Lipids

Question 1

cholesterol

Answer 1

synthesized by liver, additional from diet, membrane structure, precursor to steroid hormones

Question 2

total-C

Answer 2

LDL-C + HDL-C + VLDL-C

Question 3

LDL-C

Answer 3

low density lipoproteins, BAD

Question 4

HDL-C

Answer 4

high density lipoproteins, GOOD

Question 5

LDL classification values

Answer 5

<100 is optimal, 160-189 is high

higher CHD risk = want lower LDL value (direct relationship)

Question 6

causes of secondary dyslipidemia

Answer 6

DM, hypothyroidism, obstructive liver dx, chronic renal failure, drugs that inc LDL/lower HDL

Question 7

therapeutic lifestyles changes to lower LDL

Answer 7

TLC diet (red intake of cholesterol raising nutrients, LDL lowering therapeutic options)
weight reduction
inc physical activity

Question 8

demonstrated therapeutic benefits of statins

Answer 8

red first CV event, red major coronary events, red CHD mortality, red coronary procedures, red stroke, red total mortality

Question 9

statin-induced myopathy and rhabdomyalysis

Answer 9

serum CK > 10 ULN with unexplained mm pain/weakness
serum CK > 40 ULN with unexplained mm weakness
greatest risk in first 12 mo’s
due to metab by CYP3A4

Question 10

statin pearls

Answer 10

elevated transaminase on statin is not a reason to stop
SE’s are agent specific, not always class specific (so try a diff one)
await fallout of simvastatin relabeling (v few pt’s receive new scripts for simvastatin)

Question 11

bile acid sequestrants

Answer 11

MOA: bind to dietary cholesterol

limited evidence suggests use of these with or without statins may red risk of CV events

Question 12

niacin AIM-HIGH trial

Answer 12

niacin didnt red incidence of primary composite endpoint

trial stopped early bc unexpected inc in stroke in

Question 13

niacin aim-high trial conclusions

Answer 13

use niacin to statin-intolerant pt’s only, other trial said niacin didn’t red risk of major CV events but did inc risk of serious adverse effects
LITTLE USE

Question 14

Bempedoic Acid

Answer 14

not yet FDA approved (feb 2019)
MOA: inhibits ATP citrate lyase (key enz in cholesterol syn)
180 mg PO once daily
causes LDL, non-HDL, TC, apolipoprotein, and high sensitivity CRP dec

Question 15

PCSK9 Inhibitors

Answer 15

monoclonal ABs
addition to statins red's LDL by 50-60% (more than statins alone) 
given Sub-Q q. 2-4 weeks 
dec CV events
add-on to max dose statins

Question 16

simvastatin trial adverse effects

Answer 16

52 high dose (80 mg) developed myopathy, 22 low-dose (40 mg) developed myopathy, 22 high dose developed rhabdo, NO low dose developed rhabdo