Hyperlipidemia

Question 1

rate limiting enzyme for intracellular cholesterol biosynthesis

Answer 1

HMG-CoA reductase

Question 2

familial hypercholesterolemia

Answer 2

increased LDL

Question 3

familial hypertriglyceridemia

Answer 3

increased TG

Question 4

familial combined hyperlipidemia

Answer 4

increased LDL

increased TG

Question 5

hypoalphalipoproteinemia

Answer 5

isolated HDL < 35

Question 6

drugs that later lipid profiles

Answer 6

thiazide diuretics (increase TG)
BB (increase TG, decrease HDL)
OCP (increase cholesterol, increase TG)

Question 7

optimal LDL C

Answer 7

<100

Question 8

HDL-C

Answer 8

60 high

Question 9

TC

Answer 9

<200 desirable

Question 10

TG

Answer 10

<150 normal

Question 11

Major CHD risk factors

Answer 11

LDL
cigarette smoking
HTN
low HDL (high HDL negates a RF)
Fhx premature CHD
Age

Question 12

always use antihyperlipidemic drugs in conjunction with

Answer 12

diet, exercise, weight reduction

Question 13

inhibits mobilization of FFA’s from adipose tissue, results in decreased VLDL

Answer 13

niacin

Question 14

best med choice to increase HDL. used in hyperlipoproteinemias, and as an adjunct to decrease TG

Answer 14

niacin

Question 15

adverse effects: vasodilation, nausea, dyspepsia, activation of PUD, hyperuricemia, worsen glucose tolerance, hepatotoxicity (LFTs 3X normal!)

Answer 15

niacin

Question 16

monitor glucose, uric acid, LFTs

Answer 16

niacin

Question 17

contraindicated in DM, gout, peptic ulcer and LIVER DISEASE

Answer 17

niacin

Question 18

drug interactions: hypotension with BP lowering drugs, DM meds- hyperglycemia, and increased risk or hepatotox with statins

Answer 18

niacin

Question 19

inhibit lipolysis and increase lipoprotein lipase, decreasing serum VLDL and increasing HDL

Answer 19

fibrates

Question 20

decrease TG, increase HDL, may increase LDL

Answer 20

fibrates

Question 21

med of choice for lowering TG. also used for combined increased cholesterol and TG

Answer 21

fibrates

Question 22

adverse effects include GI, myopathy, hepatotoxicity, neutropenia, gallstones, and pancreatitis

Answer 22

fibrates

Question 23

this class inhibits enterohepatic recycling or bile acids and salts- causing the liver to convert stored cholesterol to bile acids

Answer 23

bile acid resins

Question 24

reduces TC, LDL (dose dependent), increases HDL and TG

Answer 24

bile acid resins

Question 25

adverse effects are mostly GI- constipation, bloating, gas, nausea. Avoid in pts with diverticulitis, swallowing difficulties, motility disorders

Answer 25

bile acid resins

Question 26

ADRs with warfarin, thyroid, digoxin- separate ALL meds by at least 2 hours

Answer 26

bile acid resins

Question 27

contraindicated in biliary obstruction, TG >500, or TG>200 (relative)

Answer 27

bile acid resins

Question 28

competitively inhibit HMG-CoA reductase (necessary for cholesterol synthesis-results in an increase in hepatic LDL receptors)

Answer 28

statins

Question 29

decreases LDL, decrease TG, increase HDL. Proven efficacy to reduce major coronary events and stroke, CV related and total mortality, and coronary procedures

Answer 29

statins

Question 30

pleiotropic effects: CV (stabilize plaques, enhance NO production, decrease oxidative stress), renal (modulate inflammation), endocrine (improve insulin sensitivity), and skeletal (inhibit bone resorption)

Answer 30

statins

Question 31

this class has few adverse effects. Most common are HA, myalgia, and dyspepsia. Hepatotoxicity and myopathy can occur

Answer 31

statins

Question 32

reacts with CYP450 3A4 inhibitors- cyclosporine, grapefruit juice, macrolides, triazole antifungals, fluoroquinolones, SSRIs, diltiazem, verapamil, amiodarone, omperazole, protease inh

Answer 32

statins

Question 33

statins not metabolized by 3A4

Answer 33

prava, fluva, rosuva

Question 34

this statin increased warfarin effects

Answer 34

lovastatin

Question 35

monitor AST/ALT, CK

Answer 35

statins

Question 36

caution in liver and renal disease, contra in pregnancy

Answer 36

statins

Question 37

combo niacin ER/ lovastatin- increases risk of myopathy. Monitor LFTs

Answer 37

advicor

Question 38

inhibits absorption of cholesterol at the brush border of the SI, causing a decrease in delivery of cholesterol to the liver

Answer 38

ezetimbe

Question 39

this drug may increase risk of AST/ALT elevation when used in combo with statins

Answer 39

ezetimbe

Question 40

ADRs include GI, HA< arthralgia, sinusitis

Answer 40

ezetimbe

Question 41

if LDL >205 above goal or patient is high/moderately high risk, what is our DOC

Answer 41

statins

Question 42

if TG >500, use these drugs to reduce risk of pancreatitis

Answer 42

fibrate or niacin