
PVD
Thickened Achilles
HTN

Question 3

What is xanthelasma?

Answer 3

Nodules in the skin

Question 4

What is circumferential arcus?

Answer 4

Lipid deposits around the iris

Question 5

Lab tests for cholesterol that are reliable even if non-fasting:

Answer 5

Total cholesterol

HDL-cholesterol

Question 6

Desirable/high total cholesterol levels:

Answer 6

Desirable < 200

High > 240

Question 7

Low/high HDL levels:

Answer 7

Low < 40

High > 60

Question 8

Range of LDL levels:

Answer 8

Optimal < 100
Very high > 190

Near optimal, borderline high, high in the middle - 30 pt ranges for each

Question 9

Describe primary hyperlipidemia:

Answer 9

Genetic/inherited and heterozygous

TC > 200, trigs > 500

Aka familial hypercholesteremia

Question 10

Causes of secondary hyperlipidemia:

Answer 10

Diabetes
Hypothyroid
Obstructive liver disease
Chronic renal failure
Drugs (progestins, steroids)

Question 11

Effects of ETOH use on lipids:

Answer 11

↑ TG, HDL

This is where the “a glass of wine with dinner is good for you” thought comes from!

Question 12

Effects of HIV/AIDS wasting on lipids:

Answer 12

↑ TG

↓ TC, HDL, LDL

Question 13

Effects of HIV/AIDS on HAART on lipids:

Answer 13

↑ TG, LDL, TG

Long-term effects of HAART can be deleterious

Question 14

Effects of inactivity on lipids:

Answer 14

↓ HDL

Question 15

Effects of obesity on lipids:

Answer 15

↑ TG, LDL

Question 16

Who/when to screen lipids:

Answer 16

All adults 20yrs+

4-6 year intervals

Question 17

What to include in lipid screening:

Answer 17

TC, LDL, HDL, Trigs
ALT
CK
HbA1C
10 year ASCVD risk

Question 18

Therapeutic lifestyle changes include:

Answer 18

↓ saturated fats, cholesterol
↑ physical activity
Weight control

Question 19

Dietary influences on HDL:

Answer 19

HDL ↑ by alcohol, saturated fats, weight loss

HDL ↓ by low fat diets, sugar, excess calories/polyunsaturated fats

Question 20

Dietary influences on LDL:

Answer 20

LDL ↑ by saturated fat, trans fatty acids, dietary cholesterol
LDL ↓ by monounsaturated fats, complex carbs, soy

Question 21

Dietary influences on total cholesterol:

Answer 21

TC ↑ by saturated fats, trans fatty acids

TC ↓ by MUFAs, complex carbs, soy

Question 22

Dietary influences on triglycerides:

Answer 22

TGs ↑ by ETOH, sugar, high carb diet, excess calories

TGs ↓ by weight loss, fish oil

Question 23

History risk factors for ASCVD:

Answer 23

Hx of coronary heart disease (angina, MI, coronary interventions)
PAD
CAD
AAA
Stroke/TIA

Question 24

Demographic/comorbidity risk factors for ASCVD:

Answer 24

Gender, age, race
Cholesterol
Blood pressure
Diabetes/smoker

Question 25

Four categories for preventative statin therapy:

Answer 25

Clinical ASCVD LDL > 190 Diabetes > 7.5% 10yr risk

Question 26

% LDL reduction from moderate intensity statin therapy:

Answer 26

30-50%

Question 27

% LDL reduction from high intensity statin therapy:

Answer 27

> 50% reduction

Question 28

Two drugs considered high-intensity statin therapy:

Answer 28

Atorvastatin 80mg | Rosuvastatin 20mg

Question 29

Statin class of drug:

Answer 29

HMG-CoA Reductase Inhibitors

Question 30

Statins MoA:

Answer 30

Inhibit the rate-limiting enzyme in formation of cholesterol to ↓ LDL, TGs and ↑ HDLs

Question 31

Statin guidelines for clinical ASCVD:

Answer 31

If < 75yo: high intensity statin | If > 75 or contraindications: moderate intensity

Question 32

Statins should be used for primary HLD if LDL ≥:

Answer 32

190

Question 33

Reduction of LDL by _____ decreases ASCVD by 20%.

Answer 33

39 mg/dl

Question 34

Statin guidelines for DM:

Answer 34

Moderate-intensity acceptable | High-intensity if 10yr risk > 7.5%

Question 35

10 year (vs. lifetime) ASCVD risk should be assessed for:

Answer 35

Patients without ASCVD/DM and LDL < 190 to determine if preventative statin tx will be useful

Question 36

Additional tx for triglycerides indicated when:

Answer 36

TG > 200 and LDL goal achieved

Question 37

Additional tx for HDL indicated when:

Answer 37

HDL < 40

Question 38

Bile sequestrant MoA:

Answer 38

Binds bile acid in the intestines so liver uses cholesterol to make more; ↓ LDL, ↑ HDL

Question 39

Examples of bile sequestrants:

Answer 39

Questran, Colestipol, Colesevelam

Question 40

S/E of bile sequestrants:

Answer 40

Oily stools | Low compliance d/t needing to mix powder in drink

Question 41

Nicotinic acid MoA:

Answer 41

Reduced production of VLDLs; effect is ↓ LDL, TG and ↑ HDL

Question 42

Examples of nicotinic acid:

Answer 42

Niaspan and generics

Question 43

S/E of nicotinic acid:

Answer 43

Flushing

Question 44

MoA of fibric acid derivatives:

Answer 44

Reduces the synthesis and increases breakdown of VLDLs

Question 45

Examples of fibric acid derivatives:

Answer 45

Gemfibrozil (Lopid) Fenofibrate Clifibrate All have -fib-

Question 46

S/E of fibric acid derivatives:

Answer 46

Hard on the liver

Question 47

MoA of ezetimibe (Zetia):

Answer 47

Inhibits cholesterol/phytosterol aborption from brush border

Question 48

Ezetimibe effect on vitamin absorption and CYP450 enzomes:

Answer 48

None!

Question 49

Ezetimibe should be paired with:

Answer 49

A statin

Question 50

Statin + ezetimibe = LDL reduction of:

Answer 50

25%

Question 51

Statin + bile acid sequestrant = LDL reduction of:

Answer 51

8-16%

Question 52

Statin + fibric acid derivative primarily for:

Answer 52

Decreasing trigs

Question 53

Statin + fibric acid derivative risks and contraindication:

Answer 53

↑ risk of myopathies | C/I in severe hepatic disease

Question 54

Statin + niacin risk:

Answer 54

↑ risk of hepatic dysfunction

Question 55

Drug interactions with statins:

Answer 55

``` Itraconazole/ketoconazole Erythromycin Clarithromycin Gemfibrozil Grapefruit juice ```

Question 56

Biggest s/e of statins:

Answer 56

Myopathies

Question 57

Relation of statin dose to myopathy incidence:

Answer 57

None - any statin, any dose

Question 58

Individuals at risk for statin myopathy:

Answer 58

Age > 80 Small body frame/frailty Impaired renal/hepatic ETOH abuse

Question 59

Drugs that ↑ risk of statin myopathy:

Answer 59

``` Niacin Gemfibrozil Cyclosporin HIV protease inhibitors Verapamil Amiodarone ```

Question 60

Lipid-lowering medications safe to use during pregnancy:

Answer 60

Only bile acid sequestrants!

Question 61

Four statin tx groups:

Answer 61

LDL > 189 Clinical ASCVD 40-75yo with DM, LDL > 70 without ASCVD 40-75yo with DM, LDL > 70, and 10-yr risk 7.5%+