Lipid

Question 1

A major cause of coronary artery disease

Answer 1

atherosclerosis

Question 2

CVD is a major cause of death in the US ____ people die each ehar from heart attacks, most commoly realted to ____

Answer 2

500,000

coronary artery disease

Question 3

Atherosclerosis is characterized by

Answer 3

deposits of cholesterol and lipoproteins in artery walls. Three major classes of lipoproteins are found in the serum of fasting individuals

Question 4

Three major classes of lipoproteins

Answer 4

low-density lipoproteins (LDL, “bad cholesterol”), high-density lipoproteins (HDL, “good cholesterol”), and very low-density lipoproteins (VLDL).

Question 5

High concentrations of LDLs are associated with an increased risk of

Answer 5

CVD

Question 6

Serum lipoproteins are formed via two pathways

Answer 6

dietary (exogenous) and liver synthesis (endogenous).

Question 7

Exogenous pathway

Answer 7

involves absorption of lipids via intestine

Question 8

Endogenous pathway

Answer 8

lipids originate from liver

Lipoproteins

Question 9

Change in the lipid guidelines for 2018

Answer 9

. In this guideline there is no ideal target blood level of LDL, however, the guidelines do recognize that lower is better. The guideliens ustilize a isk calculator and has reocmmendations for primary prevention and secondary prevention

Question 10

aims to prevent disease or injury before it ever occurs

Answer 10

Primary prevention

Question 11

screening to identify diseases in the earliest. stages, before the onset of signs and symptoms, through measures such. as mammography and regular blood pressure testing

Answer 11

Secondary Prevention

Question 12

Childhood screening - Risk factors

Answer 12

DM
Obesity
Family history of familial hypercholesterolemia

Question 13

what should be emphasized with children

Answer 13

diet and exercise

Question 14

Lifestyle Modifications

Answer 14

exercise 30 minutes a day

dietary therapy

Question 15

dietary therapy recomendations

Answer 15

Reduced intake saturated fats not as strong
Consuming plant sterols (2 g/day)
Increased soluble fiber intake (10 to 25 g/day)
Dietary fiber of 20 to 30 g/day
Total calories to maintain or lose weight

Question 16

3-hydroxyl-3-methyl-glutaryl-coenzyme A (HMG CoA) reductase inhibitors EXAMPLES

Answer 16

Lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin

Question 17

Fibrates: fibric acid derivatives - EXAMPLES

Answer 17

Gemfibrozil, micronized fenofibrate, clofibrate

Question 18

Bile acid sequestrants EXAMPLES

Answer 18

Cholestyramine, colestipol, colesevelam

Question 19

Drug most effective in combination with statin

Answer 19

ezetimibe (Zetia)

Question 20

drug that has lost popularity

Answer 20

Niacin

Question 21

Vitamins/antioxidants/herbs/natural products

Answer 21

Vitamin E, vitamin C, folic acid, garlic, fish oils, fiber, coenzyme Q10, flaxseed

Question 22

Active liver disease is a contraindication for all treatments for hyperlipidemia except

Answer 22

bile acid sequestrants

Question 23

Statins MOA

Answer 23

Block synthesis of cholesterol in the liver by competitively inhibiting HMG CoA reductase activity

Question 24

Statins decrease levles of LDL by

Answer 24

25 to 65%

Question 25

Statins Modest decres in ___ and very modest increase in ___ may occur

Answer 25

Modest decreases in TGs (10% to 40%) and very modest increases in HDL (5% to 17%) may occur

Question 26

Statins preganacy

Answer 26

old category X; fully contraindicated

Question 27

All statins are metabolized a lease in part by _____ (except)

Answer 27

CYP3A

except fluvastatin and rosuvastatin

Question 28

CYP3A inhibitors may increase statin

Answer 28

concentrations.

Verapamil, diltiazem, azole antifungals, erythromycin, fluoxetine, nefazodone, protease inhibitors

Question 29

CYP3A inducers may (statin)

Answer 29

decrease statin concentrations.

Rifampin, phenytoin, phenobarbital

Question 30

Statins may also interact with other

Answer 30

CYP channel substrates; for example, cyclosporine

Question 31

Statin side effects

Answer 31

HA, myalgia, fatigue, GI intolerance, flu-like symptoms

Question 32

Statin Myopathy occurrence and avoidance

Answer 32

occurs in 0.2% to 0.4% of patients, some agents more likely
Reduced by using lowest effective dose
Cautiously combining statins with fibrates
Avoiding drug interactions

Question 33

Statins can have

Answer 33

myalgia (muscle aches)

Question 34

Active liver disease is a contraindication in

Answer 34

statins

Question 35

Active liver disease in statins occurs in

Answer 35

Occurs in 0.5% to 2.5% of cases and is dose-dependent.

Serious liver problems are rare.

Question 36

Liver side effects statin managment

Answer 36

reducing dose or stopping until levels return to normal.

Question 37

Clinical studies of statins have demonstrated a 0.5 to 3.0 percent occurrence of persistent elevations in aminotransferases in patients receiving

Answer 37

statins

Question 38

Statins start with

Answer 38

lower dose and increase, as needed, according to LDL response; absolute levels of LDL not as closely monitored now

Question 39

Rosuvastatin most potent - Dose

Answer 39

5 to 20 mg day

Question 40

Atorvastatin next most potent - Dose

Answer 40

10 mg/day initially, increase no fewer than 2 to 4 weeks

Question 41

What statin has the best ADR profile

Answer 41

Atorvastin

Question 42

Simvastain dose

Answer 42

20 to 40 mg/day

Question 43

Lovastatin (IR) 20 mg/day (XR) - Dose

Answer 43

40 to 60 mg a day

Question 44

Statin test liver function every

Answer 44

4 to 6 weeks then every 3 to 4 months until control established

Question 45

Statin liver function tests

Answer 45

before starting therapy and 3 to 6 months later only if suspected issues or underlying hepatic issues