Lipid Management

Question 1

Familial Hypercholesterolemia

Answer 1

Genetic disorder, 1:500 individuals
Mutated or absent LDL receptor
High risk for atherosclerosis

Question 2

Familial combined hyperlipidemia

Answer 2

Autosomal dominant

Increased secretion of VLDLs

Question 3

Dysbetalipoproteinemia

Answer 3

1:10,000 ppl
Defective chylomicron catabolism
Atherosclerosis, PVD
Tuberous xanthomas, striae palmaris

Question 4

When to test lipids?

Answer 4

Starting at 20

Test every 5 years for normal values

Question 5

Statins

Answer 5

Lipid lowering drugs
HMG-CoA Reductase inhibitors
Well tolerated by most patients
Very effective in lowering LDL
Lipitor, crestor, zocor
They all end in statin

Question 6

Statin MOA

Answer 6

Block conversion of HMG-CoA to mevalonate, which is rate limiting step in production of cholesterol in liver.
Increases LDLs receptors in liver
Liver takes up LDLs, decreasing LDL in blood

Question 7

Statins decrease ______ along with LDL levels.

Answer 7

triglyceride levels

Question 8

Statin CI

Answer 8

Pregnancy
Active liver dz
Unexplained ALTs
Alcoholism

Question 9

Statin SE

Answer 9

GI upset
HA
Elevated LFTs
Muscle pain, weakness
Proteinuria, renal failure (specific to crestor)

Question 10

When should statins be taken?

Answer 10

Evening or bedtime

Cholesterol production occurs during sleep

Question 11

All statins have an _______ effect.

Answer 11

Anti-inflammatory

Question 12

What is the most potent statin?

Answer 12

Rosuvastatin (Crestor)

Question 13

Bile acid resins

Answer 13

Decreased cholesterol abs through exogenous path
Not absorbed in GI tract
Bind bile acids in intestines, forming insoluble molecule that is excreted in feces
Increased LDL receptors in lover

Question 14

Maximum effect of Bile acid resins?

Answer 14

dose related
3 weeks
Take with meals

Question 15

Types in bile acid resins.

Answer 15

Cholestyramine (Questran)

Colestipol (Colstid)

Question 16

Niacin

Answer 16

Naturally occurring B vitamin
at 100-300x normal daily dose can improve cholesterol levels
Lowers triglycerides by 50%

Question 17

Niacin Contraindications

Answer 17

Hepatic dysfxn
Hypotension
Peptic ulcers
Elevated uric acid levels (gout)
can worsen glucose control

Question 18

Niacin SE

Answer 18

Pruritis and flushing of face and neck
ASA 30 mins before dose helps
Hepatotoxicity
Uric acid, glucose increase

Question 19

Ezetimibe (Zetia)

Answer 19

Cholesterol absorption inhibitors
Acts on brush border to decrease abs
Increase in clearance of cholesterol from blood
Effective if taken with a statin

Question 20

Zetia SE

Answer 20

HA, nausea, diarrhea, abd pain

Question 21

Fibric acid derivatives

Answer 21

Gemfibrizol (lopid), fenofibrate (tricor)
Minimal effect of LDL
Good for lowering triglycerides
Monitor LFT’s

Question 22

Elevated triglyceride Tx

Answer 22

Fish oil supplements (omega-3)
Soluble fiber
Soy protein

Question 23

What is the goal LDL in diabetic pt’s?

Answer 23

Less than 100

Question 24

Optimal LDL Level

Answer 24

Less than 100

Question 25

Desirable total cholesterol

Answer 25

Less than 200

Question 26

Normal HDL

Answer 26

40-60

Question 27

Normal serum triglycerides

Answer 27

Less than 150

Question 28

What is the % gain with each dose doubling of a statin?

Answer 28

6%

Question 29

Best drug to decrease triglycerides?

Answer 29

Tricor