Lipids

Question 1

If a 60 year old patient with T2DM presents with an LDL of >70 what should you do?

Answer 1

• start statin immediately

Question 2

What is the main adverse effect of ezetimibe?

Answer 2

• can increase LFTs

Question 3

If a patient has an LDL > 190 what should you do immediately?

Answer 3

start on statin immediately

Question 4

What are the main adverse effects you are concerned about with statins? (2)

Answer 4

• liver dysfunction (check LFTs)

- Rhabdomyolysis

Question 5

What is the most common adverse effect of niacin?

Answer 5

flushing d/t cutaneous vasodilation

Question 6

What is the main limiting factor in synthesis of lipids?

Answer 6

HMG-CoA reductase

Question 7

Daily dose lowers LDL by approximately >50% in these 2 statins.

Answer 7

• Atorvastatin 40-80 mg

- Rosuvastatin 20 mg

Question 8

If a patient has a pre-existing ASCVD what is the LDL target goal?

Answer 8

< 70 mg/dl (decrease by 50%)

Question 9

What are the 3 main side effects of bile acid binding agents (cholestyramine)?

Answer 9

• bloating
• increased TG levels
• reduced fat soluble vitamins

Question 10

What is the recommended follow up after initiating statins?

Answer 10

4-12 weeks

Question 11

What is the MOA of ezetimibe?

Answer 11

inhibits cholesterol absorption in the intestines thus reduces LDL receptors and reduces plasma LDL

Question 12

If a patient has a moderate risk of atherosclerotic disease but does not want to go on a statin what imaging modality can be done for further evaluation?

Answer 12

coronary calcium scan

Question 13

What is the second line agent for treatment of hyperlipidemia?

Answer 13

ezetimibe

Question 14

What is the Friedewald formula?

Answer 14

LDL = total chol - (TG/5) - HDL

Question 15

Athereosclerosis is the cause of what % of all deaths?

Answer 15

50%

Question 16

what lab test allows for direct measurements of LDL?

Answer 16

electrophoresis

Question 17

People that are missing this enzyme have a low level of circulating LDL.

Answer 17

• PCSK9

new drugs to inhibit PCSK9 enzyme

Question 18

What are the 3 factors that influence lipid levels?

Answer 18

• nutrition
• genetics
• derangements on metabolism

Question 19

This drug is known to markedly increase the HDL.

Answer 19

niacin

Question 20

Which of the drugs used to treat hyperlipidemia can induce insulin resistance?

Answer 20

• niacin

Question 21

What drug significantly decreases triglyceride levels?

Answer 21

fibric acid derivatives (fibrates)

Fenofibrate**

Question 22

What vitamin is Niacin?

Answer 22

vitamin B3

Question 23

Negative feedback loop for synthesis is based on what enzyme?

Answer 23

mevalonate enzyme

Question 24

What diet is recommended for patients at high risk of atherosclerosis?

Answer 24

• DASH

Question 25

What are the 3 main side effects of fibrates?

Answer 25

• dyspepsia
• gallstones
• myalgias

Question 26

What is the LDL target goal in a patient with a starting LDL of > 190.

Answer 26

<100

Question 27

What medication is a good alternative for statins in patients who can’t deal with the muscle side effects?

Answer 27

• cholestyramine

Question 28

What are the 2 cholesterol lowering medications that also have a cardiovascular risk reduction?

Answer 28

• statins

- cholesterol absorption inhibitors (Ezetimibe)

Question 29

Which of the statins has an FDA warning for rhabdo at it’s highest dose?

Answer 29

Simvastatin (Zocor)

Question 30

If AST/ALT increases greater than ___ times the baseline you should stop statins.

Answer 30

> 3 times normal

Question 31

This drug should not be used in patients with gout.

Answer 31

Niacin

Question 32

Ezetimibe inhibits absorption of dietary cholesterol by binding to what protein?

Answer 32

Niemann-Pick C1-like 1 (NPC1L1)

Question 33

What drug undergoes CYP450 metabolism?

Answer 33

Ezetimibe