Lipids

Question 1

A screening lipid panel should be done at ____ years of age per NCEP

Answer 1

20

Question 2

HDL is synthesized in the

Answer 2

liver + intestines

Question 3

VLDL is synthesized in the

Answer 3

liver (FFA + cholesterol)

Question 4

LDL synthesizes

Answer 4

bile acid

Question 5

USPSTF recommends screening Male patients at lower risk should be screened for dyslipidemia at; at higher risk?

Answer 5

35; 25

Question 6

USPSTF recommends screening Female patients at lower risk should be screened for dyslipidemia at; at higher risk?

Answer 6

45; 35

Question 7

Assessment of cholesterol, triglycerides and lipoproteins must be done in a _________

Answer 7

in a fasting state

Question 8

Which values are measured directly on a lipid panel?

Answer 8

Total cholesterol, triglycerides and HDL

Question 9

How do you calculate VLDL using values form a lipid panel?

Answer 9

TGs divided by 5 = VLDL

Question 10

How do you calculate LDL using values form a lipid panel?

Answer 10

Total cholesterol - HDL - VLDL = LDL

Question 11

Why must lipid panels be done in a fasting state?

Answer 11

Chylomicrons will confound these measurements (present for <10 after eating)

Question 12

Recommendations: total cholesterol

Answer 12

< 200

Question 13

Recommendations: LDL

Answer 13

< 100

Question 14

Recommendations: HDL

Answer 14

> 40

Question 15

Recommendations: TGs

Answer 15

< 150

Question 16

Familial Hypercholesterolemia results from

Answer 16

mutations in the LDL (apo B/E) receptor

Question 17

Familial Hypercholesterolemia effects on Lipoproteins

Answer 17

decreases the clearance of LDL and increases circulating LDL levels

Question 18

Familial Hypercholesterolemia will have what Sx

Answer 18

Arteries (atheroma), Skin or tendons (xanthoma) Eyelids (xanthelasma), Iris (corneal arcus)

Question 19

Arteries (atheroma), Skin or tendons (xanthoma) Eyelids (xanthelasma), Iris (corneal arcus) Sx are due to

Answer 19

Excess LDL enters macrophages –> foam cell and cholesterol plaque formation

Question 20

Lab Features of Familial Hypercholesterolemia

Answer 20

Cholesterol >300 and LDL > 250

Question 21

ATP Guidelines 1-4

Answer 21

1. Cholesterol
2. CHD or CHD risk factors
3. Major risk
4. Risk Calculator

Question 22

Major Risk Factors Include:

Answer 22

Smoker, HTN or on Meds, Low HDL (< 40), FMHx of CDH in M < 55 or F < 65, Age of M > 45, F > 55

Question 23

What factor subtracts a risk?

Answer 23

High HDL > 60

Question 24

Framingham Risk Score calculates

Answer 24

10-yr CHD risk

Question 25

If patient has CHD, then their goal LDL should be

Answer 25

< 100

Question 26

If patient has CHD, then lifestyle modifications should begin when LDL is

Answer 26

>100

Question 27

If patient has CHD, then medications should begin when LDL is

Answer 27

> 130

Question 28

If a patient has 2 risk factors, then their goal LDL is _____; begin lifestyle modification at _____; begin medication at ______

Answer 28

< 130; >130; >160

Question 29

If a patient has 1 risk factor, then their goal LDL is _____; begin lifestyle modification at _____; begin medication at ______

Answer 29

< 160; >160; >190

Question 30

Therapy of choice of high LDL

Answer 30

Statins - HMG CoA Reductase Inhibitors

Question 31

Alternatives to statins:

Answer 31

Resin or Niacin

Question 32

ADA suggests that your total fat intake should be _________ of your total calorie intake

Answer 32

25-35% of your total calorie intake

Question 33

Restricting dietary intake of fat from 45% to 25% of total calories

Answer 33

Can lower total cholesterol by 15% and LDL by 25%

Question 34

Exercise can

Answer 34

raise HDL, lower TGs, no effect on LDL

Question 35

Statin Mechanism

Answer 35

HMG CoA Reductase Inhibitors i.e. prevent the rate-limiting step of cholesterol synthesis (HMG-CoA -> Mevalonate), decreases VLDL, LDL, slight increase in HDL

Question 36

Statins Side Effects

Answer 36

liver failure, rhabdomyolysis, myopathy/myositis

Question 37

Niacin

Answer 37

Inhibits lipolysis in adipose tissue and Increases HDL and lowers LDL

Question 38

Niacin Side Effects

Answer 38

Flushing (tx w/ aspirin)

Question 39

Bile Acid Resin Mechanism

Answer 39

Prevent the reabsorption of bile acids, liver must use cholesterol to make more; lowers LDL

Question 40

Bile Acid Resin have low compliance and

Answer 40

low efficacy; low complicate bc they taste terrible

Question 41

Ezitimibe

Answer 41

Prevents the absorption of dietary and biliary cholesterol in the GIT to decrease LDL

Question 42

Ezitimibe Side Effects

Answer 42

Diarrhea

Question 43

Fibrates Mechanism

Answer 43

lipoprotein lipase upregulation to increase TG clearance; Lowers TGs

Question 44

Fibrates Side Effects

Answer 44

Myositis (esp w/ statins), gallstones

Question 45

Statins decrease risk of coronary events bc

Answer 45

they also reduce inflammation; reduce stroke, MI, stabalize plaques

Question 46

What are CHD Risk Equivalent

Answer 46

PVD, DM, AAA, symptomatic carotid artery disease