Hyperlipidemia LEIK

Question 1

219. A lipid profile for a newly diagnosed hypertensive patient with a BMI (body mass index) of 27 shows a triglyceride level of 950 mg/dL, total cholesterol of
     240 mg/dL, LDL (low density lipoprotein) of 145 mg/dL, and HDL (high-density lipoprotein) of 45 mg/dL. What is the best intervention for this patient?
     A) Educate the patient about lifestyle changes that will help lower cholesterol levels
     B) Initiate a prescription of metformin (Glucophage)
     C) Recommend that the patient exercise at least 30 minutes daily
     D) Initiate a prescription of fenofibrate (Tricor)

Answer 1

219. D) Initiate a prescription of fenofibrate (Tricor) A triglyceride level above 800
     mg/dL is considered to be “very high”; there is an increased risk of acute pancreatitis,
     especially if the patient also drinks alcohol. Two fibrate drugs have been approved for
     use in the United States: fenofibrate (Tricor) and gemfibrozil (Lopid). Another
     option is nicotinic acid, but fibrates are more potent and better tolerated. In
     addition, lifestyle changes are important; these include avoiding foods with
     concentrated sugars, alcohol, weight loss if overweight or obese, and regular,
     moderate to intense aerobic exercise.

Question 2

This case is followed by questions and multiple-choice answers specific to the case. The
nurse practitioner notices a gray ring on the edge of both irises of an 80-year-old woman.
The patient denies visual changes or pain. She reports that she has had the “ring” for many
years.

313. What is the clinical significance of this finding in a 35-year-old patient?
     A) The patient has a higher risk of blindness
     B) The patient should be evaluated for hyperlipidemia
     C) The patient should be evaluated by an ophthalmologist
     D) The patient should be evaluated for acute glaucoma

Answer 2

313. B) The patient should be evaluated for hyperlipidemia Arcus senilis is caused
     by lipid deposits deep in the edge of the cornea and is quite commonly present in the
     elderly. However, it can also appear earlier in life as a result of hypercholesterolemia.

Question 3

525. A 25-year-old man with schizophrenia comes in for a routine annual physical. He
     is a heavy smoker and has a body mass index (BMI) of 28. The patient has been on
     olanzapine (Zyprexa) for 10 years. Regarding the patient’s prescription, which of the
     following laboratory tests is recommended for monitoring the adverse effects of
     atypical antipsychotics?
     A) Fasting blood glucose, fasting lipid profile, and weight
     B) Urinalysis, serum creatinine, 24-hour urine for protein and creatinine clearance
     C) Liver function tests only
     D) CBC with differential, liver function tests, and weight

Answer 3

525. A) Fasting blood glucose, fasting lipid profile, and weight Patients on atypical
     antipsychotics commonly gain weight and are at risk for obesity, hyperglycemia, and
     type 2 diabetes. Zyprexa will increase lipids (cholesterol, low-density lipoprotein
     [LDL], and triglycerides). Atypical antipsychotics also increase the risk of death
     among frail elders and older adults living in nursing homes.

Question 4

712. The 2013 American College of Cardiology/American Heart Association
     (ACC/AHA) Arteriosclerotic Cardiovascular Disease (ASCVD) risk calculator
     measures the risk of a cardiovascular event within 10 years after measurement. What
     is the cutoff value when treatment for hyperlipidemia is recommended?
     A) 6.5% or higher
     B) 7.5% or higher
     C) 8% or higher
     D) 10 % or higher

Answer 4

712. B) 7.5% or higher The estimated 10-year ASCVD risk score is 7.5% or higher.
     The 2013 ACC/AHA guidelines recommend treatment with high-intensity statins
     for patients aged 40 to 75 years with very high low-density lipoprotein (LDL) values
     who have a score of 7.5% or higher.

Question 5

713. A 55-year-old male patient with a body mass index (BMI) of 30 has a history of
     angina and type 2 diabetes. His lipid profile results are total cholesterol of 280
     mg/dL, low-density lipoprotein (LDL) of 195 mg/dL, and high-density lipoprotein
     (HDL) of 25 mg/dL. The nurse practitioner diagnoses him with hyperlipidemia and
     wants to start him on statin therapy. What intensity of treatment is recommended
     for this patient?
     A) Low-intensity statin
     B) Moderate-intensity statin
     C) High-intensity statin
     D) Very high-intensity statin

Answer 5

713. C) High-intensity statin This patient fulfills the criteria for high-intensity
     statin dosing criteria from the 2013 American College of Cardiology/American
     Heart Association (ACC/AHA) blood cholesterol guideline. He already has heart
     disease (angina), type 2 diabetes, low-density lipoprotein (LDL) of 195 mg/dL, and
     low high-density lipoprotein (HDL) of 25 mg/dL. This patient is at very high risk
     for heart disease and warrants a high-intensity dose of statin. There are only two
     choices at this level: atorvastatin (Lipitor) 40 to 80 mg or rosuvastatin (Crestor) 20
     to 40 mg.